Study suggests type 2 diabetes is “reversible” with weight loss

Type 2 diabetes could be a “reversible condition”, researchers have suggested, after a study found a third (36%) of people with type 2 diabetes who took part in a weight management programme are in remission two years later.

The latest results of the Diabetes Remission Clinical Trial (DiRECT) show that remission is closely linked to weight loss, with those who lose more weight more likely to see their type 2 diabetes recede; 64% of those who lost 10kg or more were still in remission after two years following the weight loss trial.

Those in remission after one year who stayed in remission until the two-year mark had a greater average weight loss (15.5kg) than those who did not stay in remission (12kg).

The results of the study, led by University of Glasgow and Newcastle University academics and funded by charity Diabetes UK, suggests that weight loss can lead to reduced levels of fat inside the pancreas, which in turn is associated with the recovery of pancreas function and insulin production.

Participants were considered “in remission” if their long-term blood glucose levels were recorded at less than 48mmol/mol (6.5%) without needing to use any type 2 diabetes medication. The proportion of participants using diabetes medication dropped from 75% at the beginning of the trial to 40%.

Professor Roy Taylor, director of Newcastle University’s Magnetic Resonance Centre and co-primary investigator of the DiRECT trial, said: “These results are a significant development, and finally pull down the curtain on the era of type 2 diabetes as an inevitably progressive disease.

“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.

“Even during the second year of freedom from type 2 diabetes there was a highly suggestive difference in major complications of diabetes. The numbers are still small at the moment, and further information on this must be gathered during the planned longer term follow up.”

The trial was delivered in NHS primary care. Last year, NHS England said it would scale up its Diabetes Prevention Programme and prescribe more patients with the low calorie drinks used in the DiRECT trial.

“If allowed to progress, type 2 diabetes becomes devastating,” said Professor Mike Lean, head of human nutrition at Glasgow University and co-primary investigator of the trial. “Our work has also shown that this weight management programme is relatively inexpensive when compared to the long-term management of type 2 diabetes, and this provides a compelling case for shifting resources to offer remission-based care.”