A recent study by researchers in the United Kingdom investigated whether intensive weight management programs could help type 2 diabetes patients go into remission.
Type 2 diabetes currently affects over 422 million adults globally. Related to weight gain and the accumulation of excess fat in the liver and pancreas, type 2 diabetes can be a devastating disease resulting in reduced longevity. Despite multiple guidelines and programs being in place which focus on drug treatment plans aimed to reduce blood glucose and associated risks of cardiovascular disease, the life expectancy remains substantially low. Weight management, which includes changes to diet and lifestyle, is often included as part of these programs. There have been few studies, however, to examine whether significant weight loss could result in complete remission from type 2 diabetes.
Can Weight Loss Lead to Remission?
Previous pathophysiological studies have shown that it is possible for type 2 diabetes patients to return to normal glucose control through calorie restriction. However, these studies have only shown blood glucose normalisation in type 2 diabetes patients who achieved a weight loss of between 10–15 kg over a short period (two to six months). With one in ten adults in the United Kingdom (UK) diagnosed with type 2 diabetes, UK researchers are now looking at whether the delivery of effective weight management programs in primary care settings over a sustained period (more than one year) could result in patients going into remission as a primary outcome.
They conducted a cluster-randomised trial in 49 primary care practices across parts of the UK. The practices were randomly assigned either a weight management program as the intervention or best-practice care by recommended guidelines (from the National Institute of Health and Care Excellence in England and the Scottish Intercollegiate Guidelines Network in Scotland) as the control. The 306 participants included in the trial were between 20-65 years of age, had been diagnosed within the previous six years with type 2 diabetes, were not receiving insulin, and had a body mass index (BMI) of 27–45 kg/m2.
The participants in the weight management program stopped taking their antidiabetic (help to control blood glucose levels) and antihypertensive (which treat high blood pressure) medications on day one. This was followed by a complete diet replacement for three months and then a structured reintroduction of certain foods over the next two to eight weeks. The participants also received support to help maintain weight loss long-term, as the aim was to help these type 2 diabetes patients to achieve and maintain weight loss of at least 15 kg. The results of this study, named the DiRECT trial, were recently published in the journal, The Lancet.
Weight Loss Led to Remission in Many Patients
After 12 months, 24% of the patients in the intervention group lost 15 kg or more and none in the control group. Furthermore, in the intervention group, 46% of participants went into diabetes remission compared to only six in the control group. When looking at the whole study population, remission varied with weight loss. For example, none of the participants who gained weight went into remission but 86% of participants who lost 15 kg or more did go into remission. The researchers also noted that the quality of life for the participants in the weight management intervention program increased, while it decreased for those in the control group.
This program helped almost half of the intervention group participants to revert back to a non-diabetic state. They were also able to stop anti-diabetic medications at 12 months and 68% of the participants also stopped taking antihypertensive medications without a rise in their blood pressure. Therefore, this study shows an intensive weight management intervention program conducted in real-life settings and supported by primary care facilities has the potential to help type 2 diabetes patients go into remission.
Follow-up of these participants will continue for the next four years to determine the long-term outcomes. Further studies into optimal weight management programs would help support these results. However, given the results of this study, the inclusion of weight management programs for the routine care of type 2 diabetes patients should be considered for those wanting to achieve diabetes remission.
Written by Lacey Hizartzidis, PhD
Reference: Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C, Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, Rodrigues AM, Rehackova L, Adamson AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Stefanetti R, Trenell M, Welsh P, Kean S, Ford I, McConnachie A, Sattar N, Taylor R. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2017 Dec 4. pii: S0140-6736(17)33102-1. doi: 10.1016/S0140-6736(17)33102-1.