Dietary evidence for diabetes reversal

By Rick Pendrous

- Last updated on GMT

Evidence grows on reversing type 2 diabetes by sustained weight loss
Evidence grows on reversing type 2 diabetes by sustained weight loss
Evidence has emerged and more is expected over the next few months to prove that dietary changes using low and very low energy diets in the initial stages of clinical interventions can be used to reverse type 2 diabetes and then sustain it in patients.

Research over a number of years has indicated that type 2 diabetes – often associated with obesity in people – can be reversed by dietary change. But, until now, it has not been clear whether that reversal could be sustained, according to Adrian Brown, a specialist weight management and bariatric dietician at Imperial College London.

However, the results of new research, including the Diabetes Remission Clinical Trial (DiRECT) funded by Diabetes UK – published yesterday (December 5) in The Lancet​ – suggested that dietary reversals of type 2 diabetes was possible using an initial formula-based low energy diet followed by permanent lifestyle change. The findings of this study indicate that reversal is sustainable for two years within primary care environments, said Brown.

Key to the Direct study is the target of achieving a 15kg reduction in weight in patients in the first 12 weeks of treatment using a very low energy diet and then devising methods of keeping that weight off, he added.

The Direct study was led by Professor Roy Taylor from Newcastle University and Professor Mike Lean from Glasgow University. They found that 45.6% of those who were put on a low calorie diet for three to five months were able to stop their type diabetes medications.

Prevent people from becoming diabetic

Separately, another multi-centre randomly controlled trial called PREVIEW – Prevention of diabetes through lifestyle intervention of population studies in Europe and around the world – is looking at the use of very low energy diets to prevent people from becoming diabetic in the first place. This is also expected to present its results soon, said Brown.

He added that the results of his own research, expected to be published in May 2018, will complement the two research studies mentioned.

Brown was speaking at a conference organised by the British Nutrition Foundation and Royal Society of Medicine (RSM) called ‘Starving for truth: nutrition myths and controversies’ held at the RSM in London on November 6.

If the results of the work described by Brown are confirmed, individuals might be able to come off medication used to control their type 2 diabetes, which is a metabolic disorder characterised by high blood sugar and insulin resistance and has serious associated medical risks.

‘I believe it is never too late’

“I firmly believe we should focus on weight loss and not just increasing pharmacotherapy,”​ said Brown. “It appears that 15kg weight loss is key, particularly for reducing fat within the liver and pancreas. And I believe it is never too late.”

However, for this ambition to be achieved, there “really needs to be a change in focus to weight management”,​ Brown stressed. “Intense lifestyle management is the cornerstone of this.”

Public health data had shown that diabetes in the UK had almost doubled in prevalence between 2004 and 2014, reported Brown.

The worrying thing from this data was a doubling of female diabetes prevalence in 16 to 34-year-olds – a huge issue. These are really the people we need to be targeting.”

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