Type 2 Diabetes Now "A Reversible Condition"

I've had it for over 20 years, still on low dose tablets

Type 2 Diabetes Now "A Reversible Condition"

Dr Sheena Meredith | 05 March 2024

Type 2 diabetes (T2D) can now be regarded as a curable/reversible condition, according to the lead researcher for the major UK trial of weight management intervention for the condition.

Michael Lean, professor of human nutrition at the University of Glasgow, told Medscape News UK that T2D was reversible for more than 80% of people if they were "willing and able to take it seriously and lose over 15 kg".

Most people in the US and Europe will remain very overweight even after losing that much, he added. However, people with T2D and a body mass index (BMI) of 23 to 27 don't need to lose as much: 8-10 kg may be enough to induce remission.

The conclusions come from results of the extension of the DiRECT trial of weight loss intervention, published in The Lancet. They suggest continuing benefit of weight loss for as much as 5 years with extended support, including further weight loss and remission of diabetes.

The original trial of weight management intervention showed that, following the first year of a primary care led weight management programme, almost a quarter (24%) of 149 intervention participants had achieved at least 15 kg weight loss, and almost half (46%) were in remission. At 24 months, 11% of intervention participants had weight loss of at least 15 kg compared with just 2% of the control group. Equivalent remission figures were 36% and 3%, respectively. Mean weight loss at 2 years was 7.6 kg.

The intervention involved:

Withdrawal of antidiabetic and antihypertensive drugs

A total diet replacement with a nutritionally-complete formula that provided 825-853 kcal per day for 12 weeks

Stepped food reintroduction over 6-8 weeks

Structured support for weight loss maintenance

Benefits of Extended Support Continue to 5 Years

The extension of the trial has now carried results out to 5 years from baseline. Intervention participants were offered 3-monthly nurse or dietitian review appointments at their GP surgery, with advice and support to maintain their weight loss, and an additional package of support for those who regained weight.

At 5 years, DiRECT extension participants had lost an average of 6.1 kg, and 13% were in remission. Extension participants had more visits with HbA1c <48 mmol/mol (<6.5%; 36% vs 17%, P = .0004), without glucose-lowering medication (62% vs 30%, P < .0001), and were in remission (34% vs 12%, P < .0001) compared with the non-extension group.

The team concluded: "The extended DiRECT intervention was associated with greater aggregated and absolute weight loss, and suggested improved health status over 5 years."

This supports diabetes being a reversible condition, they said, and the results have policy implications.

"The dominant and very substantial effect from weight loss of 10-15 kg or more to generate remission from T2D has now been amply demonstrated in several very different population groups," they said. However, "avoiding weight gain and regain after loss are major impediments to optimal clinical management".

T2D a Killing Disease

Lean said that the latest trial results should be incorporated into clinical management practice. "Type 2 diabetes is caused by abnormal fat accumulation in liver and pancreas. Doctors should be guiding or signposting patients to evidence-based weight management at diagnosis, not prescribing medications that lower blood sugar but leave the disease process progressing."

He added: "We can now be much more open about how awful T2D is. It is a killing disease. A silent killer, as it has few symptoms. It reduces lifespan by about 5-6 years on average, by more for younger people, and by up to 15 years for those aged under 40. That is worse than many very serious cancers."

Public messaging should emphasise that T2D can now be regarded as a curable/reversible condition, he said, and patients diagnosed with T2D should be urged to lose the weight as soon as possible after diagnosis. "Don't delay any more than you would delay cancer treatment."

Research Has Put Remission on the Map

The study was funded by Diabetes UK, whose director of research, Dr Elizabeth Robertson, told Medscape News UK that the charity was "proud to have funded over a decade of research that has forged new frontiers for people with type 2 diabetes". Recent studies have "put remission on the map", she said.

"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."

Diabetes UK has therefore launched a new remission information and support hub, including information for professionals to help them support their patients, and will continue to fund research "to understand how to help more people go into remission and stay there for longer".

Medscape

It comes down to losing weight, which you automatically do if you eat canned fish and root vegetables, Cauliflower and Broccoli, Potatoes, Carrots, etc and they help your blood sugars too - changed to basic vegetables a few weeks ago (cheap too), surprised myself today when my blood sugar readings were 5.1 where 8.0 is considered moving into Type 1 Diabetes and injections - not bad after over 20 years, Type 2 Diabetic now.

Only eat and drink non sugar meals, drinks, the stuff which is horrid, under normal before Diabetes, foods and drinks pleasures - I’m a couch potato, don’t exercise much, bullshit exercise helps Diabetes, not mine anyway - you are born with the body you got, accept it, live with it, enjoy it - it is your personality which people see and want to be around, not your body - I traveled from one side of our World to the other, to work that out, when I was 24 - a long time ago now - you think you got a wonky body - get in line, after mine.

I’m cutting back on my tablet medication (self medicating) and monitoring my sugar levels as I do that - my Diabetes Doctor tried to get me to be vaccinated, that did not happen and I sacked him when I found out his intentions, added to which, I don’t like him either - feelings mutual.

If Diabetes, you can seek my assistance here to help you manage yours - I’m NOT a doctor, but after “vaccines and their true purpose” I don’t trust the fuckers and won’t ever again.