University of Glasgow researchers have revealed that people who use diet and nutrition to help manage their weight can keep themselves in remission from type 2 diabetes for five years or more.

The researchers say the study, published in the Lancet Diabetes and Endocrinology journal, is the first to show that remission from type 2 diabetes is possible through a primary care weight management intervention.

These new findings come as part of a three-year extension to the landmark Diabetes Remission Clinical Trial (DiRECT) for people living in remission of type 2 diabetes.

Researchers say the results demonstrate the role of diet and weight management in minimising the risk of type 2 diabetes over a period of several years, highlighting the ‘critical need’ for more investment in diet-based therapies.

For those in remission from type 2 diabetes at the end of the second year of the original study, 26% were found to remain in remission at year five.

The five-year results also found wider health benefits from the diet intervention, with participants experiencing fewer illnesses than the DiRECT control group.

Overall, the remission rate was around 13% at five years, with the number of serious medical events needing hospitalisation halved among those who received the diet intervention.

Professor Mike Lean, who co-designed the original DiRECT trial and is senior author of the latest DiRECT-Extension study, says the reducing unhealthy fat accumulation around vital organs is key:

“Previously considered permanent, requiring life-long drug treatment, type 2 diabetes is now recognised to be a potentially reversible consequence of excessive or abnormal accumulation of body fat.

“When fat accumulates in vital organs, like liver, pancreas or heart, these organs stop functioning normally. Weight loss of 10-15kg is enough to remove that abnormal fat from vital organs, and the key to any type 2 remission.

“The disease is not necessarily permanent, and the 5-year results now suggest that diet treatment for weight loss to achieve a period of remission is likely to be accompanied by greater freedom from some diabetes complications and fewer people being admitted to hospital with medical problems.”

The longer study participants were able to maintain lower weight and remission of their type 2 diabetes, the less likely they were to suffer diabetes-related medical complications.

However, the team says research is particularly needed to help people maintain the longer-term weight losses required to achieve remission and other health benefits.

Funded by Diabetes UK, the DiRECT trial found that diet interventions can effectively lower blood pressure, reducing the need for anti-hypertensive medications.

DiRECT included a twelve week, 830-calorie formula diet plan to induce weight loss, followed by support to gradually reintroduce healthy meals from ordinary foods and maintain weight loss while increasing calories.

Primary care support

Continued low-intensity dietary support offered up to five years for 95 people who remained in this extended DiRECT trial from the original two year study.

Over three years, participants received GP appointments every three months to review blood sugar levels and blood pressure and offer advice and support to maintain their weight loss.

Almost half (46%) of people involved in the dietary intervention programme were in remission at one year, and 36% remained in remission at two years.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, says the charity is proud to have funded research that “put remission on the map”, adding:

“Remission from type 2 diabetes lifts the burden of 24/7 diabetes-management and can transform health and wellbeing. But we know that going into remission can be challenging and staying there even more so.

“That’s why we’ve just launched our new remission information and support hub and are continuing to fund research to understand how to help more people go into remission and stay there for longer.”

While not designed to explore factors behind maintenance in detail, DiRECT found that participants in the extension group said employment and social-related stress impacted their ability to maintain the weight loss.

While those in the extension group lost an average of 6.1kg, those who maintained remission achieved an average weight loss of 8.9kg at five years.

However, there was ‘notable weight regain’ in some participants, underscoring the difficulty that maintaining weight loss poses.

Participants were advised to regularly increase physical activity but demonstrated no net increase and physical activity was not linked to weight change in the first two years.

Professor Lean says long-term funding is needed for research including to establish the best ways to support people to overcome the factors driving weight regain:

“We must now call for much more effective, long-term funding for research to improve on these results – especially to prevent weight regain.

“However, the evidence means that we should no longer merely reduce high blood sugar with medication, but to try to check the underlying disease-process with effective weight management as a priority when type 2 diabetes is diagnosed.

“Previous research has shown that people who have type 2 diabetes but who are not overweight have excess or anormal body fat, and may be able to achieve remission with quite modest weight loss.

“New drugs being developed for type 2 diabetes and obesity are exciting, but they should not be prescribed without sound dietary weight-management.”

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