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Publication Information

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

Abstract

Introduction and Objective: In order to achieve diabetes remission, resources to support intensive lifestyle intervention (ILI) need to be directed towards people with diabetes for whom remission is achievable, i.e. short diabetes duration, lower HbA1c. We aimed to determine if responses to ILI, other than remission, justify this resource allocation. Methods: We analyzed Look AHEAD participants 20‒65 years old with BMI 27‒45kg/m2. The effect of ILI was assessed after stratification for remission eligibility at baseline (diabetes duration ≤6 years, no insulin). Cox models evaluated the effect of ILI on incidence of cardiovascular disease (CVD), chronic kidney disease (CKD), and mortality, and linear models assessed the effect on weight and HbA1c. Results: There were 3,105 participants - 60% women, median age 58 years old, median follow-up 9 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. Conclusion: The small additional benefit of intervention in people eligible for remission, compared to ineligible people, may not be enough to justify restricting resources to such eligible people.