Background: A systematic literature review was conducted to assess the strength of the evidence on intensive weight loss programs on diabetes remission, in individuals with newly diagnosed type 2 diabetes, compared with standard diabetes care.
Methods and findings: Relevant studies were identified using PubMed and Scopus. Search date: 2018-02-12. Inclusion criteria: energy-reduced diet, randomized controlled trials (RCT), overweight or obese patients >18 years, diagnosed with type 2 diabetes <6 years. Exclusion criteria: insulin therapy, bariatric surgery and non-standard control treatment. Two reviewers independently reviewed and extracted relevant data; disagreements were settled by consensus. The strength of the evidence was graded by the international system GRADE. Two studies met the eligibility criteria, one with high and one with moderate quality. Both studies compared a weight loss program with standard diabetes care and had 52 weeks follow up period. One study featuring an intensive weight loss program (>15 kg), with 3 month low calorie diet initiating the program, showed improved remission of type 2 diabetes. The strength of evidence was appraised moderate. One study combining intensive metabolic intervention with antidiabetic drugs for an initial period of a) 8 weeks, or b) 16 weeks, with moderate weight loss (5%), failed to show significant treatment effect. However, the strength of evidence for the program was appraised insufficient.
Conclusions: There is insufficient evidence on the effect of modest weight loss, combined with antidiabetic drugs, on remission in patients with newly diagnosed type 2 diabetes. There is however moderately strong evidence supporting that intensive weight loss program, using low calorie diet, leads to remission in patients with newly diagnosed type 2 diabetes. A major limitation with respect to advancement in this field is the lack of a general consensus on how to define remission. Long-term effects (>52 weeks) are also yet to be established.
Axelsen M, Jansson L and Svanqvist L