Current medical guidelines suggest that individuals in the early stages of type 2 diabetes should aim to lose at least 7% of their body weight to prevent the progression to full-blown diabetes. Experts in diabetes recommend achieving glycemic remission, which involves normalizing blood sugar regulation, as a preventive measure for individuals with prediabetes or a high risk of developing type 2 diabetes. This approach is supported by various international scientists and the DZD’s Prevention Academy.
Prediabetes is a significant risk factor for the onset of type 2 diabetes. People in the initial stages of diabetes already have elevated fasting blood sugar and impaired glucose tolerance. To prevent the development of type 2 diabetes and associated vascular damage, lifestyle changes such as diet modifications and increased physical activity are typically recommended to address prediabetes. The American Diabetes Association (ADA) guidelines advise a minimum 7% reduction in body weight. However, the number of diabetes cases has grown nearly fourfold since 1980, particularly in low-income countries. The mortality rate due to diabetes in low- and middle-income countries has also increased by 13% in the past 15 years. The authors emphasize the necessity for improved strategies to combat the escalating prevalence of type 2 diabetes globally and to address disparities in diabetes rates. In addition to weight loss, they advocate for prioritizing the normalization of blood sugar regulation, known as prediabetes remission, in diabetes prevention efforts.
Navigating Blood Sugar Regulation
The concept of “prediabetes remission” emerged from analyses of studies like the Prediabetes Lifestyle Intervention Study (PLIS) conducted by the German Center for Diabetes Research (DZD) and the US Diabetes Prevention Program (DPP). These studies demonstrated that in some individuals with prediabetes (approximately 40%), weight loss of equal to or greater than 5% of their initial body weight resulted in prediabetes remission. This subset exhibited normalized fasting blood sugar levels, improved glucose tolerance, and HbA1c levels (refer to Box 2). Even two years post-lifestyle intervention, individuals who achieved remission showed a 73% decreased risk of progressing to type 2 diabetes. They also demonstrated reduced indicators of kidney damage and better vascular health. However, some participants did not achieve remission despite weight loss and still had prediabetes.
Mechanisms of Prediabetes Remission
Studies indicate that a substantial reduction in visceral abdominal fat and enhanced insulin sensitivity are critical for attaining prediabetes remission. The authors argue that enhancing insulin resistance fosters remission from prediabetes to normal glucose regulation. This suggests that prediabetes remission may represent a critical period before beta cells sustain irreversible damage to a clinically significant degree, potentially presenting an opportunity to preserve beta cell function in the long run.
Effectiveness of Prediabetes Remission in Diabetes Risk Reduction
Researchers delved into whether achieving prediabetes remission through weight loss is more effective than current strategies for preventing type 2 diabetes. They evaluated data from 480 participants in the Diabetes Prevention Program (DPP) who had prediabetes and lost at least 7% of their weight via a one-year lifestyle intervention. Blood sugar levels normalized in 114 individuals (prediabetes remission), while the majority of the 366 participants did not experience an improvement in their blood glucose regulation. Initial findings suggest that individuals who achieved prediabetes remission along with a weight loss of at least 7% lowered their relative risk of type 2 diabetes by 76% over six years compared to weight loss alone of at least 7%.
The authors recommend the inclusion of normal glucose regulation remission in preventive strategies for individuals with prediabetes, with emphasis on weight loss. Individuals with prediabetes who fail to achieve remission after shedding at least 7% of their body weight should continue their weight loss efforts until reaching their individual threshold or consider alternative interventions.
“We advocate for the consideration of prediabetes remission in upcoming studies and guidelines as it has the potential to safeguard beta cell function against type 2 diabetes development and potentially curb the escalating global prevalence of type 2 diabetes,” emphasizes Prof. Andreas Birkenfeld. Future research should explore whether prediabetes remission also leads to a reduction in complication rates.
