Weight loss puts type 2 diabetes in remission for two years

Author: Adrian O'Dowd
Weight loss puts type 2 diabetes in remission for two years

Around a third (36%) of people with type 2 diabetes who took part in a weight management programme delivered in primary care are in remission two years later, according to a study* published yesterday in The Lancet Diabetes & Endocrinology.

The second year results of the Diabetes Remission Clinical Trial (DiRECT), funded by Diabetes UK and led by experts at Newcastle University and University of Glasgow, were announced at the Diabetes UK’s Professional Conference being held in Liverpool this week.

DiRECT is a cluster-randomised, controlled trial done at primary care practices in the UK in which practices were randomly assigned to provide an integrated structured weight-management programme or best-practice care in accordance with guidelines.

Participants were aged 20–65 years, with less than six years' duration of type 2 diabetes and not receiving insulin between July 2014 and August 2016.

The new results build on the globally-reported findings presented at the International Diabetes Federation in December 2017, which showed that 46% of participants were in remission after one year. A year later, 70% of those participants are still in remission.

The results confirm that – as with the first year results – remission is closely linked to weight loss with 64% of participants who lost more than 10 kilos being in remission at two years.

Participants regained some weight, as expected, between the first and second year. However, those in remission after one year who stayed in remission had a greater average weight loss (15.5 kilos) than those who did not stay in remission (12 kilos).

Participants were defined as being in remission if they had long-term blood glucose levels (HbA1c) of less than 48mmol/mol (6.5%) without needing to use any type 2 diabetes medications.

As well as resulting in remission for many participants, the programme led to a drop in blood glucose levels and fewer diabetes medications across the whole intervention group.

The average HbA1c fell from 60mmol/mol at the start to 54mmol/mol at the end of year two. Diabetes medication use dropped from 75% of the group to 40%.

In comparison, the average HbA1c remained similar (58mmol/mol vs 59mmol/mol) in those receiving standard care and the proportion of people taking medications increased from 77% to 84%.

Professor Roy Taylor, director of Newcastle University’s Magnetic Resonance Centre and co-primary investigator of the DiRECT trial – who co-led the trial with Professor Mike Lean – 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.”

Professor Lean, head of human nutrition at the University of Glasgow, diabetes specialist physician at Glasgow Royal Infirmary, and co-primary investigator of DiRECT, said: “Proving in DiRECT that type 2 diabetes can be put into remission for two years in more than two thirds of people, if they can lose more than 10 kilos, is incredibly exciting. Achieving that entirely in NHS primary care is vital.

“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.”

*Lean M E J, Leslie W S, Barnes A C, Brosnahan N, Thom G, McCombie L, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. DOI:10.1016/S2213-8587(19)30068-3