Losing weight can put Type 2 diabetes in remission for at least five years, new data suggests.
Figures from the Diabetes Remission Clinical Trial (Direct) show that about a quarter of people in remission from diabetes two years after starting a low-calorie diet were still in remission three years later.
These people no longer needed to take medication to manage their blood-sugar levels and had an average weight loss of about 9kg at the five-year point.
Roy Taylor, professor of Medicine and Metabolism at Newcastle University, told The National that the 2011 Counterpoint study demonstrated that weight loss has the potential to reverse the processes responsible for Type 2 diabetes by removing fat from the liver and pancreas. He added: "Removing fat from the liver causes a rapid return to normal of the insulin sensitivity of the liver (absolutely no effect on muscle insulin sensitivity).
"That allows insulin to control overnight blood sugar normally. Removing the delivery of excess fat to the pancreas very gradually allows recovery of insulin response to eating," Prof Taylor said.
The data suggests that losing weight and keeping it off can help to reverse diabetes, a serious condition that increases the risk of heart disease, stroke, high blood pressure, narrowing of blood vessels and nerve damage.
Obesity is a major driver of Type 2 diabetes, with research suggesting that obese people are up to 80 times more likely to develop the condition than those with a healthy body mass index (BMI) of less than 22.
Of the 298 people who took part in the original Direct study, half received standard diabetes care from their GP and half were put on a diet with support from health professionals.
This included a low-calorie, nutrient-complete soup and shake diet (about 800 calories a day) for between 12 and 20 weeks, together with support from a nurse or dietician to reintroduce healthy foods and maintain weight loss.
"The low-calorie diet achieves the necessary 30-pound weight loss in 12 weeks. Thereafter, people merely need to eat normally – but less than they habitually did before," Prof Taylor told The National.
Medications for Type 2 diabetes and blood pressure were stopped at the beginning of the programme and reintroduced as necessary.
"In our second study [Counterbalance], we showed that remission was more likely with a few years duration of diabetes. Beyond eight years, the rate of remission was only 50 per cent and was rare after 15 years," Prof Taylor told The National.
At the end of the original two-year study, 95 of the 149 people on the weight-loss programme agreed to take part in an extension study lasting three years.
This new data shows that of this group of 95 people, 48 were in remission at the start of the extension study, and 23 per cent of these were still in remission three years later.
The proportion of people in remission five years after the original study started was more than three times that of the Direct control group, who received only the usual GP care.
Remission was closely linked to weight loss and keeping the pounds off. Researchers said those people who came out of remission had regained the weight they had lost.
Anyone who regained more than 2kg during years three to five of the study were offered an additional package of support, available once a year, consisting of the low-calorie soups and shake diet for four weeks, followed by help while reintroducing normal meals.
Compared with the control group, those put on a diet and offered support had bigger improvements in blood pressure and blood-sugar levels and fewer people needed medication.
The number of serious health issues resulting in hospital admission in the dieting group was also less than half that in the control group.
Diabetes UK, which funded the study, said the findings support growing evidence that weight loss and remission from Type 2 diabetes can prevent or delay the complications of diabetes.
“Type 2 diabetes causes a range of progressive and life-shortening complications, notably blindness, infections, amputations, kidney failure and heart failure," said Prof Mike Lean of the University of Glasgow, who co-led the study.
“It affects over four million people in UK and accounts for about 10 per cent of NHS funding.
“The Direct extension [study] 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 five years.”
