Significant weight loss could reverse type 2 diabetes, according to early findings from a new study looking at how nurse-led diet programmes in primary care can tackle the condition.
The research, published in The Lancet today, found the use of a structured low-calorie weight management programme, provided by nurses or dieticians, led to almost half of those patients taking part moving into remission within a year.
After 12 months, 46% – or 68 people – were in remission, meaning their HbA1c level was less than 6·5% (<48 mmol/mol) after at least two months off all anti-diabetic medications.
“These findings could revolutionise the way type 2 diabetes is treated”
Professor Roy Taylor
The average weight loss among the group was 10kg, and the more weight people managed to lose, the more likely it was their type 2 diabetes would be reversed after a year.
The ongoing two-year Diabetes Remission Clinical Trial (DiRECT), being funded by Diabetes UK, is being led by academics at Newcastle University and the University of Glasgow.
It is being run in Tyneside and Scotland, with 49 GP practices participating. Around half are delivering a weight management programme, while the others are providing usual care.
A total of 306 people aged 20 to 65 years old who have had type 2 diabetes for less than six years are taking part. They have a body mass index between 27 and 45kg/m2.
The results after a year show 86% of the 36 people who lost 15kg or more saw the condition reverse, while 57% of the 28 people who lost 10 to 15kg achieved remission.
Meanwhile, 34% of the 56 people who lost 5 to 10kg saw their type 2 diabetes decline, and 7% of the 89 people who lost 0 to 5kg went into remission.
“The large numbers of people with type 2 diabetes makes it impossible to offer surgery to all people”
Diabetes Remission Clinical Trial paper
Only 4% – or six people – in the group that were not offered a weight management programme went into remission.
The structured weight management programme involves a primary care nurse or a dietitian delivering a low-calorie diet regime of shakes and soups, followed by food reintroduction and long-term weight loss maintenance advice.
Medications for type 2 diabetes and blood pressure were stopped at the beginning of the programme and reintroduced as necessary.
In the paper published today, called Primary care-led weight management for remission of type 2 diabetes, those behind the research noted discussions about how to tackle type 2 diabetes had so far been “dominated” by weight loss surgery.
“However, this option comes at a high financial cost and with the risk of long-term problems, such as post-prandial hypoglycaemia, and micronutrient deficiencies that restrict acceptability,” it said.
“Losing weight isn’t just linked to better management of type 2 diabetes: significant weight loss could actually result in lasting remission”
“The large numbers of people with type 2 diabetes makes it impossible to offer surgery to all people, even if this approach were financially possible and palatable to everyone,” it added.
Professor Roy Taylor from Newcastle University, joint lead researcher of the DiRECT trial, described the study findings as “very exciting”.
“They could revolutionise the way type 2 diabetes is treated,” he said. “This builds on the work into the underlying cause of the condition, so that we can target management effectively.”
“Substantial weight loss results in reduced fat inside the liver and pancreas, allowing these organs to return to normal function. What we’re seeing from DiRECT is that losing weight isn’t just linked to better management of type 2 diabetes: significant weight loss could actually result in lasting remission,” he added.
“We’re very encouraged by these initial results, and the building of robust evidence that remission could be achievable”
Dr Elizabeth Robertson
Professor Mike Lean from the University of Glasgow, joint lead researcher of the DiRECT trial, said: “Putting type 2 diabetes into remission as early as possible after diagnosis could have extraordinary benefits, both for the individual and the NHS.”
“DiRECT is telling us it could be possible for as many as half of patients to achieve this in routine primary care, and without drugs,” he added.
Dr Elizabeth Robertson, director of research at Diabetes UK, said: “These first-year findings of DiRECT demonstrate the potential to transform the lives of millions of people.
“We’re very encouraged by these initial results, and the building of robust evidence that remission could be achievable for some people.”