Type 2 diabetes can be reversed following an intensive weight management programme, and remission is a ‘practical target for primary care practices’, the lead researchers of a ground breaking study have concluded.
The Diabetes Remission Clinical Trial (DiRECT), funded by Diabetes UK and published today in the Lancet, found that after 12 months almost half of participants had achieved remission to a non-diabetic state on an intensive calorie controlled programme without increasing diabetes medication.
Between 2014 and 2016, GP practices across Scotland and Tyneside recruited 298 adults aged 20–65 years who had been diagnosed with type 2 diabetes in the past six years. Practices were randomly assigned to provide either the weight management programme delivered by practice dietitians or nurses, or standard best practice GP care under current guidelines.
Almost a quarter of the 149 patients in the weight management group achieved weight loss of 15 kg or more at 12 months, sufficient to achieve remission of diabetes in 90% of cases – defined as HbA1c <48mmol/mol. Additionally, half maintained more than 10 kg loss – 75% of whom achieved remission.
The weight loss programme included a low calorie, nutrient-complete diet for 3-5 months, food reintroduction, increase in physical activity and long-term support to maintain weight loss.
Professor Roy Taylor from Newcastle University, who co-led the study, said: ‘Management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments rather than addressing the root cause. Diet and lifestyle are touched upon but diabetes remission by cutting calories is rarely discussed.
‘A major difference from other studies is that we advised a period of dietary weight loss with no increase in physical activity, but during the food reintroduction phase and beyond increased daily activity is important.’
Professor Michael Lean, fellow co-lead from the University of Glasgow, added: ‘Follow up of this group to establish longer-term outcomes will continue to at least four years.
‘But our results should pave the way for this type of intervention to be considered in the routine care of patients with type 2 diabetes who wish to attain diabetes remission.’
Dr Emily Burns, Diabetes UK acting head of research communications, said: ‘Thanks to ground-breaking research like DiRECT we’re beginning to change the conversation around Type 2 diabetes, and that’s a conversation that GPs can have with their patients as well. Evidence that Type 2 diabetes remission could be possible is building, but this research isn’t finished yet.
‘In the meantime, we need to stress to people with Type 2 diabetes the importance of speaking to their GP, and seeking their support, before trying any kind of low calorie diet.’
Dr Andrew Green, the BMA GP Committee’s prescribing lead, welcomed the results. He said: ‘Many GPs will be able to think of personal examples where a patient with type 2 diabetes gets hold of their lifestyle by the scruff of the neck and manages to reverse their disease, so it is pleasing to see that this may be practical on a larger scale.
‘There has been concern for some time that there has been too much emphasis on reducing HbA1c readings with medication and too little emphasis on addressing the causes of the metabolic disturbance in its own right.’
The study will continue following the cohort for a further four years.
The new NICE guideline focuses on diabetes prevention by incentivising GPs to refer patients to the NHS Diabetes Prevention Programme.