Losing weight can reverse type 2 diabetes

An intensive weight management program can reverse Type 2 diabetes, according a randomised trial in adults who have had the condition for up to six years.

Published in The Lancet, the study showed that after one year, participants had lost an average of 10 kg, and nearly half had reverted to a non-diabetic state without using any diabetes treatment. The findings lend support to the widespread use of this type of intervention in the routine care of type 2 diabetes across health services.

“Our findings suggest that even if you have had type 2 diabetes for six years, putting the disease into remission is feasible,” said Professor Michael Lean from the University of Glasgow, who co-led the study. “In contrast to other approaches, we focus on the need for long-term maintenance of weight loss through diet and exercise and encourage flexibility to optimise individual results.”

Worldwide, the number of people with type 2 diabetes has quadrupled over 35 years, rising from 108 million in 1980 to 422 million in 2014. This is expected to climb to 642 million by 2040. This increase has been linked to rising levels of obesity and the accumulation of intra-abdominal fat.

“Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon but diabetes remission by cutting calories is rarely discussed,” explained Professor Roy Taylor from Newcastle University, UK, who co-led the study.

“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 long-term follow-up increased daily activity is important. Bariatric surgery can achieve remission of diabetes in about three-quarters of people, but it is more expensive and risky, and is only available to a small number of patients.”

Previous research by the same team confirmed the Twin Cycle Hypothesis, that type 2 diabetes is caused by excess fat within the liver and pancreas, and established that people with the disease can be returned to normal glucose control by consuming a very low-calorie diet. But whether this type of intensive weight management is practicable and can achieve remission of type 2 diabetes in routine primary care was not known until now.

On average, participants in the weight management group shed 10 kg of body weight compared to 1 kg in the control group. Importantly, the results showed that remission was closely linked with the degree of weight loss and occurred in around nine out of 10 people who lost 15 kg or more, and nearly three-quarters of those who lost 10 kg or more.

The researchers also noted an improvement in average triglyceride (blood lipid) concentrations in the weight management group, and almost half remained off all antihypertensive drugs with no rise in blood pressure. Furthermore, the weight management group reported substantially improved quality of life at 12 months, with a slight decrease reported in the control group.

Overall, one person experienced serious adverse events possibly related to the treatment (biliary colic and abdominal pain) but continued in the study. Some participants experienced constipation, headache and dizziness.

The authors note that the vast majority of participants were white and British, meaning that the findings may not apply to other ethnic and racial groups such as south Asians, who tend to develop diabetes with less weight gain.

According to Professor Taylor: “Our findings suggest that the very large weight losses targeted by bariatric surgery are not essential to reverse the underlying processes which cause type 2 diabetes. The weight loss goals provided by this program are achievable for many people. The big challenge is long-term avoidance of weight regain. Follow-up of DiRECT will continue for four years and reveal whether weight loss and remission is achievable in the long term.”

Image credit: ©stock.adobe.com/au/Piotr Marcinski