Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial.
Medical strategies targeting remission of type 2 diabetes have not been systematically studied.



This trial assessed the feasibility, safety, and potential to induce remission of a short-term intensive metabolic strategy.



A randomized, parallel, open-label pilot trial with 83 participants followed for 52 weeks.



Ambulatory care.



Patients with type 2 diabetes of up to 3 years in duration.



Participants were randomized to: (1) an 8-week intensive metabolic intervention, (2) a 16-week intensive metabolic intervention, or (3) standard diabetes care. During the intensive intervention period, weight loss and normoglycemia were targeted using lifestyle approaches and treatment with metformin, acarbose, and insulin glargine. Diabetes drugs were then discontinued in the intervention groups and participants were followed for hyperglycemic relapse.



On-treatment normoglycemia.



At 8 weeks, 50.0% of the 8-week intervention group vs 3.6% of controls achieved normoglycemia on therapy [relative risk (RR), 14.0; 95% confidence interval (CI), 1.97 to 99.38), and at 16 weeks, these percentages were 70.4% in the 16-week group and 3.6% in controls (RR, 19.7; 95% CI, 2.83 to 137.13). Twelve weeks after completion of the intervention, 21.4% of the 8-week group compared with 10.7% of controls (RR, 2.00; 95% CI, 0.55 to 7.22) and 40.7% of the 16-week group compared with 14.3% of controls (RR, 2.85; 95% CI, 1.03 to 7.87) met hemoglobin A1C criteria for complete or partial diabetes remission.



A short course of intensive lifestyle and drug therapy achieves on-treatment normoglycemia and promotes sustained weight loss. It may also achieve prolonged, drug-free diabetes remission and strongly supports ongoing studies of novel medical regimens targeting remission.
Department of Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada.|Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada.
Natalia
N
McInnes
Department of Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
Ada
A
Smith
Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario L8N 3Z5, Canada.
Rose
R
Otto
Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario L8N 3Z5, Canada.
Jeffrey
J
Vandermey
Department of Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada.|Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada.
Zubin
Z
Punthakee
Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario L8N 3Z5, Canada.|School of Nursing, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
Diana
D
Sherifali
Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada.
Kumar
K
Balasubramanian
Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada.
Stephanie
S
Hall
Department of Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada.|Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada.
Hertzel C
HC
Gerstein
D020909:Acarbose / Q000627:therapeutic use*; D000368:Aged; D000553:Ambulatory Care; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000628:therapy*; D004038:Diet, Reducing; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D012074:Remission Induction; D061217:Weight Reduction Programs
D020909:Acarbose; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D008687:Metformin; C517652:hemoglobin A1c protein, human