Rapid Weight Loss Keeps Promise of T2D Remission for 2 Years

LIVERPOOL — Type 2 diabetes patients who achieve rapid weight loss with a calorie-restricted liquid diet followed by gradual food reintroduction and a weight loss maintenance programme can reach and remain in remission at two years, the results of a UK study reveal.

The findings, from almost 300 patients enrolled in the Diabetes Remission Clinical Trial (DiRECT), show that giving a commercial formula (the Cambridge Weight Plan) followed by dedicated weight loss maintenance allowed 36% of patients to attain remission of their diabetes and sustain it for 24 months.

The results were given over three presentations during a session at the Diabetes UK Professional Conference dedicated to DiRECT, and published simultaneously online by The Lancet Diabetes & Endocrinology.

Remission Results

These results follow 1-year data published by The Lancet in 2017, which indicated that programme achieved type 2 diabetes remission in 46% of patients.

At both time points, the number of patients in the standard-care control arm who achieved remission was negligible.

The 2-year data also show that the degree of weight loss was important, with 64% of patents who lost at least 10kg over the study period in remission at the end of follow-up.

In addition, 70% of those who were in remission at 1 year remained so by 2 years.

Importantly, the weight loss intervention was associated with large falls in the proportion of patients taking diabetes medications, as well as reductions in HbA1c and triglycerides.

Quality of life improved with the intervention over control patients and, as the study went on, the intervention arm recorded fewer serious adverse events, suggesting an accrual of benefits over time.

Not ‘An Inevitably Progressive Disease’

Co-lead researcher Prof Roy Taylor, professor of medicine and metabolism, Newcastle University, Newcastle upon Tyne, commented in a news release that the results “finally pull down the curtain on the era of type 2 diabetes as an inevitably progressive disease”.

He said: “We now understand the biological nature of this reversible condition. However, everyone in remission needs to know that evidence to date tells us that your type 2 diabetes will return if you regain weight.”

Prof Mike Lean, chair of human nutrition, University of Glasgow, who co-led the study, said that “proving” that more than two-thirds of patients who lose more than 10kg can be put into type 2 diabetes remission “is incredibly exciting”.

He added: “People with type 2 diabetes and healthcare professionals have told us their top research priority is ‘can the condition be reversed or cured?’.”

“We can now say, with respect to reversal, that yes it can. Now we must focus on helping people maintain their weight loss and stay in remission for life.”

‘Exciting times’

Speaking to Medscape News UK, Prof Taylor agreed that these are “exciting times” for diabetes management.

He said that, while “the biology is clear” on how “removing fat allows the body to wake up” and achieve type 2 diabetes remission, “the human aspect needs to be considered”.