Diabetes UK is funding a research project that could lead to a definitive judgement on whether low-calorie diets should be offered as a treatment option to put Type 2 diabetes into remission.
The £2.4 million research project will be carried out by researchers at Newcastle University and the University of Glasgow. It aims to answer the question of whether losing weight on a low-calorie liquid diet, and keeping it off using a structured, personalised support programme, is a viable treatment for putting Type 2 diabetes into remission in the long term.
It will see 140 people with Type 2 diabetes spend between eight and 20 weeks consuming just 800 calories per day, mainly in the form of nutritionally-complete formula shakes. Then, as normal meals are reintroduced, they will learn how to change their lifestyles permanently. Participants will be monitored over the next two years and their results will be compared to another 140 people who have not followed the diet but have instead followed what is currently accepted as the best advice for managing weight. As well as monitoring the long-term effects of the diet, some of the participants will have MRI scans, which will show researchers what is happening inside the body during the diet.
This follows a study from 2011 that found that 11 people with Type 2 diabetes who spent eight weeks on a low-calorie liquid diet all saw their insulin production return to normal and their Type 2 diabetes put into remission. These findings backed up anecdotal reports and results from bariatric surgery to raise the prospect of transforming the way Type 2 diabetes is treated.
Not a quick fix
Dr Matthew Hobbs, Head of Research for Diabetes UK, said, "Type 2 diabetes will always be a serious health condition but perhaps it won’t always be seen as a condition that people have to manage for the rest of their lives and that worsens inevitably over time. The 2011 study and evidence from bariatric surgery has shown us that it can be put into remission. If we can do this safely, on a bigger scale and as part of routine care, then following a low-calorie liquid diet would be a real game changer in terms of reducing people’s risk of devastating health complications such as amputation and blindness.
"As exciting as those findings were, there is still so much about low-calorie diets that we do not yet understand. We don’t know whether this diet will put Type 2 diabetes into remission in the long term. Even more fundamentally, this kind of diet is certainly not an easy option or a 'quick fix'. People will still have to maintain a healthy lifestyle to stop their Type 2 diabetes coming back.
"We are also talking about consuming so few calories that people taking part are likely to feel hungry quite a lot of the time and there are real questions about what proportion of people will be able to stick to this for the length of time needed for it to be effective".
"We need to prove it actually works"
Professor Mike Lean, the lead researcher at the University of Glasgow, said, "The reason for doing this research is that we do not know whether the extra effort, and possible stress, of following a very restrictive diet for several months will indeed bring benefits in the long term. Although benefits are possible, we know that weight regain after liquid diets has been common in the past, and could have harmful effects. This is why we need to study sufficient numbers of people for long enough to be sure that the benefits outweigh the costs.
"Following the huge media interest in the 2011 study, many people might think they want this kind of treatment, but first we need to prove it actually works in routine clinical practice. If our analysis shows that this approach to weight loss and weight management is both clinically effective and cost-effective, we would aim to produce a programme that can be implemented in the NHS as soon as possible."
A quantum leap in diabetes management?
Professor Roy Taylor, the lead researcher at Newcastle University, said, "We know that changes in calorie intake can produce changes in body composition that, at least in some people, can put Type 2 diabetes into remission. But this new study will evaluate how well people do using this approach and uncover problems that might be faced.
"We are exploring uncharted territory and along the way there will be challenges, details to unravel, and other questions to ask. But I believe this study will lead to a quantum leap forward in our understanding of how best to manage Type 2 diabetes."
More information about the trial can be found on our research spotlight page on the low-calorie liquid diet.