Impact of eligibility for diabetes remission on response to intensive lifestyle intervention in overweight and obese people with type 2 diabetes: The Look AHEAD trial.

To achieve remission of type 2 diabetes, resources to support intensive lifestyle intervention (ILI) are directed toward people with diabetes for whom remission is achievable, that is, people with short diabetes duration and lower HbA1c. We aimed to determine if responses to ILI, other than remission, justify this resource allocation. We analysed participants from the Look AHEAD randomised controlled trial who were 20-65 years old with a BMI of 27-45 kg/m2. The effect of ILI was assessed after stratification for remission eligibility at baseline (diabetes duration ≤6 years and no insulin therapy). Cox proportional hazards models evaluated the effect of ILI on incident CVD, chronic kidney disease (CKD), and mortality. Linear models with generalised least squares assessed the effect of ILI on weight, HbA1c, systolic blood pressure, LDL, and eGFR. There were 3105 participants included-60% women, median age 58 years, and median follow-up time 9 years (IQR 8-10 years). At baseline, 54% were eligible for remission. Remission eligibility status did not modify the effect of ILI on CVD, CKD, or mortality. ILI led to 2.4 kg greater weight loss (-5.53 kg (95% CI -6.02, -5.03) vs. -3.17 kg (95% CI -3.86, -2.49)), and 0.1% greater HbA1c reduction (-0.28% (95% CI -0.33, -0.23) vs. -0.17% (95% CI -0.23, -0.11)) in eligible compared with ineligible people. The small additional benefit of ILI in people eligible for remission, compared with ineligible people, may not be enough to justify restricting resources for ILI to such eligible people.