Diabetes Remission Induced by Lifestyle Approaches and Glucose-Lowering Therapy

Diabetes remission can be induced following an intensive 12-week metabolic intervention combining insulin glargine/lixisenatide, metformin, and lifestyle approaches, according to study results published in Diabetes, Obesity and Metabolism.

Several trials have assessed the effects of lifestyle changes and various combinations of glucose-lowering medications on diabetes remission among patients with type 2 diabetes; however, it is unknown whether combining several therapeutic approaches would increase remission rates and which combinations can be easily followed by patients to sustain remission.

Therefore, researchers performed the open-label parallel randomized controlled Remission Evaluation of a Metabolic Intervention for Type 2 Diabetes with iGlarLixi (REMIT-iGlarLixi; ClinicalTrials.gov Identifier: NCT03130426) trial to assess whether remission can be achieved with an induction regimen comprised of a fixed-ratio combination of basal insulin glargine 100 U/mL and lixisenatide (iGlarLixi) plus metformin, combined with changes in diet and exercise.

Patients with type 2 diabetes lasting 5 years or less aged between 30 and 80 years were recruited from 8 sites in Canada. The primary outcome was the first onset of diabetes relapse within 12 weeks following randomization or later.

Participants were randomly assigned 1:1 to either a 12-week intensive metabolic intervention with a combination of basal insulin glargine 100 U/mL, lixisenatide, metformin, and lifestyle approaches, followed by 52 weeks of follow-up (intervention group, n=79) or standard diabetes care for 12 weeks followed by 52 weeks of follow-up (control group, n=81). Mean patient age was 55.5 years, 43.8% were women, and 86.9% were White.

The intervention group had a significantly lower rate of diabetes relapse compared with the control group (adjusted hazard ratio, 0.57; 95% CI, 0.40-0.81; P =.002). The intervention group had a median remission time of 93 days (95% CI, 85-161 days), while the control group had a median remission time of 48 days (95% CI, 29-78 days).

At 24 weeks, 38.0% of participants in the intervention group remained in complete or partial remission compared with 19.8% in the control group. At 36 weeks, 31.6% of the intervention group and 17.3% of the control group remained in complete or partial remission.

At 48 weeks, 27.8% of participants in the intervention group remained in remission, compared with 14.8% in the control group. At 64 weeks, the percentages were 22.8% vs 11.1%, respectively. There were no statistically significant differences between the groups at later time points.

Study limitations included the lack of blinding among participants and research staff and the short follow-up period.

The study authors concluded, “This trial suggests that the studied multimodal therapeutic approach can successfully induce drug-free remission of type 2 diabetes for at least 6 months in patients diagnosed within the previous 5 years and taking up to two glucose-lowering agents. ”

Disclosure: This research was supported by Sanofi. Please see the original reference for a full list of disclosures.

This article originally appeared on Endocrinology Advisor