NEW study: Can you get rid of type 2 diabetes by losing weight?
The prestigious journal Lancet published in December 2017 a large study, conducted in Scotland and England, with the startling findings about the relationship between intensive weight reduction and diabetes type 2. And earlier in the year the two-year results from the DIRECT study were published.
DIRECT – The Diabetes Remission Clinical Trial is an open, randomized clinical study.
The study concluded with:
Type 2 - diabetes is a complication of weight gain and excess body fat, and it is not necessarily a permanent condition.
Close to half of people with diabetes type 2 can achieve the reversal of the disease by intensive weight reduction (ie. that the blood sugar values measured within normal reference areas)
Diabetes type 2 and obesity:
In spite of the research-based guidelines for the diabetes treatment, and an escalation of drug therapy, there is still a very high rate of cardiovascular adverse circulatory events and reduced life expectancy in people with type 2 - diabetes.
Weight gain and obesity is the most common cause of diabetes type 2. The average weight of the people who get the diagnosis corresponds to a BMI at 30-31, but we see the most cases of the disease by a BMI over 35.
The purpose of the study was:
To find a solution on how to practically treat people with Diabetes type 2 in primary care.
To evaluate whether intensive weight reduction within the primary care, would give the reversal (reversal) of type 2-diabetes.
This is the first clinical study which purpose was to show that type 2 diabetes is a disease that can be reversed through diet and significant and rapid weight loss. 149 people were in the intervention section. BMI 27-45, the average BMI was 35 The goal was to achieve weight reduction of 15 kilograms or more and see if it could result in remission of the T2-D. Such weight loss has previously shown an improvement in B-cell function and normalization of glucose metabolism
Inclusion criteria was type 2 diabetes diagnosed in the last 6 years. The idea behind this was to ensure that the patient has sufficient production of insulin, so that it is more likely to have their disease, reverse and stop taking medication.
Reversal of diabetes was defined as HbA1c being below 48 mmol/mol (6.5%) for at least 2 months after all antidiabetic drugs were stopped from the beginning of the study and for 12 months thereafter. Everyone had to stop their diabetes medication and blood pressure medication from day 1 of the diet. If the blood pressure became higher than 140/80, they should start again with blood pressure medicine.
306 participants from 30 health centres/clinics in Scotland and England were included in the study, to either:
The test group: To follow a weight control program where they ate a low-calorie diet based on meal replacements (ready-made special products) where the goal was more than 15 kg weight loss and received follow-up by a nutritionist or nurse.
Control group: Receive regular follow-up in line with the official treatment guidelines.
Weight reduction program in DIRECT
For the first three to five months, they exclusively ate a "powder diet" corresponding to approx. 850 Kcal/day, shaker and soups.
Before starting this treatment, made with all the medications for diabetes and high blood pressure. The participants were also recommended to go up to 30 min daily. Then followed a period of two to eight weeks of gradual introduction of normal food and increased activity (dimensions: 15 000 steps per day)
The "powder meals" were one after another with meals consisting of normal, healthy food.
In the last phase, which lasted for approx. six months, the aim was to keep the weight stable, and in this period, the participants gained the follow-up of the nurse or nutritionist.
The study had clear findings that intensive weight reduction reversed type 2 diabetes in almost half of the study subjects in the test group compared to only 4 per cent in the control group.
86 percent diabetes-free among those who lost 15 kg or more
With a weight loss of 10-15 kg, 73 percent will have a normal blood sugar value.
These are startlingly good results, as the participants do not use any drugs for diabetes.
Average weight loss:
The intervention group: 10 kg
Control group: 1 kg
Decrease in HbA1c (long-term blood sugar):
The intervention group: minus 0.9 %
Control + 0.1 %
After two years, only 11 percent in the weight reduction group had maintained a weight loss of 15 kg or more, but 36 percent were still diabetes-free compared to three percent in the control group.
There was still a clear connection between the number of kilograms of weight lost and the remission rate:
64 percent of the participants were diabetes-free after two years if they had achieved a weight reduction of ten kg or more.
There was also a good improvement in HbA1c, blood pressure and blood lipids, especially in the test group, in addition there was significantly less use of medication and they scored better on quality of life measurements.
Weight and health
Other studies also show that significant weight loss provides many health benefits, such as lower blood pressure, less sleep apnea, better self-esteem, but the greatest effect on DM type 2.
Obesity involves more than to weigh a few kilos too much. It provides very high risk for type 2-diabetes, high blood pressure, heart disease, cancer, wear and tear of the joints, and inflammatory diseases. For many it will also lead to an experience of poorer quality of life and poorer mental health.
You put on you just 5-8 kg, you will increase the risk of type 2 diabetes, or vice versa: If you go down 5-8 kg the refreshment in the body to be equivalent.
Written by diabetes nurse and dietitian Hege Hasler Barhaughøgda