A relook at remission

Emily BurnsYou might have seen today’s exciting news about Type 2 diabetes remission: NHS England has committed to piloting a Type 2 diabetes remission programme in 2019. With similar commitments from NHS Scotland earlier this year, you might be wondering what this means for you…

Our research into action

This is fantastic news. Last year, we announced the first-year results of our DiRECT trial. This showed that nearly half of those who took part in a low-calorie weight management programme were in remission after 12 months.

Just under a year later, we have exciting commitments from NHS England and Scotland. We don’t know the full details yet, but this means that some people with Type 2 diabetes will have access to Type 2 diabetes remission programmes in 2019. Exactly who and where? TBC. But this is a significant step forward that we should celebrate.

And we wouldn’t be here without you. All of the research we fund, including the DiRECT trial that has led to this moment, happens thanks to you.

Remission is…

…when you have normal blood sugar levels for the long term without using any diabetes medications. DiRECT defined remission as having blood sugar levels at least under the threshold for diagnosing Type 2 diabetes (HbA1C of 6.5%).

We use the term ‘remission’ because Type 2 diabetes might come back, so it’s really important that people in remission continue to get regular check-ups. This way, any signs of returning Type 2 or complications can be spotted early.

How do people go into remission?

To answer this question, we need to look at how Type 2 diabetes develops. If someone’s carrying extra weight around their middle, fat can build up around important organs like the liver and pancreas. This makes it more difficult for those organs to work properly, leading to Type 2 diabetes.

Not everyone who develops Type 2 diabetes is overweight. There are other factors, like age, ethnicity and family history that play a role in our risk and influence how well the liver and pancreas work, and also where we store our fat. We can’t change those things, but we can usually change our weight. That’s why weight becomes such an important topic – and a focus of research.

Just as storing fat around the liver and pancreas is important in the development of Type 2, so is losing fat for remission.

The low-calorie approach

We know that bariatric, or weight loss, surgery can lead to remission. People have also gone into remission by losing weight on their own too, and those stories are inspirational.

But the news more recently surrounds the DiRECT trial, which is testing a low-calorie diet alongside weight loss support from a healthcare professional. At the end of year one, just under half of people taking part in the trial were in remission.

While there aren’t any NHS services offering this type of treatment just yet, NHS England and Scotland have both committed to piloting a programme in 2019. While there are lots of details to be ironed out, this is fantastic news.

We also know that people are doing low calorie diets on their own. We want you to stay safe and have the right information to make your decision, so here are some important tips:

  1. Results from DiRECT point to support from a healthcare team being absolutely key. It can be really difficult to do this type of diet on your own.
  2. Low-calorie diets come with risks if you’re taking insulin or other medications, so it’s really important that you speak to your doctor first.
  3. DiRECT only involved people who had had Type 2 diabetes for less than six years, so we don’t know if this type of approach will work in others.
  4. We’ve got a whole webpage dedicated to low-calorie diets, so go find out more.

Evidence points to weight loss being the key to remission – with around 15kg significantly increasing your chances of remission. Alongside this, it appears to be more likely in people newly diagnosed and who start off with lower blood sugar levels.

There were people on DiRECT who lost a lot of weight but didn’t go into remission. And the latest DiRECT results suggest that this is because some people’s insulin-producing cells in the pancreas wouldn’t ‘reboot’ after weight loss.

Importantly, losing excess weight is good for us – whether remission is at the end of the rainbow or not. It can mean fewer medications, better blood sugar levels, and a lower risk of complications. All of these are important for a long and healthy life, so good news all round.

What next?

We think it’s fantastic that the NHS plans to make remission a reality for people with Type 2 diabetes. But while those plans are forming, we’re going to continue funding vital research, so we’ve got as much evidence about remission to hand as possible.

For now, we’ve got a few questions we want answers to, like:

  1. Lots of research so far has focused on people with Type 2 diabetes who are overweight – will we need a different approach for people who aren’t? Luckily, Prof Roy Taylor’s ReTUNE study is looking at this.
  2. How can we make sure people stay in remission – what support do they need?
  3. Does remission reduce the risk of diabetes complications down the line? All of them? or specific ones?
  4. Although rare, children also develop Type 2 diabetes. Is remission an option here too?

While we’re waiting for evidence to build, and for NHS plans to become fully formed, we can start talking about remission.

Watch out for the latest results from DiRECT. And ask your healthcare team if they’ve heard about research into remission too. You could also ask to see a dietitian who can support you to lose weight. This way, you could work to improve your blood glucose levels and increase your chances of remission now.

Importantly, we’re about to see a shift in how we talk about Type 2 diabetes. It’s still a very serious condition – but one where remission could be a realistic goal for some. And that’s exciting.

Find out more about our research and how Karen turned her Type 2 diabetes around through exercise and diet.

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