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December 2017

Weight management programme can put type 2 diabetes into remission

Type 2 diabetes can be reversed following an intensive weight management programme, according a randomised trial in adults who have had the condition for up to 6 years, published in The Lancet.

The study showed that after 1 year, participants had lost an average of 10kg, 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 6 years, putting the disease into remission is feasible’, says 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.’

Type 2 diabetes affects almost 1 in 10 adults in the UK and costs the NHS around £14 billion a year.

‘Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diabetes remission by cutting calories is rarely discussed’, explains Professor Roy Taylor from Newcastle University, UK, who co-led the study.

The Diabetes Remission Clinical Trial (DiRECT), included 298 adults aged 20–65 years who had been diagnosed with type 2 diabetes in the past 6 years from 49 primary care practices across Scotland and the Tyneside region of England between July 2014 and August 2016. Practices were randomly assigned to provide either the Counterweight-plus weight management programme delivered by practice dieticians or nurses (149 individuals) or best practice care under current guidelines.

The weight management programme began with a diet replacement phase, consisting of a low calorie formula diet (825–853 calories/day for 3 to 5 months), followed by stepped food reintroduction (2–8 weeks), and ongoing support for weight loss maintenance including cognitive behavioural therapy combined with strategies to increase physical activity.

Antidiabetic and blood pressure-lowering drugs were all stopped at the start of the programme.

Remission was defined as achievement of an HbA1c level of less than 48mmol/mol at 12 months, off all medications.

On average, participants in the weight management group lost 10kg compared to 1kg in the control group. Importantly, the results showed that remission was closely linked with the degree of weight loss and occurred in around 9 out of 10 people who lost 15 kg or more, and nearly three quarters (47/64) of those who lost 10kg or more.

The researchers also noted an improvement in average triglyceride concentrations in the weight management group, and almost half remained off all antihypertensive drugs with no rise in blood pressure.

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 programme are achievable for many people. The big challenge is long-term avoidance of weight re-gain. Follow-up of DiRECT will continue for 4 years and reveal whether weight loss and remission is achievable in the long-term.’