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DUKPC Digest day 5: ReTUNE study shows type 2 remission possible for people with lower body weight

Professor Roy Taylor

Today on the last day at the Diabetes UK Professional Conference, Professor Roy Taylor has announced new findings from his Diabetes UK-funded study, called the ReTUNE study. He found that 70% of participants with lower body weights went into type 2 remission after losing weight through a low-calorie diet programme.

While we know that obesity increases the risk of developing type 2 diabetes, 10% of people with type 2 diabetes have a BMI that is not in the obesity or overweight category.  

We’ve been funding Professor Taylor’s trailblazing remission research for over 15 years. In 2011, our Counterpoint study first showed that shedding fat from inside the pancreas and liver – the two important organs involved in blood sugar control – was key to remission from type 2 in people living with obesity or overweight.

This led to our landmark DiRECT trial. The findings gave hope to millions of people with type 2 diabetes and obesity or overweight by showing it was possible for some people to put their condition into remission through weight loss. But we didn’t know if a similar approach could also help people with lower body weights.

The ReTUNE study - liver and pancreas fat

To find out if losing excess fat from the liver and pancreas could also help people with lower body weights to go into remission, Professor Taylor and his ReTUNE study team put 20 people with type 2 diabetes and a BMI at or just above the healthy range (BMI below 27) on a similar low-calorie diet programme to the one in the Counterpoint trial. Everyone in the study had been diagnosed with type 2 diabetes in the last five years.  

People were supported by a medical team to stop all glucose-lowering tablets and follow a low-calorie diet (800 kcal per day), made up of formula meal replacements, like soups and shakes, and non-starchy vegetables for 2-4 weeks. This was followed by a 4-6 week weight loss maintenance period, which involved gradually going back to eating normal foods. People repeated this cycle of weight loss and maintenance up to three times, until they’d lost between 10 and 15% of their original body weight. After each cycle, the research team measured the amount of fat in their pancreas and liver and looked to see who had gone into remission. 

Following on from last year’s promising early results, the full findings from the ReTUNE study show us for the first time that people with type 2 diabetes and lower BMIs can be supported to put their type 2 into remission through a structured low-calorie diet programme. And that the key to this is losing harmful fat from the liver and pancreas.  

After 12 months, the findings showed that: 

  • Participants’ BMI averaged 22.4 kg/m² at the end of the study (reduced from an average of 24.8 kg/m²). 
  • About three quarters (70%) of participants went into remission from type 2 diabetes during the study, with 50% of these going into remission after the first weight loss cycle. 
  • People needed to lose on average 8% of their body weight to go into remission. 
  • In the 14 out of 20 people who went into remission, their average HbA1c fell from 53mmol/mol at the start of the study to 45mmol/mol. Their blood pressure dropped despite taking less medication to treat this. 
  • The participants’ liver and pancreas fat levels were higher than expected at the start of the trial but then decreased to normal levels after weight loss. 

Participants reported feeling satisfied with their weight loss and health improvements and didn’t find it hard to keep the weight they'd lost off.  

Chris Askew, Chief Executive of Diabetes UK, said:

“Building on the pioneering DiRECT trial, this game-changing study from Professor Taylor and his team advances our understanding of why type 2 diabetes develops, and what can be done to treat it.  

“Our ambition is for as many people as possible to have the chance to put their type 2 diabetes into remission and live well for longer. The findings of the ReTUNE study potentially take us a significant step closer to achieving this goal by showing that remission isn’t only possible for people of certain body weights. 

“It is our hope that ReTUNE – as DiRECT did before it – will inform the development of services and support so that many more people with type 2 diabetes will have the possibility of remission open to them."

Professor Taylor said:

“This is very good news for everyone with type 2 diabetes, not only pointing the way forward for effective return to health but also challenging the misconceptions clinging to the condition.”

Is it safe to lose weight if you’re not living with overweight or obesity? 

It could be unsafe to lose weight if your BMI is in the underweight category. If your BMI is in the healthy category, getting support to lose an appropriate amount of weight can be helpful to your health if you have type 2 diabetes or are at risk of developing it.

But losing too much weight and your BMI falling in to the underweight category could affect your immune system and your bones. That’s why it’s really important to speak to your diabetes team so that you can approach any weight loss journey safely.  

If you have a lower body weight and want support to try to go into remission you can speak to your doctor for a referral to a specialist dietitian.

Why should I lose weight if my BMI is in the healthy range?

The ReTUNE study has shown us that some people with lower body weights and type 2 diabetes can benefit from losing weight. To find out if losing weight may be appropriate for you, speak to your diabetes team who may refer you to a specialist dietitian.

Catch up on day 4 conference highlights

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