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News Article

Low calorie diets may send type 2 diabetes into remission


A structured weight loss programme succeeded in reversing diabetes in nearly half the patients

Losing around 15 kg in a structured weight loss programme can cause type 2 diabetes remission in 86% of cases, finds a study in The Lancet this week. The good news is that patients were able to stay in remission long term. If health services adopt this treatment, at least some patients may be able to cease taking drugs. Diabetes UK advises diabetics to consult their doctors before attempting this weight loss approach and it advises those in remission to continue health check in case diabetes returns.

Professor Roy Taylor, of Newcastle University, the senior author of this study, describes the huge cost of type 2 diabetes to the UK National Health Service in The Lancet’s podcast accompanying the paper. Tablets cost the UK a billion pounds a year, and diabetes complications cost £14 billion per year. Taylor says that current treatment for new diabetics includes advice to change diet and lose weight. This study reinforces that message. Nearly 3.6 million people in the UK have type 2 diabetes according to Diabetes UK.

The first clue that diabetes might be reversible came when experts observed that bariatric surgery, in which the stomach is reduced in size, appeared to reverse diabetes. A debate began as to why, with one possibility being weight loss and the other being changes in hormones. A small study by Roy Taylor and colleagues in Newcastle published in 2011 of diabetics on a very low calorie diet suggested for the first time that weight loss via a low calorie diet could reverse diabetes. Last year they showed that remission was possible for 6 months. This study shows that diabetes remission is sustainable for 1 year in a wide variety of patients.

The study placed participants on a low calorie meal replacement (825–853 kcal/day) for 3–5 months followed by a stepped introduction to a low calorie diet over 2-8 weeks with long term support to maintain the diet, or on care by best practice guidelines. In the Lancet podcast Taylor said the stepped introduction to a low calorie diet is important because it aims to break the previous eating habits of the patients. Patients on the diet stopped all diabetic and hypertension medications when they began the trial.

The 306 subjects were 20–65 years old with a body-mass index of 27–45 kg/m2 and they had been diagnosed with type 2 diabetes within the past 6 years. They were not receiving insulin. The researchers defined remission as having glycated haemoglobin (HbA1c) levels of less than 6·5% after at least 2 months up to 12 months.

46% of those on the weight loss intervention were in remission 12 months later. Those in the group who lost >15 kg were most likely to go into remission: 86% of the group compared to 7% in the group losing 0-5 kg. Those who had no weight change had no remission. “Remission of type 2 diabetes is a practical target for primary care,” conclude the researchers

It is important to realise this is remission not cure. Type 2 diabetes would return if the patients gain weight commented Professor Taylor in the podcast. His theory is that type 2 diabetes develops when the body has more fat than it can cope with. To maintain diabetes remission, health services would need to provide advice and ongoing support to maintain a lower weight. Diabetes UK says: “It’s still really important for people in remission to get regular healthcare checks, so any complications can be monitored and any signs of Type 2 diabetes coming back can be caught early.”

 

Lancet study:

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. By Michael EJ Lean, Wilma S Leslie, Alison C Barnes, Naomi Brosnahan, George Thom, Louise McCombie, Carl Peters, Sviatlana Zhyzhneuskaya, Ahmad Al-Mrabeh, Kieren G Hollingsworth, Angela M Rodrigues, Lucia Rehackova, Ashley J Adamson, Falko F Sniehotta, John C Mathers, Hazel M Ross, Yvonne McIlvenna, Renae Stefanetti, Michael Trenell, Paul Welsh, Sharon Kean, Ian Ford, Alex McConnachie, Naveed Sattar, and Roy Taylor, Lancet 2017 http://dx.doi.org/10.1016/S0140-6736(17)33102-1

 

Related podcast:

http://www.thelancet.com/pb-assets/Lancet/stories/audio/lancet/2017/05december_diabetes.mp3

Article details

  • Author(s)
  • I. Hoskins
  • Date
  • 08 December 2017
  • Subject(s)
  • Nutrition & disease