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‘Remission Is Possible’ for Patients With Type 2 Diabetes

A novel approach that involves sensors, artificial intelligence, and real-time individualized lifestyle guidance from an app and live coaches led to a high rate of remission of type 2 diabetes in a new study.

Specifically, among 199 patients with type 2 diabetes in India who received the app-delivered lifestyle guidance developed by Twin Health, Mountain View, California, mean A1c dropped from 9.0% to 5.7% at 6 months.

This is “huge,” Paramesh Shamanna, MD, told a press briefing at the American Diabetes Association (ADA) 82nd Scientific Sessions in New Orleans. The research was presented as three posters by the group at the meeting.

Patients were a mean age of 43 and had had diabetes for a mean of 3.7 years and up to 8 years.

An “unprecedented” 84% of patients had remission of diabetes at 6 months, Shamanna, medical director at Twin Health, noted.

Diabetes remission was defined according to the 2021 joint consensus statement from the ADA and other organizations as an A1c < 6.5% without the use of diabetes medications for at least 3 months.

Importantly, patients’ time in range (percentage of time spent in target blood glucose range) increased from 53% to 81%, Shamanna pointed out. On average, patients’ waist circumference decreased by 10 cm (3.9 inches) and their weight dropped from 79 kg (approximately 174 lb) to 68 kg (150 lb).

These results are driven by “the continuous individualized and precise guidance regarding nutrition, activity, and sleep,” Shamanna told Medscape Medical News in an email.

Remission Is Not Reversal or Cure…

“Remission” from type 2 diabetes is not “reversal” or a “cure,” Robert A. Gabbay, MD, PhD, chief scientific and medical officer of the ADA, stressed to the press. Just like cancer, diabetes can return after remission

Therefore, it is important to follow the lifestyle guidance. Patients may still be at risk for diabetes complications after diabetes remission, so it’s also important to continue to be screened for eye disease, nerve damage, and lipid levels.

However, “remission can be made to last,” Shamanna said, by continuing to follow the lifestyle advice and getting back on track after a relapse.

“We’re in a different time right now,” Lisa Shah, MD, chief medical officer, Twin Health, noted. “This is very different from management of blood glucose to a certain number.”

This study shows that “remission [from type 2 diabetes] is possible,” she said. “How you achieve it can be precise for you.”

The program is designed to consider the health and happiness of the patient, added Shashank R. Joshi, MD, chief scientist, Twin Health. “We want remission to be complication free,” he said. “These findings give patients hope.”

“It’s exciting now that we can really start thinking about remission as an option for people with [type 2] diabetes, and that just provides such incredible hope for all of those living with [type 2] diabetes,” Gabbay echoed to Medscape Medical News.

How the Intervention Works

The Twin Precision Treatment (TPT) intervention integrates multiple data — glucose values from a continuous glucose monitor (CGM); heart rate, activity, and sleep time from a fitness tracker; blood pressure values from a blood pressure cuff; food intake from the patient’s food log; and weight and body fat data from a smart scale — and provides the patient with precise, individualized nutrition and health guidance.  

The four most critical sensors are the CGM, the fitness tracker, the smart scale, and the blood pressure cuff, Shah explained. The system gathers thousands of signals combined with patient self-reported data including mood or anxiety.

The CGM is used to build the initial nutrition guidance during the first 30 days. Once a patient is in remission, he or she can just keep the fitness tracker and smart scale.

The coaches who are part of this program include dieticians who are trained to provide compassionate patient education and help patients avoid diabetes relapse, and they are overseen by a licensed provider.

The program does not restrict calories. “It is not a diet,” Shah stressed.

The algorithm makes mini adjustments to the food a person is already eating to improve nutrition, Joshi explained. “This is personalized medicine at its best.” Patients eat food that they like and are guided to make small changes to get glucose under control and avoid glucose spikes.

The program is designed to safely deescalate diabetes medications as A1c decreases, Shamanna added.

US Clinical Trial, Health Insurance Coverage

The 1-year results of the current trial are expected in August, and the trial will continue for 2 to 5 years, Shamanna said.

The company has started a clinical trial in the United States, with 5-year results expected in 2027.

“Currently, in the United States, we are partnering with self-insured employers and select health plans that offer [Twin Precision Treatment ] as an available benefit for their members,” Shah said. It “is suitable for most members living with type 2 diabetes, with rare exclusion situations.”

The study was funded by Twin Health. Shamanna, Shah, and Joshi are employees of Twin Health.

ADA 2022 Scientific Sessions. Abstracts 221-LB, 4-LB, 26-OR. Presented June 5, 2022.

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