A third of people who went on a low-calorie diet to lose substantial amounts of weight reversed their type 2 diabetes and were still in remission two years later, a study on the long-term implications has found.
The number of people with type 2 diabetes has been soaring on the back of the obesity epidemic sweeping the world. Two-thirds of adults in the UK are now overweight or obese.
But the new study shows the condition is not a life sentence, say scientists. The results put paid to the idea that type 2 diabetes was an inevitably progressive disease, said the co-primary investigator of the study, Prof Roy Taylor from Newcastle University.
“We now understand the biological nature of this reversible condition. However, everyone in remission needs to know that evidence to date tells us that your type 2 diabetes will return if you regain weight,” he said.
The trial, called Direct, is taking place in 49 GP practices in Scotland and Tyneside. Nearly 300 people with type 2 diabetes and a body mass index of between 27 and 45 kg/m2 took part. Half got standard diabetes care and the other half were put in a structured weight management programme. For 12 to 20 weeks, they were invited to consume only low-calorie formula meals totalling 800 calories a day. They had support from a nurse or dietitian to reintroduce normal foods at the end and to help them keep the weight off.
After the first year, 46% of those on the low-calorie diet had reversed their type 2 diabetes. More than a third of those who had been put on the diet – 36% – were still in remission after two years, according to the paper in the Lancet Diabetes & Endocrinology journal. Remission is closely linked to weight loss. Most – 64% – who lost more than 10kg were still free of the disease after two years.
Participants regained some weight, as expected, between the first and second year. However, those in remission after one year who stayed in remission had a greater average weight loss (15.5kg) than those who did not stay in remission (12kg). Participants were defined as in remission if they had long-term blood glucose levels (HbA1c) of less than 48mmol/mol (6.5%) without needing to use any type 2 diabetes medications.
“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. Now we must focus on helping people maintain their weight loss and stay in remission for life,” said Prof Mike Lean from Glasgow University, who led the study with Taylor.
