The Diabetes Remission Clinical Trial (DiRECT) – backed by an unprecedented £2.4m (€3.13m) grant from charity Diabetes UK – sought to test if a very low calorie diet could reverse type 2 diabetes mellitus and return glucose control to normal.
In these first results a continuing remission of at least six months was seen in 40% of the participants who followed the eight-week weight loss programme – questioning the widely held belief that type 2 diabetes is an irreversible chronic condition.
Co-author and professor of medicine and metabolism at Newcastle University, Roy Taylor, told us the data clearly shows when total body fat is decreased, people can store this fat safely under the skin and diabetes goes away.
This stays in safe storage with normal glucose control provided weight does not increase again, he said.
“T2DM [type 2 diabetes mellitus] can now be understood to be a metabolic syndrome potentially reversible by substantial weight loss, and this is an important paradigm shift,” wrote the researchers from the Newcastle University and University of Glasgow in the UK and Lagos State University in Nigeria.
The participants were given Nestlé‘s OPTIFAST liquid diet formula product to be taken three times a day for eight weeks, which contained 43% carbohydrate, 34% protein and 19.5% fat amounting to 624 kcal per day before returning to a normal isocaloric diet.
All oral drugs and insulins were stopped at the beginning of the trial.
Twelve of the 30 participants achieved fasting plasma glucose of less than seven millimoles (mmol) per litre after returning to the isocaloric diet and 13 of the 30 after six months.
Average baseline weight fell from 98 kg to 83.8 kg during the diet period and remained at 84.7 kg after six months.
Professor Taylor said the next milestone for the trail would be to see what proportion of people with type 2 diabetes would want to take up this treatment option, and whether the diet sees longer term benefits.
“Not all people with T2DM will be willing to make the changes necessary, but for those who do, metabolic health may be regained and sustained in just under one-half. The observations carry profound implications for the health of individuals and for the economics of future health care,” the researchers wrote in the American Diabetes Association journal Diabetes Care.
Epidemic proportions
They said the findings were significant at a time when diabetes had reached “epidemic proportions”.
Diabetes was chosen by the World Health Organisation (WHO) as the theme of 2016’s World Health Day, which took place yesterday.
In a report released this week the WHO called for greater action from all stakeholders to halt the rise of the condition – adult rates of which had almost quadrupled since 1980 to reach 422 million.
Currently the UK’s National Health Service (NHS) spends about £75m (€97.93m) a year on drugs alone to help regulate the blood glucose levels of people with type-2 diabetes, not to mention the cost of invasive and potentially risky surgical operations such as gastric banding and bypasses to help patients lose weight rapidly.
Meanwhile about 9.2% of the US population is affected by the condition, costing the country an estimated $322bn (€283.31bn) in 2012 alone.
The personal cost is also enormous as the condition can mean visual loss, amputation and premature cardiovascular disease.
Source: Diabetes Care
April 2016, 39 (4), DOI: 10.2337/dc15-1942
“Very-Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiologic Changes in Responders and Nonresponders”
Authors: S. Steven, K. G. Hollingsworth, A. Al-Mrabeh, L. Avery, B. Aribisala, M. Caslake and R. Taylor