Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study

Edward W Gregg; Haiying Chen; Michael P Bancks; Raoul Manalac; Nisa Maruthur; Medha Munshi; Rena Wing; Look AHEAD Research Group

doi:10.1007/s00125-023-06048-6

Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study

Diabetologia. 2024 Mar;67(3):459-469. doi: 10.1007/s00125-023-06048-6. Epub 2024 Jan 18.

Authors

Edward W Gregg^{1

2}, Haiying Chen³, Michael P Bancks³, Raoul Manalac⁴, Nisa Maruthur⁵, Medha Munshi⁶, Rena Wing⁷; Look AHEAD Research Group

Affiliations

¹ School of Population Health, Royal College of Surgeons of Ireland, Dublin, Ireland. edwardgregg@rcsi.ie.
² Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. edwardgregg@rcsi.ie.
³ Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁴ Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
⁵ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Joslin Diabetes Center, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁷ Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.

Abstract

Aims/hypothesis: We examined the association of attainment of diabetes remission in the context of a 12 year intensive lifestyle intervention with subsequent incidence of chronic kidney disease (CKD) and CVD.

Methods: The Look AHEAD study was a multi-centre RCT comparing the effect of a 12 year intensive lifestyle intervention with that of diabetes support and education on CVD and other long-term health conditions. We compared the incidence of CVD and CKD among 4402 and 4132 participants, respectively, based on achievement and duration of diabetes remission. Participants were 58% female, and had a mean age of 59 years, a duration of diabetes of 6 year and BMI of 35.8 kg/m². We applied an epidemiological definition of remission: taking no diabetes medications and having HbA_1c <48 mmol/mol (6.5%) at a single point in time. We defined high-risk or very high-risk CKD based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, and CVD incidence as any occurrence of non-fatal acute myocardial infarction, stroke, admission for angina or CVD death.

Results: Participants with evidence of any remission during follow-up had a 33% lower rate of CKD (HR 0.67; 95% CI 0.52, 0.87) and a 40% lower rate of the composite CVD measure (HR 0.60; 95% CI 0.47, 0.79) in multivariate analyses adjusting for HbA_1c, BP, lipid levels, CVD history, diabetes duration and intervention arm, compared with participants without remission. The magnitude of risk reduction was greatest for participants with evidence of longer-term remission.

Conclusions/interpretation: Participants with type 2 diabetes with evidence of remission had a substantially lower incidence of CKD and CVD, respectively, compared with participants who did not achieve remission. This association may be affected by post-baseline improvements in weight, fitness, HbA_1c and LDL-cholesterol.

Trial registration: ClinicalTrials.gov NCT00017953 DATA AVAILABILITY: https://repository.niddk.nih.gov/studies/look-ahead/.

Keywords: Cardiovascular disease; Chronic kidney disease; Diabetes; Lifestyle intervention; Remission; Weight loss.

MeSH terms

Cardiovascular Diseases* / epidemiology
Diabetes Mellitus, Type 2* / complications
Exercise
Female
Humans
Male
Middle Aged
Renal Insufficiency, Chronic*

Associated data

ClinicalTrials.gov/NCT00017953

Abstract

MeSH terms

Associated data

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