At PGI, new hope to rein in type-2 diabetes
2
Chandigarh: Type 2 diabetes mellitus (T2DM) may not be invincible after all. Researchers are exploring the possibility of achieving remission through a combination of medication and lifestyle changes.
The study, 'DiaRem-1' – recently published in the 'Indian journal of endocrinology and metabolism' – challenges the traditional view that T2DM is a permanent condition and provides evidence that remission is a feasible goal for some patients.
The DiaRem-1 trial was an open-label, randomised controlled study at a single centre in India. It involved adult patients with T2DM of less than five years duration and an HbA1c level below 8.5%
All participants were medicated for three months, followed by a three-month off-treatment period to assess for remission. Remission was officially defined as maintaining an HbA1c below 6.5% without any antidiabetic medication for three months.
Nearly a third of the patients achieved remission. This small but powerful trial offers a cost-effective and scalable strategy that can work in outpatient clinics across India and the world.
"With early, intensive treatment and continued support, many patients may no longer need diabetes medication. That's a powerful message of hope," said Dr Rama Walia, lead investigator of the study, adding: "Physical workout for an hour daily, including brisk walk, yoga or dance, was advised in the trial.
Patients were kept on home-based healthy diet."
Unlike other methods that rely on intensive, impractical diets or expensive surgeries, this study focused on using modern, widely available medications along with standard dietary and physical activity advice.
Doctors now understand that two major culprits drive diabetes progression: glucotoxicity (too much sugar damaging beta cells) and lipotoxicity (fat accumulation impairing insulin action). By reversing these with medication and lifestyle therapy, the pancreas gets a much-needed break and, in some cases, begins to function more normally again.
SWEAT & DIET MAY KEEP PILLS AWAY
Chandigarh is considered the diabetic capital of India as the prevalence of prediabetes and diabetes is the highest in the country
How Test Was Conducted
Participants were divided into two groups:
Intervention arm: 14 patients received a combination of liraglutide, dapagliflozin, and metformin.
Control arm: 15 patients received vildagliptin, glimepiride, and metformin.
Definition of Remission: HbA1c <6.5% for at least 3 months without medication
Key Findings
Remission Rate: 9 of the 29 participants (31%) achieved remission. Four from the intervention arm and five from control arm maintained HbA1c below 6.5% without treatment
Weight Loss: Both groups experienced significant weight loss, as well as reductions in fat mass and body fat percentage. Intervention group had a median weight loss of -4.9 kg and the control group -3 kg,
No Special Meds: Both modern and standard drugs helped when tightly managed
Hope Floats: Not a cure, but a realistic and hopeful path to freedom from drugs
Any Predictors Of Success? No baseline characteristics could be identified to predict which patients would achieve remission. However, those who did achieve remission tended to have a shorter duration of diabetes and greater weight loss.
What's Next?
PGI team is continuing research to test how long remission lasts and whether longer treatment duration might improve outcomes further
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