The more weight lost by people with type 2 diabetes, the greater the odds that the disease will go partially or even completely into remission, according to a recent analysis published in The Lancet Diabetes & Endocrinology.
Reviewing 22 earlier randomised trials testing weight loss interventions in overweight or obese patients with type 2 diabetes, the pivotal study by researchers at Aman Hospital and Weill Cornell Medicine-Qatar (WCM-Q) found complete remission of the disease in half of those who lost 20% to 29% of their body weight. Nearly 80% of patients who lost 30% of body weight no longer appeared to have diabetes.
That means their haemoglobin A1c levels – a standard measure reflecting average blood sugar levels over the past few months – or their fasting blood sugar levels, had returned to normal without use of any diabetes medications.
Reuters reports that no one who lost less than 20% of their body weight achieved a complete remission, but some were in partial remission, with haemoglobin A1c and fasting glucose levels returning almost to normal.
Partial remission was seen in roughly 5% of those who lost less than 10% of their body weight, and that percentage rose steadily with greater weight loss, reaching nearly 90% among those who lost at least 30%.
Overall, for every percentage point decrease in body weight, the probability of reaching complete remission increased by roughly two percentage points and the probability of reaching partial remission increased by roughly three percentage points, regardless of age, sex, race, diabetes duration, blood sugar control or type of weight loss intervention.
Type 2 diabetes accounts for 96% of all diagnosed cases of diabetes, and more than 85% of adults with the disease are overweight or obese, the researchers noted.
“The recent development of effective weight loss medications, if made accessible to all who could benefit, could play a pivotal role in reducing the prevalence of diabetes and its complications,” they said.
Study details
Impact of bodyweight loss on type 2 diabetes remission: a systematic review and meta-regression analysis of randomised controlled trials
Sarah Kanbour, Rwedah A Ageeb, Rayaz A Malik, Laith J Abu-Raddad et al.
Published in The Lancet Diabetes & Endocrinology on 26 February 2025
Summary
Background
Bodyweight loss is associated with type 2 diabetes remission; however, the quantitative relationship between the degree of bodyweight loss and the likelihood of remission, after controlling for confounding factors, remains unknown. We aimed to analyse the relationship between the degree of bodyweight loss and diabetes remission after controlling for various confounding factors, and to provide estimates for the effect sizes of these factors on diabetes remission.
Methods
This systematic review and meta-regression analysis followed Cochrane and PRISMA guidelines to systematically review, synthesise, and report global evidence from randomised controlled trials done in individuals with type 2 diabetes and overweight or obesity. The outcome was the proportion of participants with complete diabetes remission (HbA1c <6·0% [42 mmol/mol] or fasting plasma glucose [FPG] <100 mg/dL [5·6 mmol/L], or both, with no use of glucose-lowering drugs) or partial diabetes remission (HbA1c <6·5% [48 mmol/mol] or FPG <126 mg/dL [7·0 mmol/L], or both, with no use of glucose-lowering drugs) at least 1 year after a bodyweight loss intervention. We searched PubMed, Embase, and trial registries from database inception up to July 30, 2024. Data were extracted from published reports. Meta-analyses and meta-regressions were performed to analyse the data. The study protocol is registered with PROSPERO (CRD42024497878).
Findings
We identified 22 relevant publications, encompassing 29 outcome measures of complete diabetes remission and 33 outcome measures of partial remission. The pooled mean proportion of participants with complete remission 1 year after the intervention was 0·7% (95% CI 0·1–4·6) in those with bodyweight loss less than 10%, 49·6% (40·4–58·9) in those with bodyweight loss of 20–29%, and 79·1% (68·6–88·1) in those with bodyweight loss of 30% or greater; no studies reported on complete remission with 10–19% bodyweight loss. The pooled mean proportion of participants with partial remission 1 year after the intervention was 5·4% (95% CI 2·9–8·4) in those with bodyweight loss less than 10%, 48·4% (36·1–60·8) in those with 10–19% bodyweight loss, 69·3% (55·8–81·3) in those with bodyweight loss of 20–29%, and 89·5% (80·0–96·6) in those with bodyweight loss of 30% or greater. There was a strong positive association between bodyweight loss and remission. For every 1 percentage point decrease in bodyweight, the probability of reaching complete remission increased by 2·17 percentage points (95% CI 1·94–2·40) and the probability of reaching partial remission increased by 2·74 percentage points (2·48–3·00). No significant or appreciable associations were observed between age, sex, race, diabetes duration, baseline BMI, HbA1c, insulin use, or type of bodyweight loss intervention and remission. Overall, data were derived from randomised controlled trials with a low risk of bias in all quality domains.
Interpretation
A robust dose–response relationship between bodyweight loss and diabetes remission was observed, independent of age, diabetes duration, HbA1c, BMI, and type of intervention. These findings highlight the crucial role of bodyweight loss in managing type 2 diabetes and reducing the risk of diabetes-related complications.
Reuters article – Health Rounds: Weight loss can improve or reverse type 2 diabetes. (Open access)
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