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Publication Information

PubMed ID
Public Release Type
Journal
Publication Year
2025
Authors
Agus Salim, Dianna J Magliano, Joanna Y Gong, Jonathan E Shaw
Studies

Abstract

Aims: In order to achieve remission of type 2 diabetes, resources to support intensive lifestyle intervention (ILI) are directed towards people with diabetes for whom remission is achievable, i.e. people with short diabetes duration and lower HbA1c. We aimed to determine if responses to ILI, other than remission, justify this resource allocation. Materials and methods: We analysed participants from the Look AHEAD randomised controlled trial who were 20‒65 years old with a BMI of 27‒45 kg/m2. The effect of ILI was assessed after stratification for remission eligibility at baseline (diabetes duration ≤6 years and no insulin therapy). Cox proportional hazards models evaluated the effect of ILI on incident CVD, chronic kidney disease (CKD), and mortality. Linear models with generalised least squares assessed the effect of ILI on weight, HbA1c, systolic blood pressure, LDL, and eGFR. Results: There were 3,105 participants included – 60% women, median age 58 years, and median follow-up time 9 years (IQR 8‒10 years). At baseline, 54% were eligible for remission. Remission eligibility status did not modify the effect of ILI on CVD, CKD, or mortality. ILI led to 2.4 kg greater weight loss (-5.53 kg (95%CI -6.02, -5.03) vs -3.17 kg (95%CI -3.86, -2.49)), and 0.1% greater HbA1c reduction (-0.28% (95%CI -0.33, -0.23) vs -0.17% (95%CI -0.23, -0.11)) in eligible compared to ineligible people. Conclusions: The small additional benefit of ILI in people eligible for remission, compared to ineligible people, may not be enough to justify restricting resources for ILI to such eligible people.