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Research spotlight – putting Type 2 diabetes into remission

Low-calorie weight management programmes

Thanks to our research funding, scientists are busy investigating a new weight management treatment, which includes a low-calorie diet, to help people put their Type 2 diabetes into remission.

The ground-breaking study is called DiRECT, short for Diabetes Remission Clinical Trial, and it could completely change the way Type 2 diabetes is treated in the future.

The study isn't finished yet, but we've already seen some exciting results.

Thanks to those results, NHS Scotland and England have committed to piloting Type 2 diabetes remission programmes in 2019. Get the latest on this exciting news.

So, what do we know so far?

Results so far

The first year results showed that it’s possible for some people to put their Type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. Almost half (45.6 per cent) of those who took part in the programme were in remission after a year.

The study found there was a close link between Type 2 diabetes remission and total weight loss. 86 per cent of people who lost more than 15kg on the programme were in remission after a year, as were 57 per cent of people who lost 10–15kg, and 34 per cent who lost 5–10kg.

In the comparison group, where people had the best diabetes care currently available, but didn't try the new weight management approach, only 4 per cent went into remission.

But what does remission actually mean? It’s when blood glucose (or blood sugar) levels are in a normal range again. This doesn’t mean diabetes has gone for good. It’s still really important for people in remission to get regular healthcare checks, so any complications can be monitored and any signs of Type 2 diabetes coming back can be caught early. Find out more about remission.

In this study, the team defined remission as having blood glucose levels (HbA1c) below 6.5% (48mmol/mol) after 12 months, with at least two months without any Type 2 diabetes medications.

Isobel Murray took part in DiRECT and has put her Type 2 diabetes into remission:

“When doctors realised that my pancreas was working again, it felt fantastic, absolutely amazing. I don’t think of myself as a diabetic anymore, I get all my diabetes checks done, but I don’t feel like a diabetic. I’m one of the lucky ones to have gone into remission.”

Read Isobel's full story.

A bit of background on DiRECT

We awarded our largest ever research grant of £2.5 million to help our scientists find out if an intensive low-calorie, diet-based, weight management programme can put Type 2 diabetes into remission, and keep it there. And to test if this can be delivered entirely within the NHS.

Professor Roy Taylor at Newcastle University and Professor Mike Lean at the University of Glasgow are leading the study.

Professors Roy Taylor (left) and Mike Lean (right)

They’re building on the results of two previous smaller studies, which gave us the first evidence that a low-calorie diet approach could put Type 2 diabetes into remission.

These studies at Newcastle University tested 11 and 30 people with Type 2 diabetes. After eight weeks on the low-calorie diet, participants had reduced the amount of fat in their liver and pancreas. This helped them produce insulin again and put their Type 2 diabetes into remission. Some people were still in remission six months after the diet.

An MRI scan of the liver - shows high levels of fat in green (left) and a big decrease in fat after a low-calorie diet (right)

Both of these studies were very small, happened in a research environment and only followed participants for a short time. DiRECT was designed to help us build on these findings and understand more about the long-term effects of this programme – and how it could be used in a real-life setting.

What DiRECT involves

Professors Roy Taylor and Mike Lean have recruited 306 participants for the study, all from GP practices across Scotland and Tyneside. The people taking part are aged between 25 and 65, and were diagnosed with Type 2 diabetes within six years of starting the study. They are all overweight. We know not everyone with Type 2 diabetes is overweight, but weight gain and obesity are the most important risk factors for Type 2 diabetes.

Half of the participants are getting the best Type 2 diabetes care available. The other half are on a low-calorie diet for between eight and 20 weeks, followed by a long-term programme of weight loss maintenance.

The low-calorie diet of 800 calories a day is made up of four soups or shakes. These have all the essential vitamins and minerals.

After the low-calorie diet, those taking part are supported to gradually reintroduce normal food and get expert support to help them maintain their weight loss in the long term.

People getting the best care available also get support with weight loss, but aren't on the low-calorie, weight management programme.

The researchers will also test metabolisms and measure fat levels inside the body, to find out exactly how weight loss can put Type 2 diabetes into remission. They’re also carrying out psychological assessments with the participants and healthcare professionals taking part in the study, to work out how this approach might form part of routine GP care in the future.

Low-calorie diet

This is no quick fix, and we’re not recommending you try it alone. Some of the people in the study are finding the diet incredibly challenging and this programme is about more than just the low-calorie diet. After this phase, people may need to work hard to keep to a healthy weight and stay in remission. That’s why it’s so important to get support from a healthcare professional.

Dougie Twenefour, our Deputy Head of Care, says speak to your GP first:

“If you’re thinking about trying a low-calorie diet, it’s really important you speak to your GP and get referred to a dietitian. This is to make sure you get tailored advice and support.

It’s also important to bear in mind that if you’re treating your Type 2 diabetes with certain medications, such as insulin or sulphonylurea, a low-calorie diet can make hypos more likely. So you’ll need support to make changes to your medications and check your blood sugar levels more often.”

We have more information about low-calorie diets.

We need more research

It's fantastic news that, based on these results, NHS England and Scotland have committed to piloting a Type 2 diabetes remission programme in 2019. Read our latest news story on DiRECT.

But DiRECT isn’t over yet. 

We’ve committed another £300,000 to DiRECT, so some participants can be followed for another three years, and so the cost-effectiveness of the programme can be evaluated. This will help us understand the longer-term benefits, and provide the NHS with even more information to inform what they do next.

This research could completely transform the way Type 2 diabetes is treated and be of enormous benefit to millions of people living with Type 2 diabetes in the UK.

Dr Elizabeth Robertson, our Director of Research, said the first year's results are hugely promising, but just the beginning:

“The first year results of DiRECT have shown that this type of approach has the potential to transform the lives of millions of people. While this ground-breaking study continues to build vital evidence, we're delighted that this work has inspired the NHS to pilot remission programmes in 2019. 

In the meantime, it’s very important that anyone living with Type 2 diabetes considering losing weight in this way gets support and advice from a healthcare professional.”

And there will still be more questions to answer after DiRECT. We need more evidence to fully understand if putting Type 2 diabetes into remission can protect people against diabetes-related complications later in life.

We also need to find out who could benefit most from treatments like this in the future, taking into account things like weight, ethnicity or how long someone has lived with Type 2 diabetes.

Research like this is helping us create a world where diabetes can do no harm.

But our scientists across the UK aren't finished. And it’s only with your help that we can push ahead with ground-breaking research. Will you donate today and help us lead the fight against diabetes?

Donate today


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