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Trial finds weight loss can put diabetes into remission for at least two years

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More than a third of people with type 2 diabetes taking part in a weight management programme delivered in primary care are in remission two years later, according to latest UK study findings, which researchers have decribed as “incredibly exciting”.

Results of the trial, funded by Diabetes UK and announced today, showed that 46% of participants were in remission after one year. A year later, 36% in were still in remission.

“Proving that type 2 diabetes can be put into remission for two years in more than two thirds of people, if they can lose more than 10 kilos, is incredibly exciting”

Mike Lean

The second-year trial results also confirmed that – as with its first-year results – remission is closely linked to weight loss, said the study authors, with most of the participants who lost over 10kg still in remission at two years.

The Diabetes Remission Clinical Trial (DiRECT), led by experts at Newcastle University and the University of Glasgow, aims to find an effective way to put type 2 diabetes into remission for the long term.

The trial is delivered through 49 GP practices in Scotland and Tyneside and set out to uncover if a structured weight management programme can be delivered in a primary care setting.

At year one of the trial, 46% of intervention participants were in remission and 24% had achieved at least 15kg weight loss. The aim of its second year analysis was to assess the durability of the weight management intervention effect.

“These results are a significant development, and finally pull down the curtain on the era of type 2 diabetes as an inevitably progressive disease”

Roy Taylor

Professor Roy Taylor – who co-led the trial with Professor Mike Lean – said the latest findings from the trial “pull down the curtain on the era of type 2 diabetes as an inevitably progressive disease”.

Key findings included a close link between remission and weight loss and that taking part in a programme to manage weight can also reduce the need for diabetes medications.

The findings were announced today at Diabetes UK’s professional conference and published in the journal The Lancet Diabetes & Endocrinology.

The study also noted that, as expected, participants regained some weight between the first and second year of results.

However, those in remission after one year who stayed in remission had a greater average weight loss (15.5 kilos) than those who did not stay in remission (12 kilos).

In the trial, participants were defined as in remission if they had long-term blood glucose levels of less than 48mmol/mol (6.5%) without needing to use any type 2 diabetes medications.

According to the study, as well as resulting in remission for many participants, the weight management programme also led to a drop in blood glucose levels and fewer diabetes medications across the whole intervention group.

“These results further challenge the perception that type 2 diabetes needs to be a lifelong condition for everyone diagnosed with it”

Elizabeth Robertson

Results highlighted that the average HbA1c fell from 60mmol/mol at the start of the trial to 54mmol/mol at the end of year two. In addition, the use of diabetes medication dropped from 75% of the group to 40%.

For the control participants receiving standard care, the trial found that the average HbA1c remained similar and the proportion of people taking medications increased from 77% to 84%.

In addition, the study identified that quality of life scores increased across both groups, though the authos noted that the intervention group reported a larger improvement.

The researchers behind the study believe that by understanding the biology of remission, it should be possible to provide better care for people diagnosed with type 2 diabetes in the future.

Professor Taylor, director of Newcastle University’s magnetic resonance centre, and co-primary investigator of the DiRECT trial, said: “These results are a significant development, and finally pull down the curtain on the era of type 2 diabetes as an inevitably progressive disease.”

“We now understand the biological nature of this reversible condition,” he said. “However, everyone in remission needs to know that evidence to date tells us that your type 2 diabetes will return if you regain weight.”

Professor Taylor highlighted that, even during the second year of “freedom” from type 2 diabetes, “there was a highly suggestive difference in major complications of diabetes”.

“The numbers are still small at the moment, and further information on this must be gathered during the planned longer term follow up,” he said.

“We’re continuing to invest in further research, to understand the biology underlying remission and find ways to make remission a reality”

Elizabeth Robertson

Co-primary investigator Professor Mike Lean, head of human nutrition at Glasgow University and diabetes specialist physician at Glasgow Royal Infirmary, said: “Proving in DiRECT that type 2 diabetes can be put into remission for two years in more than two thirds of people, if they can lose more than 10 kilos, is incredibly exciting.

“Achieving that entirely in NHS primary care is vital,” he said. “People with type 2 diabetes and healthcare professionals have told us their top research priority is ‘can the condition be reversed or cured’. We can now say, with respect to reversal, that yes it can.”

He called for a focus on “helping people maintain their weight loss and stay in remission for life,”. “If allowed to progress, type 2 diabetes becomes devastating,” he noted.

Professor Lean highlighted that the weight management programme was “relatively inexpensive” in comparison to the “long-term management” of the condition. He added that this provides a “compelling case for shifting resources to offer remission-based care”.

Dr Elizabeth Robertson, director of research at Diabetes UK, said: “These results further challenge the perception that type 2 diabetes needs to be a lifelong condition for everyone diagnosed with it.”

She said the charity was committed to working with the researchers and the NHS to ensure these “exciting findings” reach those with the condition as soon as possible.

“But we know type 2 diabetes is a complex condition, and this approach will not work for everyone,” she said. “That’s why we’re continuing to invest in further research, to understand the biology underlying remission and find ways to make remission a reality for as many people as possible.” 

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