Reaching (and Maintaining) Type 2 Diabetes Remission Is More Doable Than You Think
By April Hopcroft
New research shows that it’s possible to reverse type 2 diabetes or put it into remission through a low-calorie diet. We spoke with Dr. Roy Taylor, lead investigator of the DiRECT trial, to understand these findings and what they mean for people with type 2 diabetes.
Although type 2 diabetes is considered a progressive disease, there is a growing amount of research showing that weight loss can drive diabetes reversal or remission.
New data from a study known as the Diabetes in Remission (DiRECT) trial found that nearly one in four people with type 2 diabetes was able to reverse their diabetes for up to five years through weight loss using a low-calorie diet.
Defining diabetes remission
The term “diabetes remission” is often debated, and there are several definitions. At diaTribe and in the DiRECT trial, remission is defined as an A1C below 6.5% without needing to use any diabetes medications for at least two to three months.
Results of the Diabetes in Remission (DiRECT) trial
The DiRECT trial, which has been led by Dr. Roy Taylor, a professor of medicine and metabolism at the University of Newcastle School of Medicine in England, first gained attention in 2017.
Initial results showed that weight loss using a low-calorie diet can help reverse type 2 diabetes. Almost half (46%) of DiRECT study participants remained in remission at one year, and over one-third (36%) achieved remission at two years.
The trial’s weight loss program took place in primary care settings where no specialist appointments were needed. Participants received a low-calorie diet for 12 weeks in addition to education on how to incorporate healthy foods into their diet. Participants attended appointments every three months to review their weight, blood sugar, and blood pressure. Any person who regained weight was able to return to the low-calorie diet for one month.
Recent results from an extension to the trial found an average weight loss of 13 pounds after five years, with 23% of participants maintaining remission for five years. Among those who were still in remission at five years, weight loss was about 20 pounds. Participants also saw improvements in blood pressure and blood sugar.
We spoke to Taylor to better understand what these findings mean for people with type 2 diabetes.
diaTribe: Can you explain the purpose of the DiRECT extension trial and the key findings?
Taylor: The principal question to answer was whether people in remission at the end of the randomized controlled trial (two years) could maintain remission if weight regain was avoided. The answer to the principal question was a resounding yes. At five years, the extension group was still 13 pounds below their baseline weight, and 13% of the extension group was still free of diabetes. They had put on some weight, but far less than those who lost remission.
Serious adverse events were 54% less common at five years in those randomized to weight loss. Contributing to this were fewer bacterial infections, strokes, and notably fewer cancers.
diaTribe: Should everyone with type 2 diabetes ask their healthcare providers about achieving remission?
Taylor: This is something that should be explained to everyone at diagnosis of type 2 diabetes. They have a choice – lose around 30 pounds in weight by this proven and acceptable method or, alternatively, take medications and accept the risk of illness.
Type 2 diabetes is a condition of having more fat than an individual can tolerate inside the liver and pancreas, as originally established by the Counterpoint study. The mechanisms underlying the reversal to non-diabetic glucose control were summarized in Diabetes Care review.
In April 2023, NHS England announced that the method developed for the Counterpoint study had been so successful (24 pounds of weight loss in one year in several thousand people with diabetes) that it’s now being rolled out as a full NHS Programme for the whole of England.
diaTribe: What advice do you have for people with type 2 diabetes who are hoping to achieve remission?
Taylor: Write down why you want to escape from diabetes. It has to be worth the undoubted effort, and it helps to have something to remember if things get tough. Also, discuss your diet and what it will mean with your nearest and dearest, and your friends. Support from others is very helpful both during the weight loss phase and then the ongoing matter of avoiding weight regain.
diaTribe: What opportunities do you see for the field of type 2 diabetes remission going forward?
Taylor: A very large number of questions need to be answered. Documenting the improvement in kidney, heart, and vascular health will require large studies, although not as large as most drug studies.
diaTribe: What do we know about the relationship between diabetes remission and cancer?
Taylor: In DiRECT at five years, there were eight cancers in the “best management” group and one in the weight loss group (by intention to treat). All types of cancers were known to be more common in heavier people. And the one cancer that occurred in the weight loss group was in a person who had dropped out of the study early on.
Although the DiRECT extension study was not powered to detect individual serious health conditions, the effect size implied by these findings is huge. Further large follow-up studies are needed. As it will be possible to access all medical records in relation to the NHS England Type 2 Diabetes Path to Remission Programme, the effect of weight loss in the population should be able to be determined in the future.
Final thoughts on diabetes remission
If you’re living with type 2 diabetes and are ready to think about remission, consider discussing the different ways to achieve it with your healthcare provider. It’s important to note that remission is easier to achieve for some people than others. The longer you’ve had type 2 diabetes, the harder it is to reach remission.
You may want to discuss some of the following questions with your healthcare provider:
- How likely is it that I will achieve remission of my T2D?
- How should we define remission for my diabetes?
- What dietary plan should I follow?
- What kind of support is available to me to help achieve remission?
- What is a reasonable goal and timeframe for me to achieve remission?
- How do I manage my diabetes medications and prescriptions during this time
