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

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Day, AJ 
Irving, G 


AIM: To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5-year follow-up. METHOD: We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40-69 years from the ADDITION-Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self-report), and alcohol consumption (self-report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1-5 years, as well as remission at 5-year follow-up. RESULTS: Diabetes remission was achieved in 257 participants (30%) at 5-year follow-up. Compared with people who maintained the same weight, those who achieved ≥ 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission [risk ratio 1.77 (95% CI 1.32 to 2.38; p<0.01)]. In the subsequent 1-5 years, achieving ≥10% weight loss was also associated with remission [risk ratio 2.43 (95% CI 1.78 to 3.31); p<0.01]. CONCLUSION: In a population-based sample of adults with screen-detected Type 2 diabetes, weight loss of ≥10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.



Adult, Aged, Cohort Studies, Diabetes Mellitus, Type 2, Diet, England, Exercise, Female, Follow-Up Studies, Health Behavior, Humans, Life Style, Male, Middle Aged, Remission Induction, Risk Reduction Behavior, Weight Loss

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Diabet Med

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Medical Research Council (MC_UU_12015/4)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0515-10119)
Medical Research Council (G0001164)
NIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
Wellcome Trust (061895/Z/00/Z)
NIHR Evaluation Trials and Studies Coordinating Centre (08/116/300)
ADDITION-Cambridge was supported by the Wellcome Trust (grant reference no: G061895), the Medical Research Council (grant reference no: G0001164 and Epidemiology Unit programme: MC_UU_12015/4), the NIHR Health Technology Assessment Programme (grant reference no: 08/116/300), NIHR Programme Grants for Applied Research (RP-PG-0606-1259) National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and the NIHR. SJG is an NIHR Senior Investigator. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. Bio-Rad provided equipment for HbA1c testing during the screening phase. The Primary Care Unit is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. GI was an NIHR Clinical Lecturer. HDM was an NIHR Doctoral Research Fellow at the time of this study and is now an NIHR Clinical Lecturer. JS is supported by an MRC Epidemiology Unit Core programme MC_UU_12015/4 fellowship.