Title: Clinical Resolution of Type 2 Diabetes with Reduction in Body Mass Index Using Meal Replacement Based Weight Loss
Volume: 5
Issue: 1
Author(s): Katherine E. Nori Janosz, Karen A. Koenig Berris, Carrie Leff, Wendy M. Miller, Jose Yanez, Samantha Myers, Claire Vial, Merry VanderLinden, Barry A. Franklin and Peter A. McCullough
Affiliation:
Keywords:
Obesity, diabetes, BMI (body mass index), weight loss, waist circumference, meal replacement, portion control, glycosylated hemoglobin
Abstract: Background: The positive correlation between body mass index (BMI) and type 2 diabetes (DM) is well established. Data on the clinical resolution of DM through diet-induced weight loss, however, are limited. Objective: Examine the relationship between BMI reduction and resolution of type 2 DM using a medically-monitored, behavior modification, weight-management program involving low-calorie, meal replacement diets in obese subjects. Methods: Through a retrospective, chart review in a suburban weight management center, case patients (n=33) that clinically resolved DM were identified in a suburban weight loss clinic and compared with age- and gender-matched control patients (n= 100), that did not clinically resolve DM following the same interventions in the same weight loss clinic. Clinical resolution of DM was defined as an initial elevated glycohemoglobin (HbA1C) ≥ 6.0% that decreased to < 6.0% with weight loss allowing discontinuation of all diabetic medications. Results: The mean ± SD age was 54.1 ± 9.7 and 58.2 ± 9.4 years for cases and controls respectively, p = 0.03. The baseline BMI was similar for cases and controls, 42.0 ± 9.0 and 42.9 ± 8.6 kg/m2, p = 0.63. The absolute and relative reduction in BMI was 7.6 ± 3.7 kg/m2 and 18.1 ± 8.2% in cases vs. 3.9 ± 3.7 kg/m2 and 8.5 ± 8.0% in controls, respectively, (p < 0.0001 for both comparisons) over a mean duration of 11.2 ± 4.9 and 14.9 ± 13.0 months for cases and controls. Multiple logistic regression found that lower baseline HbA1C (p = 0.02), younger age (p = 0.01), and greater relative BMI reduction (p < 0.0001) were independent predictors of the clinical resolution of DM. Conclusions: Positive predictive factors for clinical resolution of DM through diet-induced weight loss include younger age and better baseline glycemic control. Clinical resolution of DM likely requires a minimum BMI reduction of 10% in obese individuals.
