- About 828 million adults around the world have diabetes, and 90% have type 2 diabetes.
- Only about 5% of people with type 2 diabetes will achieve remission.
- A new study has found a combination of an SGLT-2 inhibitor drug and a moderately calorie-restrictive diet provides higher rates of type 2 diabetes remission compared to just calorie restriction alone.
Researchers estimate that about
Recent studies predict the number of people globally living with diabetes will grow to at least
While type 2 diabetes can be managed with medications and lifestyle changes, only about 5% of people with this form of diabetes will ever achieve disease remission.
“Diabetes has been considered as an incurable illness and is dependent on medication for [a] lifetime,” Xiaoying Li, MD, PhD, professor and director of the Department of Endocrinology and Metabolism at Zhongshan Hospital Fudan University in China explained to Medical News Today.
“Diabetes complications gradually occur as diabetes progresses. Thus, it is important to find a strategy to stop the progression of diabetes for prevention of the complications,” he added.
Li is the lead author of a new study recently published in
This study received funding from biopharmaceutical company AstraZeneca.
For this study, researchers focused on the SGLT-2 drug dapagliflozin, and how it worked in combination with a calorie-restricted diet.
“SGLT-2 inhibits are a class of medications that inhibit glucose reabsorption from
“We hypothesized that SGLT-2 inhibitor plus moderate calorie restriction could achieve more body weight reduction,” he continued. “On the other hand, SGLT-2 could produce more metabolic benefits and remodel metabolic state, which could help [improve] insulin resistance and beta cell function.”
To conduct the study, researchers recruited 328 people between the ages of 20-70 from China who had type 2 diabetes for more than 6 years and visited medical centers from June 2020 to January 2023.
All study participants had a starting body mass index (BMI) greater than 25, and were not taking any diabetes medications other than metformin.
Scientists randomly assigned participants into two groups — one taking dapagliflozin with a moderate calorie-restricted diet, and one taking a placebo and following the diet.
The calorie-restrictive diet lowered participants’ normal daily calories between 500-750 kilocalories (kcal).
Study participants were asked to keep a detailed food journal and encouraged to take part in 150 minutes of brisk walking each week or more than 10,000 steps each day.
They also received dietary counseling from dieticians on a monthly basis, as well as messages or phone calls every 2 weeks for the first 6 months, to help support them.
Upon analysis, Li and his team found that after 12 months, 44% of study participants in the combination dapagliflozin and calorie restriction group achieved type 2 diabetes remission, compared to 28% in the placebo group.
“The remission rate in patients receiving dapagliflozin plus calorie restriction (44%) is significantly greater than those receiving calorie restriction alone (28%),” Li detailed.
“The chance to achieve diabetes remission in patients receiving dapagliflozin plus calorie restriction is increased by 56%, as compared with those receiving calorie restriction alone,” he noted.
Researchers also discovered that participants in the combination dapagliflozin group also experienced a greater reduction in body weight and insulin resistance, as well as benefits to body fat mass,
“It is thought that those metabolic changes including body weight, insulin resistance, body fat mass, and systolic blood pressure are associated with improvement of cardiovascular outcomes and kidney outcomes, which are possibly associated with diabetes remission,” Li said.
MNT spoke with Jennifer Cheng, DO, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center in New Jersey, about this study.
“It makes sense that a diabetes medication, dapagliflozin, with calorie restriction would achieve better remission for type 2 diabetes than calorie restriction alone,” Cheng, who was not involved in the study, explained.
“Dapagliflozin is a SGLT-2 class of medication, which helps your kidneys remove more sugar from your blood through urination. At times, it also enables mild weight loss,” she noted.
“It is understandable that this may cause better glucose control for people who are taking the medication,” she continued. “More and more people are starting dapagliflozin for heart failure, and other indications, so it is good to know that sugar control may occur as a side effect for patients who are taking it for other indications.”
“Diabetes is an under-recognized disease that many people do not even realize they have,” Cheng added. “It can cause a significant health burden as well as financial burden if left untreated. It is important to obtain new treatments because of the significant financial burden that diabetes may present for patients. Early treatment and better control of diabetes prevents complications of diabetes later in life.”
MNT also spoke with Pouya Shafipour, MD, a board-certified family and obesity medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, about this study.
Shafipour, who was also not involved in the research, commented that he was not surprised by its results:
“Diabetes, as we know, is on the rise, so it is a major health issue. It not only just impacts blood sugar, but also
kidney function ,heart disease , Alzheimer’s [disease risk], [the] eyes, nervous system, [and]neuropathy , so it almost encompasses, from head to toe, the entire body.”
“The more we can find efficient drugs before people go on insulin because once someone goes on insulin, then it’s almost the end of the line — if someone has been diabetic for too long [they] become insulin dependent,” he continued. “The more we can find drugs that are very effective earlier on, we keep the pancreatic function when [improving] insulin sensitivity.”
When it comes to the next steps in this type of research, Shafipour said there are some medications in the research pipeline that are a combination of SGLT-2 drugs and glucagon-like peptide-1 (GLP-1) receptor agonists. Ozempic and Zepbound are both examples of GLP-1 medications.
“Both of these classes have shown a lot of benefits in terms of diabetic control, as well as weight loss,” he explained. “Obviously, the GLP-1s have more weight loss effect, but if we can see some data that uses both these classes together, that would be great.”
