Studies highlight ‘legacy’ effect of intensive diabetes interventions
medwireNews: Three studies published in Diabetes Care support the notion that even a temporary respite from the effects of Type 2 diabetes has long-term benefits for patients’ vascular health, with benefits reported for a range of interventions and outcomes.
For the most aggressive intervention, of bariatric surgery, Karen Coleman (Kaiser Permanente Southern California, Pasadena, USA) and team found a significantly reduced risk of microvascular outcomes in patients who had experienced diabetes remission after surgery – even if their diabetes later returned.
Among 4683 patients who underwent surgery, the risk of retinopathy, neuropathy, and/or nephropathy during up to 10 years after surgery was a significant 29% lower among those who achieved remission than those who did not. And among patients who relapsed, each additional year that they spent in remission conferred a 19% reduction in the risk of microvascular events.
There were similar effects in the ACCORD Follow-On (ACCORDION) Eye Study, which assessed the long-term effects of intensive glycaemic control on retinopathy in 1310 participants 4 years after the close of the original trial. By this time, the effects of intensive glycaemic control had lapsed, with both groups having an average glycated haemoglobin level of just over 8%, report Emily Chew (National Institutes of Health, Bethesda, Maryland, USA) and colleagues.
Yet just 5.8% of those whose glycated haemoglobin target during ACCORD had been 6.0% or below had progressed by three or more steps on a standardised visual acuity chart (ETDRS chart), compared with 12.7% of those treated to the standard 7.0% or lower, giving a significant 58% reduction in risk.
The third study grouped participants of the Look AHEAD trial according to how much weight they had lost after 1 year of an intensive lifestyle intervention. Researcher Rena Wing (Miriam Hospital, Providence, Rhode Island, USA) and team “found positive legacy effects of having lost large amounts of weight initially, even if that weight loss was not maintained in full.”
They say: “It is possible that the initial weight losses delayed progression of [the patients’] diabetes.”
Glycated haemoglobin levels rose again over the subsequent 3 years irrespective of initial weight lost and whether it was maintained, but remained below baseline in patients who had lost between 8% and 20% of their initial bodyweight. Furthermore, glycated haemoglobin levels were significantly reduced, by 0.14% relative to at baseline, in patients with initial large weight loss who then regained it all, whereas patients whose weight remained stable throughout the trial had no such benefits.
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