ADULTS with Type 2 diabetes can reduce their risk of chronic kidney disease (CKD) and cardiovascular disease (CVD) by lowering their glycated haemoglobin (HbA1c), and maintaining diabetes remission. A post-hoc analysis of the Look AHEAD trial revealed that adults who lowered their HbA1c to <6.5%, and experienced remission during follow-up visits, reduced their risk of CKD and CVD.
Edward Gregg, Imperial College London, UK, described the novelty of this work: “This is the first study we are aware of to look beyond the efforts and attainment of remission to consider longer-term implications.”
The researchers collected data from 4,488 adults aged 45–76 years with Type 2 diabetes, classified as overweight or obese. The study was of a randomised control design, where the cohort was assigned either an intensive lifestyle intervention, or diabetes support and education. The baseline clinic visits occurred between 2001–2004, with follow-up taking place annually for 4 years, and then every other year until 12 years. Adults were considered to have diabetes remission if they had HbA1c <6.5%, with no use of glucose-lowering medications at any follow-up. Incidence of high-risk, or very high-risk, CKD was defined as an estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m2, an eGFR of <60 mL/min/1.73 m2 plus a urine albumin-to-creatinine ratio of at least 30 mg/g, or any eGFR level with an albumin-to-creatinine ratio of >300 mg/g. CVD was defined as any occurrence of CVD death, non-fatal acute myocardial infarction, non-fatal stroke, or hospital admission for angina.
Diabetes remission was achieved by 12.7% of participants at least once during the investigation, and rate of diabetes remission remained approximately 2.0% for the diabetes support and education group throughout follow-up. The branch receiving intensive lifestyle intervention had a remission prevalence of 11.2% at 1 year, declining by close to 0.7% annually, until reaching 3.7% at 12 years.
Multivariable analysis discovered that adults experiencing diabetes remission at any point in the study had a lower risk for CKD (adjusted hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.52–0.87) and CVD (adjusted HR: 0.6; 95% CI: 0.47–0.79) compared with those who did not achieve remission. Risk of CKD and CVD was lower for those who had diabetes remission during at least four follow-up visits. In an analysis stratified by randomisation group, those receiving intensive lifestyle intervention who achieved diabetes remission had a lower risk for CKD (adjusted HR: 0.66; 95% CI: 0.48–0.91) than those who did not experience remission. However, no difference was observed for CVD risk. Among the diabetes support and education group, those achieving diabetes remission at any point had a lower CVD risk than those who did not have diabetes remission (adjusted HR: 0.32; 95% CI: 0.18–0.59), but no association was found with CKD risk.
This work is expected to guide further long-term studies to assess the impact of diabetes remission, using a variety of lifestyle interventions.
