Remission should be the primary goal of GP treatment for people with type 2 diabetes

Achieving “remission” for people with type 2 diabetes through dietary approaches and weight loss should be the primary goal of treatment for general practitioners and healthcare professionals, concludes a large-scale review of clinical evidence led by researchers at UCL and Aston University.

Type 2 diabetes (T2DM) is a serious disease caused when the body resists the insulin produced in the pancreas and not enough insulin is made. This leads to high levels of sugar (glucose) in the blood and is associated with multiple health problems, including an increased risk of heart disease, blindness, and amputation. In the UK, T2DM affects around 3.9 million people and 179 million worldwide. The care and treatment of T2DM costs the NHS around £ 10 billion a year.

Given all the evidence, our review suggests that remission should be discussed as a primary goal of treatment with people living with type 2 diabetes. Several dietary approaches have been shown to lead to remission of T2DM, although Currently, meal replacements offer the best evidence of quality. Low-carb diets have been shown to be very effective and should also be considered as a dietary approach for remission.. “

Dr Duane Mellor, corresponding study author, Aston University

Lead author Dr Adrian Brown, UCL Division of Medicine, said: “Traditionally, T2D has focused on managing a person’s blood sugar with medication, but the approach does not treat the underlying causes of T2DM. There is now a growing body of research that shows significant weight loss of 10 to 15 kg, whether through bariatric surgery or dietary approaches, can lead to remission of type 2 diabetes (blood sugar levels). non-diabetic). “

For the study, published in the Journal of Human Nutrition and Dietetics, dietitians and obesity experts conducted a critical narrative review of more than 90 research articles covering international clinical trials and clinical practice data of dietary methods used to treat T2DM.

The study found that meal replacement diets helped about one in three people (36%) achieve remission, while low-carb diets could help about one in five (17.6%) to achieve and to maintain remission for at least two years. People who lost the most weight and maintained their weight using these two dietary approaches were able to stay in remission.

Calorie-restricted and Mediterranean diets have also been able to help people achieve remission – but at much lower rates. Only around 5% of people on a low-calorie diet remained in remission after one year, while only 15% of people on a Mediterranean diet remained in remission after one year.

In reaching their conclusions, the research team had to take into account that there is no single definition of remission; it is generally defined as a return to non-diabetic blood sugar (glycated hemoglobin less than 48 mmol / mol), without the use of anti-diabetic drugs. Other definitions however say that the weight (especially the fat around the midsection) must be lost to achieve remission, and other that drugs can continue to be used.

What’s more, some reports suggest that low-carb diets can normalize blood sugar even without weight loss. This happens when carbohydrates are consumed, they are broken down into sugars which raise our blood sugar levels. A low-carbohydrate diet means less blood sugar appears in the bloodstream, which improves blood sugar control. However, if weight loss is not achieved but individuals are able to achieve non-diabetic blood sugar levels, the authors suggest that this should instead be called attenuation, as the underlying mechanisms of T2DM are not addressed.

Dr Brown said: “It is clear that the main factor in remission remains the degree of weight loss achieved by a person. Therefore, for those who are not achieving weight loss but non-diabetic blood sugar, we suggest that it is not a remission by themselves, but rather “the alleviation” of their diabetes. “

Research concludes that while weight loss appears to be the best predictor of successful remission, it involves pancreatic and liver fat loss. They note that it will be important for future studies to compare how these diets work for different ethnic groups, as T2DM can occur at lower body weights in different ethnic groups, who may have less weight to lose.

Dr Mellor added: “Not everyone will be able to go into remission, but younger (under 50), males, who have had type 2 diabetes for less than six years and who are losing more weight. are more likely to be successful.

“This could be because these people are able to tackle the root causes of their diabetes, thereby regaining more of the pancreas’ ability to make insulin and the liver’s ability to use it. But that doesn’t mean that others will not be successful if they improve their diet and lifestyle and lose weight.

“Whether or not a person goes into remission, lowering blood sugar is important for managing the negative effects of type 2 diabetes and reducing the risk of complications. But when it comes to choosing a diet, the most important thing is choosing the right one for you. – one that you are likely to stick to in the long run. “

The initial meeting that led to the writing of this article was supported by the British Dietetic Association and Diabetes UK.