A Team of researchers putting people with Type 2 diabetes on a low calorie diet has found the hidden causes of the condition and established that it is curable.
                        
Experts urge healthcare professionals to better record remission rates.

            

A Team of researchers putting people with Type 2 diabetes on a low calorie diet has found the hidden causes of the condition and established that it is curable.

 

But, many doctors and patients do not realize that weight loss can reverse type 2 diabetes. Instead, there is a widespread belief that the disease is "progressive and incurable,"according to a new report published in the BMJ.


Professor Roy Taylor at Newcastle University and his colleagues, UK have spent almost four decades studying the condition and will present an overview of his findings at the European Association for the Study of Diabetes (EASD 2017) in Lisbon.


The result of the research can be summarized as follows:

  • Excess calories leads to excess fat in the liver
  • As a result, the liver responds poorly to insulin and produces too much glucose
  • Excess fat in the liver is passed on to the pancreas, causing the insulin producing cells to fail
  • Losing less than 1 gram of fat from the pancreas through diet can re-start the normal production of insulin, reversing Type 2 diabetes
  • This reversal of diabetes remains possible for at least 10 years after the onset of the condition


“I think the real importance of this work is for the patients themselves,”Professor Taylor says. “Many have described to me how embarking on the low calorie diet has been the only option to prevent what they thought – or had been told – was an inevitable decline into further medication and further ill health because of their diabetes. By studying the underlying mechanisms we have been able to demonstrate the simplicity of type 2 diabetes.”

Fig: People with diabetes in wordwide (in millions)

            

This is despite there being "consistent evidence" that shedding around 33pounds (15 kilograms) often produces "total remission" of type 2diabetes, note Prof. Mike E. J. Lean and other researchers from the University of Glasgow in the United Kingdom.


The thrust of their paper is that greater awareness,when combined with better recording and monitoring of remissions, could result in many more patients no longer having to live with type 2 diabetes and a massive reduction in healthcare costs.


The global burden of type 2 diabetes has nearly quadrupled over the past 35 years.In 1980, there were around 108 million people with the disease, and by 2014,this number had risen to 422 million.


The vast majority of diabetes cases are type-2 diabetes which is a disease that results the body becomes less effective at using insulin to help cells to convert blood sugar, or glucose, into energy. Excess body weight is a main cause of this type of diabetes.


Only in the United States, an estimated 30.3 million people, or around 9.4 percent of the population, have diabetes - including around 7.2 million who do not realize it.


Diabetes accounts for a high portion of the national bill for taking care of the sick.The total direct and indirect cost of diagnosed diabetes in the U.S. was estimated to be $245 billion in 2012.


In that year, of the $13,700 average medical spend for people with diagnosed diabetes, more than half (around $7,900) was directly attributed to the disease.

Present treatment for diabetes mainly rely on drugs

Study leader Prof. Lean and colleagues note that the current management guidelines for type 2 diabetes rely on reducing blood sugar levels and cardiovascular risks primarily through the "use of anti diabetes drugs, with only lip service paid to diet and lifestyle advice."


Therefore the result is that many patients develop further health problems and live, on average, 6 years less than people who do not have diabetes.


In the meantime, while remission of the disease"is clearly attainable for some, possibly many, patients," the authors note that currently, it is "very rarely achieved or recorded."


As they highlight a U.S. study that followed 120,000 patients over 7 years and found that only 0.14 percent of them were recorded as remissions.


A further example is that of the Scottish Care Information database, which holds records for every patient in Scotland. It shows that only 0.1 percent of type 2diabetes patients are coded as being in remission.

How weight loss might reverse type 2 diabetes

“The good news for people with Type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you're likely to be able to reverse it by moving that all important tiny amount of fat out of the pancreas. At present, this can only be done through substantial weight loss”, Professor Taylor adds.


The Counterbalance study published in 2016,demonstrated that Type 2 diabetes remains reversible for up to 10 years in most people, and also that the normal metabolism persists long term, as long as the person doesn’t regain the weight.


Professor Taylor explained the science behind the mechanisms: “Work in the lab has shown that the excess fat in the insulin producing cell causes loss of specialized function. The cells go into a survival mode, merely existing and not contributing to whole body well being.Removal of the excess fat allows resumption of the specialized function of producing insulin. The observations of the clinical studies can now be fully explained.”


He added: “Surprisingly, it was observed that the diet devised as an experimental tool was actually liked by research participants. It was associated with no hunger and no tiredness in most people,but with rapidly increased well being. The ‘One, Two’ approach used in the Counterbalance study was a defined two phase programme. The Phase 1 is the period of weight loss – calorie restriction without additional exercise. A carefully planned transition period leads to Phase 2 - long term supported weight maintenance by modest calorie restriction with increased daily physical activity.”


This approach consistently brings about 15kg of weight loss on average.

A good coding guidance is needed to treat type 2 diabetes

Part of the problem, argue the study authors, is that clinicians hesitate to code patients as being in remission because of a lack of agreed criteria and guidance.


However,they suggest that the main likely cause of low remission recording in type 2diabetes is that few patients are actually trying to achieve it.


They urge health authorities worldwide to agree clearer guidelines about how to measure type 2 diabetes remission and make sure that it is officially recorded.


"Appropriate coding," they note, "will make it possible to monitor progress in achieving remission of type 2 diabetes nationally and internationally and to improve predictions of long-term health outcomes for patients with a known duration of remission."

Bottom Line

After the details were posted on the Newcastle University website, this has been applied clinically and people who were highly motivated have reported that they have reversed their type 2 diabetes and continued to have normal glucose levels (normoglycaemic) over years.


A further study in general practice, the Diabetes Remission Clinical Trial(DiRECT) funded by Diabetes UK is now underway to determine the applicability of this general approach to routine Primary Care practice with findings due before the end of the year.

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