The findings of the Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT) have revealed that more than a third (36%) of people with type 2 diabetes who took part in the weight management programme, delivered in GP practices, are in remission two years later.
The results were announced at our Professional Conference in 2019 and published in The Lancet Diabetes & Endocrinology.
The new results build on the first-year findings, announced in December 2017, which showed that 46% of participants were in remission after twelve months. A year later, 70% of those participants are still in remission.
Remission is closely linked to weight loss, 64% of participants who lost more than 10 kilos were in remission at two years. Participants regained some weight, as expected, between the first and second years of the trial. However, those who were in remission after one year, and who had stayed in remission, had lost a greater amount of weight on average (15.5 kilos) than those who didn’t stay in remission (12 kilos).
As well as resulting in remission for some people, there appear to be additional benefits to taking part in a weight management programme overall. These include a reported better quality of life, improved blood glucose levels and a reduced need for diabetes medications.
The future of remission research
Understanding why significant weight loss results in remission of Type 2 diabetes is at the heart of DiRECT. Studies have so far revealed that weight loss reduces the levels of fat inside the liver and pancreas, which in turn leads to the pancreas ‘rebooting’ insulin production again.
By understanding the biology of remission, Professors Taylor and Lean believe it should be possible to provide better care for people diagnosed with Type 2 diabetes in the future.
Professor Roy Taylor, Director of Newcastle University’s Magnetic Resonance Centre, and co-primary investigator of the DiRECT trial, said:
"These results are a significant development, and we now understand the biological nature of this reversible condition. However, everyone in remission needs to know that evidence to date tells us that your Type 2 diabetes will return if you regain weight."
Professor Mike Lean, Head of Human Nutrition at Glasgow University, diabetes specialist physician at Glasgow Royal Infirmary, and co-primary investigator of DiRECT, said:
“Proving in DiRECT that Type 2 diabetes can be put into remission for two years in over two thirds of people, if they can lose over 10 kilos, is incredibly exciting. Achieving that entirely in NHS primary care is vital.
“People with Type 2 diabetes, and healthcare professionals, have told us their top research priority is ‘can the condition be reversed or cured’. We can now say, with respect to reversal, that yes it can. Now we must focus on helping people maintain their weight loss and stay in remission for life.”
Dr Elizabeth Robertson, our Director of Research said:
“Remission of Type 2 diabetes can be life changing, DiRECT offers one potential solution, we are committed to working with the researchers and the NHS to ensure these exciting findings reach people with Type 2 diabetes as soon as possible.
"But we know Type 2 diabetes is a complex condition, and this approach will not work for everyone. That’s why we’re continuing to invest in further research, to understand the biology underlying remission and find ways to make remission a reality for as many people as possible.”
What does remission mean for you?
In DiRECT, people were defined as in remission if they had long-term blood glucose levels (HbA1c) of less than 48mmol/mol (6.5%), without needing to use any Type 2 diabetes medications.
Kathleen took part in our DiRECT trial and has been in remission for two years.
“I was so pleased when I was told I was in remission. I thought it’s all been worth it - going to the hospital, taking blood and doing all the tests. When they showed me the scan of the liver and the difference in fat, I was elated.
"Ironically, I wasn’t bothered about the outside, but the fat on the inside around the liver. It’s been a good journey!”