Looking to take type 2 diabetes into remission

Since launching two years ago, an innovative study, led by Western professor Irene Hramiak, aims to induce remission of type 2 diabetes and has captured the attention of hundreds of Londoners. For those with type 2 diabetes, like Greg Ackland and Jocelyne Chauvin, the idea of stopping all medications has translated from a dream to a reality through participation in the REMIT study at Lawson Health Research Institute.

With a family history of type 2 diabetes, Ackland was first diagnosed over six years ago when he underwent an operation for a hernia. He developed a mild infection and, while being treated, his care team discovered his blood sugar levels were high. Ackland started treatment and was eventually taking four pills per day.

"I watched the progression of my medications and thought 'I'm losing this battle,'" said 51-year-old Ackland.

He saw information about the REMIT study on the local news and after meeting the criteria he was enrolled. The outcomes have been incredible. Ackland has now stopped all medications and his blood sugar levels are good. He has recommitted to exercise which has resulted in weight loss and muscle gain.

"I'm glad I jumped at the opportunity to participate in this trial," he said. "I've reset myself."

Lawson is one of seven Canadian sites taking part in the REMIT study, considered a significant departure in strategy in the care of people with type 2 diabetes. The study consists of a series of clinical trials that tests an aggressive approach in recently diagnosed patients. The first two trials in London saw significant interest in participation. A third REMIT trial is now being launched providing another opportunity for individuals with type 2 diabetes to take part.

"The goal of the REMIT study is to take a proactive approach to help people early in the disease, normalize their blood sugars for a period of 12 weeks and then slow the progression of the disease and the need for additional medications," said Hramiak, a Schulich School of Medicine & Dentistry professor and Chief of the Centre for Diabetes, Endocrinology and Metabolism at St. Joseph's Health Care London. "We want to know if we can induce remission, for how long and whether it matters what combination of medications we use."

The standard treatment for type 2 diabetes is to start on a single medication, which is followed by the addition of more drugs and insulin, as the disease progresses. In the REMIT study, patients receive intensive treatment early in their care journey that consists of two diabetes medications plus insulin at bedtime for three months to see if remission can be induced. In addition, patients are supported to make lifestyle changes with a diet and 30 minutes of exercise each day.

"When I saw a gentleman on the news talking about the REMIT study and how it allowed him to stop taking all medications, I thought 'cool,'" said Chauvin. The 62-year-old Londoner was first diagnosed with type 2 diabetes three years ago after a regular checkup. While it was difficult news, she had a family history of the disease and health issues before her diagnosis.

"I started taking one pill a day and was told I'd be up to four pills a day within six months," she said. "But with good nutrition and exercise I worked hard to stay on one pill a day for three years."

After hearing about the study, she contacted the research team and, after meeting the criteria, was enrolled last April. Chauvin has now stopped all medications and says she feels much better. She exercises more and her blood sugar levels are close to normal.

"This is my first time participating in a clinical trial and I'm very excited about my experience," she said.

REMIT is being led by the Population Health Research Institute (PIHR), a joint institute of McMaster University and Hamilton Health Sciences. The study follows a PHRI pilot study of early aggressive treatment that resulted in up to 40 per cent of intervention group participants with type 2 diabetes going into remission and not needing any diabetes treatment for at least three months.

"The idea of putting type 2 diabetes into remission is changing the way we think about the disease. It has a strong appeal to both those with type 2 diabetes and clinicians," said Hramiak. "It's changing the paradigm of when and how to use medication for type 2 diabetes."

Those who would like more information about the trial can call 519-646-6100 ext. 65373.