Dataset Information

Remission of recently diagnosed type 2 diabetes mellitus with weight loss and exercise.

ABSTRACT:

Purpose

To determine the rate of remission of recently diagnosed (<1 year) type 2 diabetes mellitus (T2DM) in overweight/obese individuals, with a 6-month program of weight loss and exercise.

Methods

Subjects (N = 12) were overweight/obese (body mass index = 35.8 ± 4.3 kg/m), sedentary, and unfit ((Equation is included in full-text article.)O2peak = 20.7 ± 4.7 mL·kg·min) and recently (<1 year) diagnosed with T2DM. They were willing to participate in a lifestyle program of behavioral weight loss counseling and supervised exercise located at a cardiac rehabilitation program prior to consideration of diabetes medications. Glycated hemoglobin (HbA1c) level before and after the study intervention was the primary study outcome, along with secondary metabolic, fitness, and body composition variables.

Results

Subjects had a baseline HbA1c of 6.5% to 8.0% (mean 6.8 ± 0.2). Subjects lost 9.7 ± 0.2 kg body weight (9%) and improved peak aerobic capacity by 18%. Two subjects withdrew for medical reasons unrelated to the lifestyle program. Eight of 10 completers (80%) went into partial T2DM remission, with the mean HbA1c decreasing from 6.8 ± 0.2% to 6.2 ± 0.3% (P < .001).

Conclusions

For individuals with recently diagnosed T2DM willing to undertake a formal lifestyle program, 80% of study completers and 67% of our total population achieved at least a partial T2DM remission at 6 months. Further study of this intervention at the time of diagnosis of T2DM with randomized controls and longer-term followup is warranted.

SUBMITTER: Ades PA

PROVIDER: S-EPMC4409919 | biostudies-literature | 2015 May-Jun

REPOSITORIES: biostudies-literature

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Publications

Remission of recently diagnosed type 2 diabetes mellitus with weight loss and exercise.

Ades Philip A PA Savage Patrick D PD Marney Annis M AM Harvey Jean J Evans Kimberly A KA

Journal of cardiopulmonary rehabilitation and prevention 20150501 3

<h4>Purpose</h4>To determine the rate of remission of recently diagnosed (<1 year) type 2 diabetes mellitus (T2DM) in overweight/obese individuals, with a 6-month program of weight loss and exercise.<h4>Methods</h4>Subjects (N = 12) were overweight/obese (body mass index = 35.8 ± 4.3 kg/m), sedentary, and unfit ((Equation is included in full-text article.)O2peak = 20.7 ± 4.7 mL·kg·min) and recently (<1 year) diagnosed with T2DM. They were willing to participate in a lifestyle program of behavior ...[more]

PMID: 25636149

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Project description:There is marked heterogeneity in the response to weight loss interventions with regards to weight loss amount and metabolic improvement. We sought to identify biomarkers predictive of type 2 diabetes remission and amount of weight loss in individuals with severe obesity enrolled in the Longitudinal Assessment of Bariatric Surgery (LABS) and the Look AHEAD (Action for Health in Diabetes) studies. Targeted mass spectrometry-based profiling of 135 metabolites was performed in pre-intervention blood samples using a nested design for diabetes remission over five years (n = 93 LABS, n = 80 Look AHEAD; n = 87 remitters), and for extremes of weight loss at five years (n = 151 LABS; n = 75 with high weight loss). Principal components analysis (PCA) was used for dimensionality reduction, with PCA-derived metabolite factors tested for association with both diabetes remission and weight loss. Metabolic markers were tested for incremental improvement to clinical models, including the DiaRem score. Two metabolite factors were associated with diabetes remission: one primarily composed of branched chain amino acids (BCAA) and tyrosine (odds ratio (95% confidence interval) [OR (95% CI)] = 1.4 [1.0-1.9], p = 0.045), and one with betaine and choline (OR [95% CI] = 0.7 [0.5-0.9], p = 0.02).These results were not significant after adjustment for multiple tests. Inclusion of these two factors in clinical models yielded modest improvements in model fit and performance: in a constructed clinical model, the C-statistic improved from 0.87 to 0.90 (p = 0.02), while the net reclassification index showed improvement in prediction compared to the DiaRem score (NRI = 0.26, p = 0.0013). No metabolite factors associated with weight loss at five years. Baseline levels of metabolites in the BCAA and trimethylamine-N-oxide (TMAO)-microbiome-related pathways are independently and incrementally associated with sustained diabetes remission after weight loss interventions in individuals with severe obesity. These metabolites could serve as clinically useful biomarkers to identify individuals who will benefit the most from weight loss interventions.

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Dataset Information

Remission of recently diagnosed type 2 diabetes mellitus with weight loss and exercise.

Purpose

Methods

Results

Conclusions

Publications

Remission of recently diagnosed type 2 diabetes mellitus with weight loss and exercise.

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