Weight Loss as a Key Determinant of Type 2 Diabetes Remission: A Systematic Review and Meta-Analysis

Introduction

Bodyweight loss is widely recognized as a critical factor in improving type 2 diabetes outcomes. However, the precise quantitative relationship between the extent of weight loss and the likelihood of diabetes remission has not been fully established. This systematic review and meta-regression analysis aimed to investigate this relationship while accounting for various confounding factors.

Methods

Following Cochrane and PRISMA guidelines, a comprehensive review and meta-analysis were conducted using data from randomized controlled trials involving individuals with type 2 diabetes who were overweight or obese. The primary outcome was diabetes remission at least one year post-intervention, classified as:

Complete remission: HbA1c <6.0% (42 mmol/mol) or fasting plasma glucose (FPG) <100 mg/dL (5.6 mmol/L) without glucose-lowering drugs.

Partial remission: HbA1c <6.5% (48 mmol/mol) or FPG <126 mg/dL (7.0 mmol/L) without glucose-lowering drugs.

Data were extracted from PubMed, Embase, and trial registries up to July 30, 2024. Meta-analyses and meta-regressions were performed to analyze the data. The study protocol was registered with PROSPERO (CRD42024497878).

Findings

A total of 22 relevant publications were identified, comprising 29 measures of complete remission and 33 measures of partial remission. The results demonstrated a strong association between the degree of weight loss and the likelihood of diabetes remission.

Complete Diabetes Remission Rates:

• 0.7% of participants with <10% weight loss achieved complete remission.

• 49.6% of those with 20–29% weight loss experienced complete remission.

• 79.1% of participants with ≥30% weight loss achieved complete remission.

• No studies reported complete remission for the 10–19% weight loss category.

Partial Diabetes Remission Rates:

• 5.4% of participants with <10% weight loss achieved partial remission.

• 48.4% of those with 10–19% weight loss achieved partial remission.

• 69.3% of those with 20–29% weight loss experienced partial remission.

• 89.5% of participants with ≥30% weight loss achieved partial remission.

A strong positive association was observed between bodyweight loss and diabetes remission. For each 1% decrease in bodyweight, the likelihood of achieving complete remission increased by 2.17 percentage points, while partial remission probability increased by 2.74 percentage points.

Additional Observations

Despite analyzing multiple variables, including age, sex, race, diabetes duration, baseline BMI, HbA1c levels, insulin use, and the type of weight loss intervention, no significant associations were found between these factors and remission outcomes. The findings suggest that the degree of weight loss itself is the primary determinant of diabetes remission.

Conclusion

This meta-analysis highlights a robust, independent relationship between weight loss and type 2 diabetes remission. The results underscore the importance of weight management as a central strategy in diabetes care, with greater weight loss significantly increasing the likelihood of remission. These findings reinforce the need for healthcare professionals to prioritize effective weight loss interventions to reduce the burden of diabetes-related complications.

Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00346-2/abstract