Dr Umesh Dashora
Consultant, Endocrinology and Diabetes at Conquest Hospital, Hastings
and meeting secretary, Association of British Clinical Diabetologists
Diabetes is increasing worldwide, with 4.41 million people in the UK currently diagnosed with type 2 diabetes and another 13.6 million at increased risk of developing it.
Approximately 850,000 people have type 2 diabetes in the UK but are not diagnosed yet. Diabetes leads to 185 amputations, 30 incidents of serious vision loss and 700 premature deaths every week, in addition to other complications like heart attack and stroke. The NHS spends 1 billion every year (10% of its budget) on diabetes.
Physical activity and sustained weight loss can reduce the risk of diabetes by about 50%, and people with diabetes can achieve sustained remission.
Reversing diabetes in overweight people
The Diabetes Remission Clinical Trial (DiRECT) research shows that with a structured low-calorie diet (800 calories) programme — supplied by a total diet replacement programme, followed by structured weight loss maintenance — 50% of people with diabetes can achieve remission.
Almost 9 out of 10 can succeed if they lose 15 kg or more in the first year. Results show that 36% of people were still in remission two years later. These results were associated with a reduction of fat around the liver and pancreas, with improved morphology and function of the pancreas, among other benefits.
In addition to the health benefits, the DiRECT approach to diabetes results in financial savings of about £1,337 per person over their lifetime.
Approximately 850,000 people have type 2 diabetes in the UK but are not diagnosed yet.
Weight reduction in people with normal weight
Although most people with type 2 diabetes are overweight, about 10% are of normal weight. Recent results of the ReTUNEing type 2 diabetes remission (ReTUNE) trial in participants who had normal weight (BMI <27) show exciting results with a low-calorie diet (800 Kcal per day) for two to four weeks. It is followed by a four to six-week weight loss maintenance period, gradually returning to normal food.
These cycles were repeated until the participants had lost 10–15% of their original body weight. The research shows that this approach reduced the average BMI from 24.8 kg/m2 to 22.4 kg/m2 — with 70% of participants achieving diabetes remission.
How does weight loss help?
It appears that beta cells in the pancreas which secrete insulin are not dead but just asleep in people with type 2 diabetes. They can wake up and start functioning normally with enough weight loss.
These recent developments offer hope to millions. They can reverse, or at least delay, the development of type 2 diabetes and its complications with attention to diet and weight loss irrespective of their initial weight.
