1. GHF 2018
Patient Education for Type 2 Diabetes Remission  
Grégoire Lagger1, Jorge Cesar Correia2, Peter Fernandes1, Frédéric Sittarame1, Alain Golay Service of Therapeutic Patient Education for Chronic Disease - Department of Community Medicine, Primary and Emergency Care, University Hospital of Geneva, Switzerland 2. Division of Tropical and Humanitarian Medicine - Department of Community Medicine, Primary and Emergency Care, University Hospital of Geneva, Switzerland   Corresponding author:
Introduction: Type 2 Diabetes (T2D) remission has been demonstrated in patients undergoing bariatric surgery or low caloric diet1,2.
Objective: To investigate the effects of therapeutic patient education alone on T2D reversal in early diagnosed patients (< 7 years of DT2).
Schematic outline of the research protocol
17 T2D patients underwent a
one-week therapeutic education program,
followed by 12 months of 1 hour session
every month, targeting diabetes reversal.
Protocol
Behaviour changes potentially linked to T2D reversal
A strong therapeutic alliance coupled with a 5 dimension patient education are much more efficient than just explaining to patients3. 
Many elements can be learnt and changed by the patient, in order to induce a diabetes reversal, at least in the first years after diagnosis4… 
Models
T2D reversal was determined using the DiaRem score which integrates glycated hemoglobin levels and antidiabetic drug treatment 5.
DiaRem score (0-100) calculation formula for T2D patients (adapted from Ref. 5). Probability of remission (in %) =
100 – 0.45∙(age - 40) - 9∙(HbA1C - 6) - 9∙(number of antidiabetic molecules excluding insulin) - 55∙(1 if patient on insulin treatment, 0 if not).
Results
Antidiabetic drugs doses decreased by 25% (p<0.05), and the DiaRem score increased by 15% (p<0.01), indicating a reversal of the disease.
These results were not correlated to weight loss, age or diabetes duration.
After 1 year, the mean HbA1C fell from 7.2% (±1.9) to 6.2% (±0.8) (p<0.05).
Δweight
Age
Diabetes duration
ΔDiaRem
-0.14
0.05***
0.16*
Variation of main parameters before/after the study
Variation of HbA1c and AntiDiabetic Drugs before/after the study
Glycemic control first ↓
then disease reversal ←
Variable
Before
After
Weight / kg
96.8 (19.1)
93.4 (16.4)*
BMI / kg m-2
33.9 (5.2)
32.7 (5.6)*
HbA1c / %
7.2 (1.9)
6.2 (0.8)*
Anti-Diabetic Drugs / Number
2.0 (1.0)
1.5 (1.0)***
Adapted DiaRem Score / %
62.5 (28)
77.1 (15)**
Emotional physical activity
2.7 (0.9)
3.2 (0.5)*
Cognitive type 2 diabetes
2.5 (0.8)
2.9 (0.6)*
Infra- one cause for one disease
2.4 (0.6)
2.8 (0.4)*
At the end of the study, 15 out of 17 patients had excellent glycemic control (HbA1C <7.0%) and 4 patients had parameters compatible with partial diabetes remission.
A significant improvement in glycemic control coupled with a lowering of antidiabetic drug treatment was observed.
Conclusions: Following a 1 year therapeutic education program, early diagnosed patients may reverse their Type 2 Diabetes.
This simple, transferrable and low cost approach could rapidly be implemented in all regions where T2D is now a major burden.
Références
1. L. Sjöström, M. Peltonen, P. Jacobson, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA, 2014; 311:
2. E.L. Lim, K.G. Hollingsworth, B.S. Aribisala, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia, 2011; 54:
3. A. Golay, G. Lagger, A. Giordan. Comment motiver le patient à changer ? Paris: Maloine; 2009.
4. G. Lagger. Guérir du diabète de type 2. Nice: Ovadia; 2014.
5. C.D. Still, G.C. Wood, P. Benotti, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diab Endocrinol, 2014; 2: