Remission of Type 2 Diabetes?

Sadly, I missed the Diabetes UK conference this year, despite the fact it was held in a city so close to me. It looks, from all the tweets and press, that this was a big year for the role of Nutrition and Dietary interventions for the prevention and management of Type 2 Diabetes particularly.

We have known about the DiRECT, (Diabetes Remission Clinical Trial), for some time now but the conference this week saw the launch of the 2 year follow up results.

The DiRECT trial, tested remission from Type 2 diabetes during a weight management programme. The intervention program was delivered in local areas by a Dietitian and Nurse and was a very low-calorie diet (around 800-850 Kcals/day) made up of a meal replacement drink. This was followed for 3-5 months and then a healthy balanced diet was gradually reintroduced (6-8 weeks) with structured support for weight loss. The main kick here is that the participants had a lot of support and were even offered 30 minute follow up and support appointments monthly over two years using tailored workbooks. Additionally, if they were at risk of gaining weight, (over 2 Kg), they were offered a rescue plan whereby they returned to a partial meal replacement schedule for a few weeks to get them back on track. Exercise was advised alongside the program and antidiabetic drugs were withdrawn from day one to test effectiveness.

Results from the first year showed that it’s possible for some people to put their Type 2 diabetes into remission using a low-calorie, diet-based, weight management programme.

At one year 46% of intervention participants were in remission with 86% remission for people who lost 15kg or more.

So, achieving and maintaining weight loss looks to be a dominant factor behind remission of type diabetes; (in people who have had Type 2 Diabetes for 6 years or less)

Things were looking good. But, as ever, these trials do need to be looked at for the long term. The beauty of the DiRECT trial is that it is one of the few studies to think long term. In fact, it’s still going. So, this week, the findings were presented for the two year mark.

The second-year results of the trial showed that, at two years 36% of intervention participants were in remission with 70% remission for people who maintained a weight loss of 15kg.

Great news, but we do need to consider that the two year study also showed that weight regain, even in small amounts, took people out of remission and back into Type 2 Diabetes.

So what are my take-aways on this?

We can use the term remission in Type 2 Diabetes!
It definitely looks like focussing on weight loss , when relevant, should be first line in Type 2 Diabetes management, and can indeed put people into remission if they maintain their weight loss.
It is extremely positive that GPs were reported to have changed their practice in a recent survey saying that they now provide lifestyle and weight loss intervention advice much earlier on.
Participants in this study had a hell of a lot of support that may not usually be to the level that can be offered in NHS practices
Re-gain of weight knocked people back into Type 2 Diabetes
We need to focus on weight loss maintenance and looking at long term studies around weight loss as whole.
The most important factor was weight loss. With weight loss, different methods suit different people so programs can be tailored. You don't have to use a liquid diet as long as you get results