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SAN FRANCISCO – In recent years, diabetologists have warned people with newly diagnosed type 2 diabetes that they had a progressive disease that eventually required insulin treatment. But one expert believes that his latest research supports a different approach.
"We can say:" If you maintain your current weight, or even if you take it as some people, you will follow the trail of a slow descent, "said Roy Taylor, MB, professor of medicine and metabolism at the University of Newcastle, Newcastle. in Tyne, United Kingdom. "And do not worry, we can take care of you and give you medicine, but we will monitor your disappearance, so it's a choice."
"On the other hand, you may want to do that, which is difficult, and you escape." The path that leads to this "escape" is the weight loss, pure and simple, said Taylor Medscape Medical News.
And while this message may not seem new, linking it to the remission potential of diabetes makes it more appealing, he said, pointing to the "extraordinary" response rate of 28 percent that he and his UK team have achieved. to recruit letters for the clinical trial of Diabetes Rehabilitation (Direct).
"It's possible to go back even after diagnosing type 2 diabetes," Taylor said at a press briefing. "It's very good news for people with diabetes."
Remarkable results achieved in the real world
Alvin C. Powers, MD, director of the Diabetes and Endocrinology Division of the Vanderbilt University School of Medicine in Nashville, Tenn., Said, "Diabetes is considered a progressive disease These are remarkable results obtained by Taylor [and colleagues] in the real world. "
The DiRECT study has shown that sustained rapid weight loss can lead to remission of type 2 diabetes at 2 years in patients with early disease.
"We had a truly representative group of people with diabetes in real life," said Taylor, presenting the results here at the 2019 Scientific Sessions of the American Diabetes Association (ADA) to an American audience after the have previously reported to the UK Diabetes Professional Conference (DUPC), when they were also published simultaneously in Lancet Diabetes and Endocrinology.
"The [patients] want to get rid of their diabetes and pills. As diabetes doctors, we are therefore very motivated, "said Taylor. Medscape Medical News.
"But then we could not tell people [before]"Look, it's possible to escape that." "
In the UK, where DiRECT has been conducted, pilot studies are underway but additional investments are needed for a national rollout.
Beta Cells Producing Sleeping Insulin, Not Dead
In the DiRECT study, patients with newly diagnosed type 2 diabetes followed a liquid diet containing fewer calories (800 calories a day) for 3 to 5 months, followed by a reintroduction. progressive food and a maintenance program for weight loss.
The remission of diabetes has been defined as the maintenance of an HbA1 C <6.5% and fasting glucose <126 mg / dL without the use of drugs.
Overall, 36% of patients achieved remission of diabetes and maintained it for 24 months.
Achieving remission was linked to several factors, including weight loss. Of the participants who lost more than 10 kg (about 22 pounds), 64% achieved remission at the age of 2 years.
But as all those who lost so much weight had reached remission, researchers sought to differentiate between "responders" and "nonrespondents."
The average time elapsed since the diagnosis of diabetes was one of the factors badociated with being an responder, Taylor explained.
Respondents were diagnosed an average of 2.7 years prior to the study, while non-respondents were diagnosed on average 3.8 years earlier.
According to him, even though the destruction of insulin-producing beta cells is a hallmark of evolving type 2 diabetes, some beta cells were dormant and weight loss and the badociated reduction in metabolic stress allowed the cell to become dormant. "
"By eliminating" stress " [of a toxic food environment], the specialized function of the beta cell returns, "he told reporters.
Further studies are needed to determine the factors that determine whether significant weight loss can lead to diabetes remission, Taylor said.
"We all have our own pancreas and it is doing the right thing," he said, responding to delegates' questions about the role of genetics.
"The clues are there," he said, adding, "It's the beginning of the story, not the end."
Taylor did not reveal any relevant financial relationship.
ADA scientific sessions. Presented June 7, 2019. Summary 66-OR
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