For adults living with prediabetes and carrying extra weight, the fear of relapse is real. A new look at a large international trial offers some clarity on what happens when people try to keep off the pounds for three years. The study involved 846 participants who joined a program designed to help them lose weight quickly at first and then maintain that loss for years. The results show that 12% of these people achieved sustained remission of prediabetes by the end of the three-year mark. This group, called maintainers, kept their weight down and saw lasting benefits. Those who did not respond to the program or who lost weight but then gained it back did not see the same long-term success. The data suggests that the ability to keep weight off is the key to staying in remission. People in the maintainers group lost more weight and lost more fat than others. They also saw improvements in how their liver handled sugar. In contrast, those who relapsed gradually returned to a state where their bodies struggled to use insulin properly. The study was a post-hoc analysis, meaning researchers looked at existing data after the trial ended. This approach helps explain the results but does not change the original trial design. No serious safety issues were reported during the study. The findings suggest that focusing on keeping weight off is essential for preventing the return of insulin resistance in people with prediabetes.
Lifestyle intervention linked to sustained prediabetes remission in 12% of adultsThree years of lifestyle changes helped 12% of people with prediabetes achieve sustained remission
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Key Takeaway
Consider that sustained prediabetes remission after lifestyle intervention is associated with improved hepatic insulin sensitivity, but post-hoc findings need validation.
This post-hoc analysis of a randomized controlled trial examined predictors of sustained prediabetes remission in 846 adults with prediabetes and overweight or obesity. Participants underwent a 3-year lifestyle intervention: 8 weeks of rapid weight loss followed by 148 weeks of weight loss maintenance. The analysis compared maintainers (n=102, 12% who achieved sustained remission) with non-responders (n=618) and relapsers (n=126).
At 3 years, maintainers achieved greater weight loss than non-responders (mean difference -4.0 kg, 95% CI -5.8 to -2.2 kg) and greater fat mass loss. Changes in visceral adiposity index were similar between maintainers and relapsers. Maintainers showed further improvements in markers of hepatic insulin sensitivity, while relapsers gradually reverted to an insulin-resistant state at 2 and 3 years.
Safety and tolerability data were not reported. Key limitations include the post-hoc design, which precludes causal conclusions. The findings suggest that sustained remission of prediabetes was associated with enduring improvements in hepatic insulin sensitivity.
Clinically, this analysis highlights the potential importance of targeting hepatic insulin sensitivity to prevent relapse in prediabetes, but results should be interpreted cautiously given the exploratory nature of the analysis.
What this means for you:
Keeping weight off for three years helped 12% of people with prediabetes reach sustained remission. More on Prediabetes
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View Original Abstract ↓
BACKGROUND: Recent investigation advocates the use of prediabetes remission as a goal of diabetes prevention. We aimed to compare changes in metabolic markers in participants with and without sustained remission of prediabetes during a 3-year lifestyle intervention.
METHODS: This post-hoc analysis used data from the PREVIEW trial, a 3-year, multinational, multicenter, randomized controlled trial aiming to examine the effects of lifestyle interventions on prevention of type 2 diabetes among high-risk adults. Adult participants with prediabetes and overweight/obesity underwent 8-weeks of rapid weight loss followed by a 148-week lifestyle intervention for weight loss maintenance. Participants who completed the full protocol and had available data (n = 846) were included in the current analysis. Participants were classified into prediabetes maintainers, relapsers, and non-responders according to blood glucose levels at 1 and 3 years. Changes in metabolic markers over 3 years were compared in those who achieved sustained remission (maintainers, n = 102) vs those who failed (non-responders, n = 618), as well as those who were successful at 1 year but then relapsed (relapsers, n = 126).
RESULTS: Only 12% participants experienced sustained remission at 3 years. After adjusting for baseline covariates, compared with non-responders, maintainers achieved greater weight loss (mean difference -4.0 kg; 95% CI -5.8, -2.2 kg) and fat mass loss at 3 years. Maintainers also made further improvements in markers of hepatic insulin sensitivity, regardless of weight change. Compared with relapsers, maintainers had greater decreases in weight and fat mass, but changes in visceral adiposity index were similar. Relapsers gradually reverted to an insulin resistant state at 2 and 3 years compared with maintainers, independent of weight change.
CONCLUSIONS: In a long-term lifestyle intervention, sustained remission of prediabetes was associated with enduring improvements in hepatic insulin sensitivity, regardless of weight change. In addition to weight loss, targeting hepatic insulin sensitivity per se may help prevent relapse in prediabetes.
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