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Does Weight Loss Lead to Type 2 Diabetes Remission?

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Does Weight Loss Lead to Type 2 Diabetes Remission?

— By Dawn Sweet, Ph.D.

Losing weight could lead to type 2 diabetes remission.

There is strong association between weight loss and type 2 diabetes remission.1,2,3 Diabetic remission could help many patients eliminate medications to treat diabetes, which in turn would affect their annual health care costs and reduce their chances for developing risk factors associated with type 2 diabetes. Type 2 diabetes remission has been found to be achievable without intensive lifestyle changes.

Predicting Type 2 Diabetes Remission

The Diabetes Remission Clinical Trial (DiRECT) (n = 149; age range 20 – 65)2, a cluster-randomized clinical trial, found evidence for weight loss as the strongest predictor of type 2 diabetes remission at 12 months and 24 months. The goal of the DiRECT trial was to identify predictors of type 2 diabetes remission.

WHO criteria for diagnosing type 2 diabetes were used. Additional inclusion criteria included a type 2 diabetes diagnosis withing six years of the trial start date, a BMI of 27 – 45 kg/m2 for < 6 years, the most recent HbA1c ≥ 48 mmol/mol [≤6.5%; or ≥ 43 mmol/mol (≤6.1%) if on anti-diabetes medication]. The intervention was an evidence-based program for weight management that included meal replacements (825 – 853 kcal/day) visits with a nurse or dietician every two weeks, food reintroduction, and monthly support for long-term weight loss maintenance for two years.

Type 2 diabetes remission was defined as HbA1c < 48 mmol/mol (< 6.5 percent) after a minimum of two months without the support of diabetes medications. Data were collected at 12 month and 24 month intervals.  Type 2 diabetes remission occurred in 46 percent of participants at 12 months and in 36 percent at 24 months. Results suggest that weight loss is the strongest predictor of type 2 diabetes remission. The duration of participants’ diabetes, fasting insulin, and C-peptide concentrations did not significantly predict diabetic remission. The authors note that weight loss in the early weeks of diabetes treatment (four weeks) was associated with remission at 12 and 24 months, thus confirming more rapid weight loss as a predictor of better long-term outcomes. 2

In a parallel group cluster randomized control trial conducted in the UK that investigated behavior change and weight loss as predictors of type 2 diabetes remission (n = 867)1, 30 percent of participants achieved diabetic remission at a five-year follow up. Participants included adults with Cambridge Diabetes Risk Score of ≥ 0.17, which corresponds to the top 25 percent of participants’ risk distribution. WHO criteria for diagnosing type 2 diabetes were used, like the DiRECT study. Physical activity and food intake were assessed via self-report. Alcohol and smoking status were also self-reported. Diabetic remission was defined as HbA1c < 48 mmol/mol (< 6.5 percent).

Results suggest that weight loss of ≥ 10 percent at five years post-diagnosis was a strong predictor of type 2 diabetes. Results also suggest that the more weight that is lost, the higher the likelihood of remission is. Behavior change, e.g., smoking or physical activity were not predictors of type 2 diabetes remission. However, a positive association with diabetic remission was observed with unit changes in alcohol levels but there was variation between the adjusted and unadjusted models.

Implications for Clinical Practice

Health care providers should consider talking with patients about the importance of and the likelihood of type 2 diabetes remission vis à vis weight loss efforts as soon as possible once a diagnosis has been given. Attending the quality of patients’ diets, for example, working with them to develop healthy eating habits that could be supported through scientifically-designed meal replacements. Nutritionally formulated pre-packaged meal replacements provide necessary proteins, fiber, vitamins, and minerals offers patients convenience and essential nutrition.


1 Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study

2 Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial

3 Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT)

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.

About Robard: For 45 years, Robard Corporation’s medical obesity treatment programs and nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online at, email us at, or call (800) 222-9201.

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