This site is intended for health professionals only

Type 2 diabetes remission a 'practical target for primary care'

Type 2 diabetes remission is a ‘practical target for primary care’, the lead researchers of a ground breaking study have concluded, after finding that the condition can be reversed with a weight management programme.

The Diabetes Remission Clinical Trial (DiRECT), funded by Diabetes UK and published today in the Lancet, found that after 12 months almost half of participants had achieved remission to a non-diabetic state on an intensive calorie controlled programme that did not involve prescribing or increasing antidiabetes medication.

This compares to just 4% who achieved remission in the group that continued with guidance-recommended medication.

Between 2014 and 2016, GP practices across Scotland and Tyneside recruited 298 adults aged 20-65 years who had been diagnosed with type 2 diabetes in the past six years. Practices were randomly assigned to provide either the weight management programme delivered by practice dietitians or nurses, or standard best practice GP care under current guidelines.

Almost a quarter of the 149 patients in the weight management group achieved weight loss of 15kg or more at 12 months, sufficient to achieve remission of diabetes in 90% of those cases - defined as a HbA1c <48mmol/mol after two months without antidiabetes medication. Additionally, half maintained more than 10kg of weight loss - 75% of whom achieved remission.

The weight loss programme included a low calorie (825-853 calories per day), nutrient-complete diet for 3-5 months, followed by food reintroduction, an increase in physical activity and long-term support to maintain weight loss. All antidiabetes drugs were stopped on the first day of the programme.

Professor Roy Taylor, professor of medicine and metabolism at Newcastle University, who co-led the study, said: 'Management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments rather than addressing the root cause. Diet and lifestyle are touched upon but diabetes remission by cutting calories is rarely discussed.

‘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 food reintroduction phase and beyond increased daily activity is important.’

Professor Michael Lean, study co-lead and consultant physician and chair of human nutrition at the University of Glasgow, added: ‘Follow up of this group to establish longer-term outcomes will continue to at least four years.

‘But our results should pave the way for this type of intervention to be considered in the routine care of patients with type 2 diabetes who wish to attain diabetes remission.’

Lancet 2017, online 5 Dec