Not enough people know that Type 2 diabetes may be reversed through weight loss, experts have suggested.
Researchers from the University of Glasgow and University of Newcastle said both patients and doctors may not realise the condition can be reversed and called for greater awareness of ‘diabetes remission’.
“If diabetes patients are able to lose a large amount of weight they will return to normal,” Professor Mike Lean, a specialist in human nutrition at University of Glasgow, told HuffPost UK.
“We know anecdotally it happens. We’ve seen it with bariatric surgery and we’ve seen it with individuals who have not accepted the diagnosis and have got rid of it. In most cases you need to lose a large amount of weight (15kg or more). If you catch the diabetes early, there’s a chance it might reverse with less weight loss.”
Professor Lean and his colleagues have also called for better documentation and surveillance of diabetes ‘remissions’ to improve public health and reduce healthcare costs. The NHS spends almost £1 billion a year (£22 million a day) on anti-diabetes drugs, and costs are rising worldwide as diabetes rates and drug prices escalate.
Type 2 diabetes is a common long-term condition affecting 3.2 million people in the UK. It is caused when the pancreas doesn’t produce enough insulin to maintain a normal blood glucose level or the body is unable to use the insulin that is produced. This results in a person’s blood sugar levels rocketing.
Current guidelines for tackling Type 2 diabetes advise reducing blood sugar levels and cardiovascular risks, primarily with drugs and general lifestyle advice.
But many patients still develop complications and life expectancy remains up to six years shorter than for those without diabetes. The diagnosis also carries important social and financial penalties for individuals as well as poor health prospects, the researchers said.
What needs to change?
Professor Lean believes doctors should be letting patients know there’s potential to reverse the problem as soon as they’re diagnosed.
“Patients are currently told they have Type 2 diabetes and that they can take tablets to manage it,” he said. “But what they really have is this horrible, ghastly destructive disease which will damage every organ in the body.
“People need to be told about the severity of it. They need to be told to go through this difficult programme to lose the excess weight and keep it off, not just receive an offer of tablets.
“The problem is that nobody has suggested these people can become non-diabetic.”
Professor Lean and his team of researchers said there is consistent evidence showing that weight loss is associated with extended life expectancy for people with diabetes, and that weight loss of around 15kg can result in total remission of Type 2 diabetes.
Achieving remission not only has health benefits, they wrote in the BMJ, but it also produces a strong sense of personal achievement and empowerment, removes stigma and may even reduce insurance premiums.
Yet remission is rarely recorded, they said. For example, a US study found remissions in only 0.14% of 120,000 patients followed for seven years, while the Scottish Care Information Diabetes database, which includes every patient in Scotland, shows that less than 0.1% of those with Type 2 diabetes were coded (or documented) as being in remission.
The research team suggest that lack of agreed criteria and guidance may have led to hesitation in coding remission, but the main reason for the low rates of recording is probably that few patients are attempting or achieving it in the first place.
“It is in everybody’s interest to reclassify people with Type 2 diabetes when they become non-diabetic,” wrote the authors.
“Official guidelines and international consensus for recording diabetes in remission are needed.”
In response to the report, Emily Burns, head of research communications at Diabetes UK, said: “The ability to put Type 2 diabetes into remission could be transformative for millions of people around the world, and evidence is building to suggest that it’s possible. In the meantime, we need to ensure that those who do achieve remission are recognised in the right way and receive the right care.”
The charity is currently funding research to find out how to put Type 2 diabetes into remission, as well as who might benefit and whether it’s effective for the long-term.
The evidence so far
A 2016 study found Type 2 diabetes patients could completely reverse their condition by sticking to a low calorie diet.
A group of 30 volunteers with Type 2 diabetes were asked to follow a very low calorie diet, consisting of between 600-700 calories per day. At the end of the trial, 12 patients - all of whom had suffered diabetes for less than 10 years - had reversed their condition.
Six months later they still remained free of the condition and a 13th patient had managed to reverse their diabetes too.
Study author Professor Roy Taylor, from Newcastle University, told the Press Association: “What we have shown is that it is possible to reverse your diabetes, even if you have had the condition for a long time, up to around 10 years.
“If you have had the diagnosis for longer than that, then don’t give up hope - major improvement in blood sugar control is possible.
“The study also answered the question that people often ask me - if I lose the weight and keep the weight off, will I stay free of diabetes? The simple answer is yes.”
