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GPs go forth

GP-based weight loss programme leads to diabetes remission for third of patients

Primary care-based weight loss programmes may lead to sustained remission for patients with type 2 diabetes, a study has found.

More than a third of patients who took part in a weight loss programme delivered at their GP surgery are in remission from type 2 diabetes two years later, according to the research, funded by charity Diabetes UK.

The DiRECT study, carried out by researchers at the universities of Newcastle and Glasgow, looked at just under 300 patients from UK general practices with type 2 diabetes.

Half of the patients were assigned to a weight loss programme, delivered by a practice nurse or dietician, which included three to five months on a calorie-controlled total diet replacement drink, six to eight weeks of food reintroduction and then monthly appointments with the nurse or dietician for two years. They also had their diabetes and antihypertensive medications stopped during the intervention.

The other half of the patients received usual care from their GP surgery.

After two years 36% of patients on the weight loss programme were in remission from type 2 diabetes, compared with just 3% of those in the control group. Those who received the weight-loss intervention also had significant reductions in HbA1c and blood pressure levels compared with the controls.

The researchers noted 70% of patients who maintained a weight loss of over 15kg were in remission after two years - and that those who reverted to diabetes regained more weight during the follow-up period than those who achieved remission.

The paper authors said: ‘The two-year results… confirm that type 2 diabetes is potentially reversible by weight loss in many cases.

'A structured primary care-based weight management programme within six years of diagnosis can sustain remission to a non-diabetic state, off anti-diabetes drugs, for more than a third of people with type 2 diabetes, with sustained remission linked to the extent of sustained weight loss.’

These findings come after NHS England anounced in November that it would be launching a pilot that would see up to 5,000 diabetes patients trialling a calorie-controlled liquid diet to see if it helped them to achieve remission.

NHS England’s announcement came after initial results from the first year of the DiRECT study were published, showing that almost half of patients were able to achieve remission on the weight loss programme. 

GPs warned at the time that while the results were ‘encouraging’ in a clinical setting, they may not be replicated when patients are ‘less motivated’ to maintain the very low calorie diet.

Readers' comments (4)

  • David Banner

    It’s been known for many decades that significant weight loss, exercise and dietary change will put T2DM into remission, and trial after trial using extreme calorie control proves this. The problem is Real World experience, when any initial weight loss is rapidly reversed with a plethora of excuses and a return to former bad habits.
    If these low calorie drinks are bought by patients then fair enough as they are cost neutral (they don’t have to buy food). But if they are put on free prescription then patients will rush to demand them, fail to maintain lifestyle change and still end up on expensive medications. It would be an appalling waste of scarce resources.

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  • Was this not reported extensively last year?
    Is this a slow news day??

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  • Dear All,
    No not a slow story, an old and obvious story. Loose weight and your diabetic potential decreases. Oh and by the way this "remission" is actually just a deferral. Unless the pressure is kept up they will still be diabetic one day, just that that day is slightly delayed.
    Its the same as nothing ever "saves lives". All anything can ever do is "defer death".
    Think on.
    Paul C

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  • Reply to Paul Cundy.
    Exactly right, I wince every time the politicians or media suggest that MI/CVAs are going to be prevented and that cancers will be eradicated. All are simply postponed as you say. Unfortunately the misleading statements lead to ever more unrealistic expectations.

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