Type 2 diabetes remission: what you need to know – by Faye Riley

Our scientists have just announced their first findings from a landmark study, called DiRECT. They’re testing a new weight management programme, using a low-calorie diet, that could put Type 2 diabetes into remission. The study isn’t over yet, but we’re pretty excited about what the initial results could mean in the future. Take a look at our Research Spotlight for all the background info on the study, who’s involved and how it works.

Here, I delve deeper into the results and answer your burning questions.

I have Type 2 diabetes – what do the results actually mean for me?

The findings so far are really promising. They suggest it’s possible for some people to put their Type 2 diabetes into remission using a low-calorie diet-based weight management programme. And the success of this approach seems to be linked to the amount of weight people lose. Nearly 9 in 10 people who lost 15kg or more put their condition into remission.

So can a low-calorie diet put your Type 2 diabetes into remission? The short answer is, potentially yes. It works for some people, but it might not work for you. We need to finish the research to get all the answers. And this programme isn’t just as simple as cutting calories from your diet.

Is this a cure?

Remission doesn’t mean diabetes has been reversed or cured. Whatever the headlines say, we’re just talking about putting Type 2 diabetes into remission here.

Remission means that blood sugar levels return to normal and people no longer need to take diabetes medication. But Type 2 diabetes might come back, so you’d still need regular health check-ups.

Reversal means that Type 2 diabetes no longer exists and the impacts it’s had on the body so far has been fixed. At the moment, we don’t have the evidence to say that Type 2 diabetes can be reversed. While blood sugar levels are in the normal range, we don’t know if the effects (like damage to the nerves and blood vessels in the eye) are reversible.

Can I try a low-calorie diet myself?

A low-calorie diet certainly isn’t a quick fix. For many, this type of diet would be a big change and a real challenge to stick to.

The low-calorie diet is around 800 calories a day, made up of four soups or shakes. If you wanted to try this diet, you’d need help from a healthcare professional all the way through to make sure you’re getting the nutrients your body needs. And because it can be dangerous if you’re using certain types of diabetes medications, like insulin, sulphonylureas or blood pressure lowering medication.

The treatment isn’t over once you’re done with the low-calorie diet (which would last for between 8 and 20 weeks). People need lots of support to introduce normal food back into their diet, maintain weight loss and stay in remission.

What’s more, the programme being tested isn’t available on the NHS, and the diet soups and shakes can be expensive to buy yourself.

The research we’re funding is the best way to tell if weight management using a low-calorie diet is safe, practical and if it works. But we need to wait for the full results of DiRECT before we’ll know if it should be offered as a routine treatment for people with Type 2 diabetes.

At the moment, we recommend that people with Type 2 diabetes eat a healthy, balanced diet that’s low in sugar, salt and saturated fat and includes plenty of fruits and vegetables.

For people who want to lose weight, approaches such as low carb, Mediterranean, low-calorie and meal replacements could be used with the right medical supervision. Have a read of our information on managing weight.

So there are a lot of things to consider when deciding whether to try this low-calorie approach, and your GP or diabetes healthcare professional should be your first go-to beforehand.

How does this put Type 2 diabetes into remission?

Professor Taylor examining liver scans from his previous research

Research into the biology behind Type 2 diabetes has shown that excess fat around the pancreas can cause insulin-producing beta cells to lose their ability to make insulin. Earlier research, in a small number of people with Type 2, has found that people who lost weight through this low-calorie diet programme reduced the amount of fat in their liver and pancreas.

When this fat is lost, it helps the beta cells to work properly again and make the right amount of insulin the body needs. This helps blood sugar levels return to normal and puts Type 2 diabetes into remission.

As DiRECT continues, the team will be looking into these mechanisms in more detail. They’ll test metabolisms and measure fat deposits inside liver and pancreas, to understand more about how major weight loss brings about remission.

Does a low-calorie diet work for everyone?

It might not. I know we might sound like a broken record, but there’s still a lot of research to be done.

Some earlier studies suggest that this kind of diet is most likely to work for people who’ve lived with Type 2 diabetes for less than 10 years. DiRECT involves people who’ve been diagnosed within the last six years. And all of the participants were overweight.

We’re currently funding another research project led by Professor Roy Taylor at Newcastle University, called ReTUNE. This is testing whether people of healthy weight with Type 2 diabetes could benefit from a low-calorie diet and put their condition into remission.

So we still need to understand who would benefit most and why it might work for some people and not for others.

How long can remission last for?

In DiRECT, just under half of those who’d taken part in the programme were in remission at the 12-month point. But we don’t yet know how long remission could last for.

To help answer this, we’re investing a further £300,000 in DiRECT so researchers can follow-up participants for up to three years. This’ll help us get a better understanding of the long-term effects of this programme and whether people can stay in remission.

We’ll be updating you as this research continues and we put together more pieces of the puzzle. For now, you can find out more about this study and what’s next and find out about what remission means for you

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