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Weight Loss Can Put Type 2 Diabetes in Remission

Weight loss can put type 2 diabetes into remission for at least 5 years, according to results of a new study.

The Diabetes Remission Clinical Trial (DiRECT) was the first study to show it was possible to put type 2 diabetes into remission through diet-induced weight loss in a primary care setting. Findings from the 3-year extension of the DiRECT study indicated that it is possible to maintain significant weight loss and keep type 2 diabetes in remission for at least 5 years. The study's findings are to be presented at the Diabetes UK Professional Conference in Liverpool next week.

The study found that almost 1 in 4 (23%) participants who were in remission after 2 years remained in remission at 5 years, maintaining an average weight loss of 8.9 kg.

Professor Mike Lean, from the University of Glasgow and co-lead of the latest study, said: "Type 2 diabetes causes a range of progressive and life-shortening complications, notably blindness, infections, amputations, kidney failure, and heart failure. It affects over four million people in UK and accounts for about 10% of NHS funding."

Last week, Diabetes UK said that the UK was gripped by a "rapidly escalating diabetes crisis" as new analysis estimated the number of people living with the condition had topped five million for the first time.

Longer-Term Benefits of Weight Management

The DiRECT weight management programme, for people with a diagnosis of type 2 diabetes within the previous 6 years, involved a 12-week low-calorie formula diet, followed by support to reintroduce healthy food gradually and maintain weight loss. The trial reported almost 1 in 2 (46%) people in remission at 1 year, and over 1 in 3 (36%) at 2 years.

A spokesperson for Diabetes UK explained that a person with type 2 diabetes was in remission if they had an HbA1c level below 6.5% (48 mmol/mol) for a least 3 months, and they had not taken any medications to manage their blood glucose levels during this time.

The original DiRECT study ran for 2 years. To understand the longer-term benefits of the programme, the extension study enrolled the 95 intervention group participants from the original study (48 of whom were in remission at the start of the extension) and provided support to help maintain their weight loss over the next 3 years. Participants received nurse or dietitian appointments at their GP surgery every 3 months to review their weight, blood sugar levels, and blood pressure, and were offered advice and support to maintain their weight loss.

Participants who regained over 2 kg during years 3-5 were offered an additional package of support, available once each year, consisting of the low-calorie 'soups and shakes' diet for 4 weeks, followed by support while reintroducing normal meals.

Control participants did not receive the 3-monthly appointments, or additional 'soups and shakes' packages during the extension period.

Almost One Quarter of Participants in Remission After 2 Years

The study found that almost 1 in 4 (23%) participants who were in remission after 2 years remained in remission at 5 years, maintaining an average weight loss of 8.9 kg. The research also revealed that the proportion of participants in remission after 5 years was more than three times that of the DiRECT control group, who did not take part in the original low-calorie diet programme or receive continued low-intensity weight management support in the extension trial.

Specifically, 3.4% of the original DiRECT control group who provided data were in remission at 5 years, compared with 12% of participants of the original intervention group, said the authors.

"Overall, the low-intensity support offered in the DiRECT extension to the original DiRECT intervention group led to significant average weight loss maintenance of 6.1 kg at 5 years, and sustained improvements to blood sugar levels and blood pressure," trumpeted the authors.

The number of 'serious adverse events' (resulting in hospital admission) in the intervention group was less than half that in the control group, the authors said.

Next Steps

"The DiRECT Extension has shown us that a substantial proportion of people, managed in primary care, can maintain sufficient weight loss to be free from the condition for up to 5 years," said Professor Lean. "The weight management intervention also reduced blood pressure and the need for antihypertensive drugs."

Professor Roy Taylor, from Newcastle University and co-leader of the study, added that the "most important question now is how the follow-up programme can be even more successful at an affordable cost".

Professor Lean said that, although the findings were important both for individuals and for national considerations of healthcare costs, and that the programme used in DiRECT was a huge improvement on previous management of type 2 diabetes, "future studies must seek even better ways to help maintain weight loss".

Mr Askew reassured that "with the right care and support, cases of type 2 diabetes can be prevented or put into remission".

The NHS low-calorie diet programme had granted many more people with type 2 diabetes the opportunity to put the condition into remission, highlighted Dr Elizabeth Robertson, director of research at Diabetes UK. "We now need to understand how best to support more people to maintain weight loss and stay in remission in the long term."

Funding for the study was provided by Diabetes UK.