A brief history of type 2 diabetes reversal

2021 marks 100 years since scientists discovered insulin as a treatment for type 2 diabetes—a breakthrough discovery that has since saved millions of lives around the world. Now, the type 2 diabetes research community is just getting started with the next big thing—type 2 diabetes reversal.
Annabel Nicholson
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Quick summary

  • After two small studies at the University of Newcastle found a nutritional way to reach type 2 diabetes reversal, the DiRECT trial was set up to explore this further and at scale.
  • In the DiRECT trial, hundreds of patients were monitored during a 12-month programme combining a low calorie diet and behaviour change.
  • 86% of participants in the DiRECT trial who lost over 15kg of weight successfully reversed their type 2 diabetes.
  • There's still a lot to learn about type 2 diabetes reversal but there’s no doubt that we’re at a turning point in type 2 diabetes treatment.

We talk about type 2 diabetes reversal so much here at Habitual that it can be easy to forget just how new this discovery is. So, while we celebrate 100 years of life-changing diabetes discoveries, we thought it would be the perfect time to introduce you to the research that’s going on to make remission a reality and the scientists behind it.

The beginning

We’ve chosen to start our story of remission in 2008, when a study of bariatric surgery patients found that type 2 diabetes remission was achieved in patients who lost 15kg or more in weight. [1] These results were really exciting, but researchers struggled to understand the link between weight loss and type 2 diabetes remission.

Interestingly, Professor Roy Taylor from Newcastle University had spotted that in patients about to go into theatre for a bariatric procedure, their blood sugars had normalised. Prior to bariatric surgery, patients are on a low-calorie diet to make sure the stomach and intestines are empty for the procedure. This got him thinking: is there a nutritional way to achieve remission?

In 2011, Professor Taylor and his team decided to explore this further by putting a small group of people with type 2 diabetes through a significant weight loss programme and studying what was happening inside their body. Astonishingly, MRI scans of the patients showed that after 8 weeks of a low-calorie diet, the amount of fat in the liver and pancreas reduced. The crowning glory came when the researchers discovered that as a result of this fat loss, the organs were able to regain their ability to control blood sugar—within just one week, the patient’s blood sugar levels fall to within a normal range without medication.[2,3]

For a condition that had, up until that moment, been thought of as irreversible and progressive, this was a monumental moment for researchers, doctors, and patients alike.

The middle

The two studies at Newcastle University were very small, covered a short amount of time, and  were based in a research setting. To help understand this mechanism of remission further, and to see if it would be possible in a real-life setting, Professor Taylor joined forces with Professor Mike Lean from the University of Glasgow to run the now famous DiRECT trial. 

The trial studied hundreds of patients undergoing a 12-month programme combining total diet replacement and behaviour change. After the first year, almost half (45.6%) of the participants had lost enough weight to put their type 2 diabetes into remission. Even more remarkably, in those that lost over 15kg of weight, 86% reached remission. At the 2 year mark, 70% of those in remission after year 1 were still in remission. These second year results showed once again that remission is closely linked to weight loss, but that’s not the only benefit—participants reported an improved quality of life, better blood sugar control, and a reduced need for diabetes medications.[4] 

The end

Well, we’re nowhere near the end of this work to be honest! Type 2 diabetes reversal is an extraordinary discovery and researchers are continuing this work so that they can further understand the intricacies of remission, such as the best way to deliver remission at scale, how we can help people stay in remission for longer, and why some people don’t reach remission, even with substantial weight loss. While it's early days in terms of our collective understanding of remission, there’s no denying that we’re at a turning point that will hopefully change the lives of millions of people around the world. 

Our goal at Habitual has always been to help as many people as possible reach remission, and even more importantly stay there, for a happy and healthy life.

Dr Ian Braithwaite, co-founder of Habitual

That’s where we come in—at Habitual we want to share this incredible discovery with as many people as possible, and to help them reach it. Our 6-month programme is geared towards type 2 diabetes reversal but our patients also celebrate loads of other successes along the way, such as reducing the body’s need for medication, losing weight for life, and building new, healthy habits. We do this through a combination of total diet replacement, an expert behaviour change course, and unparalleled daily support. The science proves it’s an effective tool and our patients tell us the level of support we offer really sets us apart.

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The people behind the papers

Meet the scientists behind this life-changing research:

Professor Roy Taylor

Newcastle University

Newcastle-based Professor Taylor is part of the team behind the major discovery that type 2 diabetes is in fact reversible. A medicine graduate from the University of Edinburgh, Professor Taylor has been researching type 2 diabetes for over 40 years. As well as his breakthrough work on remission with Professor Lean, he also developed the system now used throughout the UK for screening for diabetic eye disease, which has resulted in a major reduction in blindness due to type 2 diabetes across the country.

Professor Mike Lean

University of Glasgow

A prominent nutritionist, it was Professor Lean and his team who proved that waist circumference is an indicator of the risk of heart disease, touting the use of the humble tape measure as an easier way to measure risk. His research also encompasses diabetes and Professor Lean joined forces with Professor Taylor to work on the DiRECT trial (the study that proved remission is possible) to develop and evaluate cost-effective weight management that can be used routinely in the NHS.

Dr David Unwin

Norwood Surgery, Southport

A strong advocate of lifestyle medicine, Dr Unwin was awarded the prestigious NHS Innovator of the Year award in 2016 for his work with diabetes patients. A lot of Dr Unwin’s research hails the low-carb diet as a treatment plan for type 2 diabetes, and in 2017-2018, his practice saved £57,000 on drugs for type 2 diabetes, hypertension, and other conditions by offering patients this dietary alternative to medications. He’s now doing his best to spread the word about the power of low-carb among other medical professionals.

Professor Ildiko Lingvay

University of Texas Southwestern Medical Center 

An endocrinologist (someone who specialises in hormones), Professor Lingvay specialises in clinical research in obesity, diabetes, and metabolic complications. She’s currently leading a research programme that hopes to understand why type 2 diabetes develops and how it relates to obesity. In a recent paper, the professor proposes that many patients with type 2 diabetes would benefit from a weight-centric approach to treating their condition.[5]

Thank you

So, any time you hear about type 2 diabetes research or remission, spare a thought for these incredible researchers dedicating their careers to understanding the causes of diabetes, finding life-changing treatments, and bringing us closer to a cure—thank you.


[1] Dixon, J.B., O'Brien, P.E., Playfair, J., et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. (2008). JAMA 23;299(3):316-23. Accessible here.

[2] Lim, E.L., Hollingsworth, K.G., Aribisala, B.S., et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. (2011). Diabetologia 54(10):2506-14. Accessible here.

[3] Taylor, R., Al-Mrabeh, A., Sattar, N. Understanding the mechanisms of reversal of type 2 diabetes. (2019). Lancet Diabetes Endocrinol 7(9):726-736. Accessible here.

[4] Lean, M.E.J., Leslie, W.S., Barnes, A.C., et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. (2019). Lancet Diabetes Endocrinol 7(5):344-355. Accessible here.

[5] Lingvay, I., Sumithran, P., Cohen, R.V., le Roux, C.W. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. (2021). Lancet. Epub ahead of print. Accessible here.

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