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How to reverse type 2 diabetes with weight loss

Type 2 diabetes is a serious and common health condition, making effective and costly treatment a major health priority. In a remarkable turn of events, scientists have discovered that it can in fact be reversed, bringing hope to millions of people living with type 2 diabetes around the world.
Rin Mosher
3/24/2022
11
min read
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Quick summary

  • Type 2 diabetes is a prevalent condition that can have serious complications around the body
  • Scientists have discovered that type 2 diabetes can be put into remission
  • Weight loss seems to be key to effectively managing and reversing type 2 diabetes
  • There are a number of different weight loss methods that can help reverse type 2 diabetes depending on what best suits you and your lifestyle

Type 2 diabetes is a major problem around the world, affecting an estimated 462 million individuals globally [1]. Requiring lifelong monitoring, living with type 2 diabetes can be tough, not only in the practical aspects of dealing with the condition every day but also its mental burden. Without care and attention, type 2 diabetes can cause serious health problems around the entire body.

The NHS spends £10 billion treating type 2 diabetes and its complications every year, making effective treatment a major health priority.[2] In recent years, life-changing research has made the hope of finding a solution a reality.

Can type 2 diabetes be reversed?

Over the years type 2 diabetes can get progressively worse, causing increasingly dangerous and irreversible health complications as a result of elevated blood sugar levels. Once considered a lifelong, chronic condition, researchers have recently discovered that up to 60% of type 2 diabetes can be reversed.[3] An exciting new area of research, the idea of type 2 diabetes reversal, meaning blood sugar levels can once again be controlled naturally rather than with medication, is life-changing for millions of people around the world.

The theory behind type 2 diabetes reversal relates to weight loss. Type 2 diabetes is a complex condition that has many risk factors and while no single factor is responsible for its development, scientists have found that significant weight loss can help someone reach remission.[4]

Before going any further, we want to take a moment to highlight a couple of points worth keeping in mind as you keep reading. We use the phrases ‘reversal’ and ‘remission’ to describe the reversal of the underlying disease process, which puts type 2 diabetes into remission. While an incredible feat, it's important to note that this doesn’t equate to a cure. Type 2 diabetes remains a lifelong condition, so someone in remission can absolutely return to a state of high blood sugar (and therefore type 2 diabetes). 

The science behind type 2 diabetes reversal

As with everything we write about, there's substantial scientific evidence demonstrating the role of weight loss in type 2 diabetes reversal.

The Diabetes Remission Clinical Trial (DiRECT) enrolled 306 participants, all with type 2 diabetes that had been diagnosed within the preceding 6 years, to determine the role of weight loss in type 2 diabetes remission following promising results from two previous smaller studies.[4-6] The aim of DiRECT was to explore these results further and test whether the method was possible for larger numbers of patients.

Half of the study participants received the existing care plan for type 2 diabetes while the other half followed a low-calorie total diet replacement (TDR) before gradually reintroducing healthy food and following a behaviour change programme. The research team is still documenting the long-term progress of participants but results from the early years of the trial are incredibly exciting.

A weight loss of 15kg or more increases your chance of reaching and staying in remission

Lean et al, Lancet

After the first year, nearly half the participants (45.6%) on the low-calorie TDR programme were in remission. The amount of weight lost seemed to strongly influence remission, with 86% of people who lost 15kg+ reversing their type 2 diabetes, 57% of those who lost 10-15kg, and 34% of people who lost 5-10kg. After the second year, 70% of those in remission at the 1-year mark were still in remission. The results of the second year further confirmed that a greater weight loss led to higher chances of remission, with 64% of those in remission after the second year having lost more than 10kg.[4,7]

The results of a similar study, published after the DiRECT trial, found similarly astounding results—following a low-calorie TDR and physical exercise programme, over 60% of participants reached type 2 remission.[3]

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Questions that still need answering

The findings from these two studies in particular are life-changing—not only have they shown that significant weight loss and behaviour change can help people lose enough weight to reach type 2 diabetes remission, they’ve also demonstrated that it can be cost-effective when scaled up. 

That being said, there are still questions that need answering. Both of these studies have so far only published results covering a relatively short period of time (1-2 years). While a large percentage of participants did stay in remission after the second year of the DiRECT trial, some people didn’t and this raises the question of permanence in type 2 diabetes reversal. Researchers are now looking into how people who reach remission can stay there and also how people who lost weight but didn’t enter remission can get there.

Another trial currently underway, the ReTUNE study, is investigating how people who don’t need to lose weight can reach remission.[8] You’ll have noticed that much of this research focuses on significant weight loss but with 10% of people with type 2 diabetes not needing to lose weight, researchers want to find out how people of a healthy weight can reverse type 2 diabetes.

The ReTUNE study is still underway but early results look promising—short 2-week cycles of TDR (as opposed to the 3 months of TDR in DiRECT) seem to be enough to help two-thirds of participants reach remission![8]

How much weight loss is needed to reverse type 2 diabetes?

Before we dive into numbers, we wanted to first recap why weight loss leads to type 2 diabetes reversal. When we think of weight loss, we probably think of the visible fat—the fat under the skin—but what about internal fat? Studies have shown that people with type 2 diabetes, regardless of they’re ‘visibly’ overweight, tend to have internal fat deposits in their liver and pancreas, the two organs responsible for natural control of blood sugar.[5] These fat deposits stop these two organs from functioning properly, which is when blood sugar levels start rising. All of the research trials mentioned above found that with enough weight loss these fat deposits disappear, and the liver and pancreas regain their ability to regulate blood sugar naturally. The key takeaway here is that weight loss plays a key role in managing and controlling type 2 diabetes (regardless of remission) thanks to its beneficial effects on insulin resistance and blood sugar levels. 

So, how much weight loss are we talking about? Well, we know that the more weight you lose, the more likely you are to reach remission. Of course, all our bodies are different and one theory even suggests that we all have a ‘personal fat threshold’—that is, the amount of fat our body can take on before experiencing complications such as type 2 diabetes. So, the exact amount will differ from person to person but the most successful results in the trials were seen when an overweight individual lost 15kg or more.[3,4,7] But remember, any weight loss will have a positive effect on blood sugar levels, type 2 diabetes symptoms, and general quality of life.

Methods of weight loss to reverse type 2 diabetes

As mentioned above, a weight loss of 15kg or more increases your chances of reaching and staying in remission but it's important to keep yourself safe and healthy if aiming for such a significant weight loss. There are a number of different weight loss approaches to try, largely depending on your health goals, lifestyle, and budget. Some are geared towards the goal of remission, while others might take longer and focus on keeping blood sugar levels more stable. 

Early research into type 2 diabetes looked at patients undergoing bariatric surgery.[9] While effective, the trials discussed in this article have highlighted that it is possible to reach remission through dietary and lifestyle intervention. There are a lot of different factors to consider when choosing a weight loss approach but a good place to start is to read up on different eating methods such as total diet replacement, low-carb, keto, veganism, and even intermittent fasting. Think about what’s right for your daily schedule, lifestyle, family, and budget. 

It’s important at this stage to highlight the importance of behaviour change. While losing a significant amount of weight can improve your health and help you reverse type 2 diabetes, it's vital to couple this with behaviour change to keep the weight off—and keep you in remission.[10] By taking the time to build healthy eating habits and physical exercise into your daily routine, you’ll set yourself up for long-term success no matter your health goal. Before starting a new eating plan or exercise routine, we do recommend speaking to your doctor first—they can help advise you on which approach to try and can make any necessary adjustments to your medication to keep you safe and well.

References

[1] Khan, M.A.B., Hashim, M.J., King, J.K., et al. (2020). Epidemiology of type 2 diabetes - global burden of disease and forecasted trends. J Epidemiol Glob Health 10(1):107-111. Accessible here.

[2] The cost of diabetes. Diabetes UK. Retrieved 7 March 2022. Accessible here.

[3] Taheri, S., Zaghloul, H., Chagoury, O., et al. (2020). Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet 8(6):477-489. Accessible here.

[4] Lean, M.E.J., Leslie, W.S., Barnes, A.C., et al. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 391(10120):541-551. Accessible here.

[5] 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.

[6] 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

[7] 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.

[8] ReTUNE type 2 diabetes study preview. Diabetes UK. Retrieved 26 January. Accessible here.

[9] 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.

[10] Astbury, N.M., Aveyard, P., Nickless, A., et al. (2018). Doctor referral of overweight people to low energy total diet replacement treatment (DROPLET): pragmatic randomised controlled trial. BMJ 362:K3760. Accessible here.

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