A radical low-calorie diet can reverse type 2 diabetes, even six years into the disease, a new study has found.
The number of cases of type 2 diabetes is soaring, related to the obesity epidemic. Fat accumulated in the abdomen prevents the proper function of the pancreas. It can lead to serious and life-threatening complications, including blindness and foot amputations, heart and kidney disease.
A new study from Newcastle and Glasgow Universities shows that the disease can be reversed by losing weight, so that sufferers no longer have to take medication and are free of the symptoms and risks. Nine out of 10 people in the trial who lost 15kg (two-and-a-half stone) or more put their type 2 diabetes into remission.
Prof Roy Taylor from Newcastle University, lead researcher in the trial funded by Diabetes UK, said: “These findings are very exciting. They could revolutionise the way type 2 diabetes is treated. This builds on the work into the underlying cause of the condition, so that we can target management effectively.
“Substantial weight loss results in reduced fat inside the liver and pancreas, allowing these organs to return to normal function. What we’re seeing … is that losing weight isn’t just linked to better management of type 2 diabetes: significant weight loss could actually result in lasting remission.”
Worldwide, the number of people with type 2 diabetes has quadrupled over 35 years, rising from 108 million in 1980 to 422 million in 2014. This is expected to climb to 642 million by 2040. Type 2 diabetes affects almost 1 in 10 adults in the UK and costs the NHS about £14bn a year.
Type 2 diabetes is usually treated with medication and in some cases, bariatric surgery to restrict stomach capacity, which has also been shown to reverse the disease.
“Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon, but diabetes remission by cutting calories is rarely discussed,” said Taylor.
“A major difference from other studies is that we advised a period of dietary weight loss with no increase in physical activity, but during the long-term follow up increased daily activity is important. Bariatric surgery can achieve remission of diabetes in about three-quarters of people, but it is more expensive and risky, and is only available to a small number of patients.”
The trial results, published in the Lancet and presented at the International Diabetes Federation Congress in Abu Dhabi, show that after one year, participants had lost an average of 10kg, and nearly half had reverted to a non-diabetic state.
There were 298 adults on the trial aged 20–65, who had been diagnosed with type 2 diabetes within the last six years, from 49 primary care practices in Scotland and Tyneside. Half of the practices put their patients on the very low calorie diet, while the rest were a control group, in which patients received usual care. Only 4% of the control group managed to achieve remission.
The diet was a formula of 825–853 calories per day for 3 to 5 months, followed by the stepped reintroduction of food over two to eight weeks. The participants were all given support throughout, including cognitive behaviour therapy and were encouraged to exercise.
“Our findings suggest that even if you have had type 2 diabetes for six years, putting the disease into remission is feasible”, says Prof Michael Lean from the University of Glasgow who co-led the study. “In contrast to other approaches, we focus on the need for long-term maintenance of weight loss through diet and exercise and encourage flexibility to optimise individual results.”
Isobel Murray, 65 from North Ayrshire, was one of those who took part. Over two years she lost three and a half stone (22kg) and no longer needs medication. “It has transformed my life,” she said. “I had type 2 diabetes for two to three years before the study. I was on various medications which were constantly increasing and I was becoming more and more ill every day.
“When the doctors told me that my pancreas was working again, it felt fantastic, absolutely amazing. I don’t think of myself as a diabetic anymore.”
Taylor said that the trail shows that the very large weight losses that bariatric surgery can bring about are not necessary to reverse the disease. “The weight loss goals provided by this programme are achievable for many people. The big challenge is long-term avoidance of weight re-gain,” he said.