Structured weight management programme for remission of Type 2 diabetes
Our scientists are busy researching a new weight management treatment, which includes a low-calorie diet, to help people put their Type 2 diabetes into remission. The 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.
A year into the research and we've made a breakthrough – and we’re excited to share the news with you.
Results so far
The first year results are hugely promising. They show 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%) 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% of people who lost more than 15kg on the programme were in remission after a year, as were 57% of people who lost 10 to 15kg, and 34% who lost 5 to 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% 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.
In this study, the team defined remission as having blood glucose levels (HbA1c) below 6.5% (48mmol/mol) after 12 months, with at least 2 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.”
ReadIsobel'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.
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 8 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.
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 8 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.
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 aboutlow-calorie diets.
We need more research
DiRECT isn’t over yet. We don’t know how long remission will last for and need to work out whether it’s possible to deliver this type of treatment through the NHS.
That’s why 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 see if a treatment like this could be offered to people with Type 2 diabetes in the future.
If this study shows that this treatment is an effective and practical way to put Type 2 diabetes into remission, now and in the longer-term, it could completely transform the way Type 2 diabetes is treated.
It could be of enormous benefit to the millions of people living with Type 2 diabetes in the UK – helping people with Type 2 live for longer and improving their quality of life.
Dr Elizabeth Robertson, our Director of Research, said these latest results are hugely promising but it’s just the beginning:
“These first year findings of DiRECT demonstrate the potential to transform the lives of millions of people. We’re very encouraged by these initial results, and the building of robust evidence that remission could be achievable for some people.
The trial is ongoing, so that we can understand the long-term effects of an approach like this. 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?