Remission should be the primary treatment goal of GPs for people with type 2 diabetes

Achieving “remission” for people with type 2 diabetes through dietary approaches and weight loss should be the primary goal of care for general practitioners and healthcare professionals, concludes a large-scale review of clinical evidence led by researchers at UCL and Aston University .

Type 2 diabetes (T2DM) is a serious condition that is caused when the body starts to resist the insulin made in the pancreas and not enough insulin is made. This leads to high blood sugar (glucose) levels and is linked to several health problems, including an increased risk of heart disease, blindness, and amputation. T2DM affects around 3.9 million people in the UK and 179 million worldwide. The care and treatment of T2DM costs the NHS about £ 10 billion a year.

Taking into account all of the evidence, our review suggests that remission should be discussed as the primary treatment goal in people with type 2 diabetes. There are several dietary approaches that have been shown to result in T2DM remission, although meal replacements currently offer the best evidence of quality. Low-carbohydrate diets have been shown to be highly effective and should also be considered as a dietary approach to remission. “

Dr. Duane Mellor, Study Corresponding Author, Aston University

The lead author Dr. Adrian Brown, UCL Division of Medicine, said, “Traditionally, T2DM has focused on controlling a person’s blood sugar with medication, but the approach doesn’t address the underlying causes of T2DM significant weight loss of 10-15 kg, either through weight loss surgery or dietary approaches, can lead to remission of type 2 diabetes (non-diabetic blood sugar levels). “

For the study, published in the Journal of Human Nutrition & Dietetics, specialist nutritionists and obesity experts conducted a critical narrative review of over 90 research papers on international clinical trials and clinical practice data on diet methods used to treat T2DM.

The study found that a meal replacement diet helped about one in three (36%) people achieve remission successfully, while a low-carb diet helped about one in five (17.6%) people get one Achieve remission and maintain it for at least two years. People who lost the most weight and kept the weight off using these two nutritional approaches were able to stay in remission.

Low-calorie and Mediterranean diets have also been able to help people achieve remission – but at much lower rates. Only about 5% of people on a reduced calorie diet remained in remission after a year, while only 15% of people on a Mediterranean diet remained in remission after a year.

In developing their results, the research team had to take into account the fact that there is no single definition of remission; it is typically defined as returning to non-diabetic blood sugar levels (glycated hemoglobin below 48 mmol / mol) without taking diabetes medication. However, other definitions say that weight (especially mid-range fat) must be lost to achieve remission and others that medication can still be used.

In addition, some reports suggest that a low-carb diet can normalize blood sugar levels even without weight loss. It does this so that when carbohydrates are eaten they are broken down into sugar, which causes our blood sugar levels to rise. A low-carbohydrate diet means that less blood sugar appears in the bloodstream, which leads to improved blood sugar control. However, when weight loss is not achieved, but individuals are able to achieve non-diabetic blood sugar, the authors suggest that this should be referred to as reduction instead, as the underlying mechanisms of T2DM are not addressed.

Dr. Brown said, “The evidence is clear that the main reason for remission remains the degree of weight loss a person has achieved. Therefore, for those who do not achieve weight loss but do achieve non-diabetic blood sugar, we suggest that this is not remission per se, but rather “alleviation” of their diabetes. “

Research concludes that although weight loss appears to be the best predictor of success in remission, fat loss from the pancreas and liver is believed. They suggest that for future studies it will be important to compare how these diets work for different races, as T2DM may occur at lower body weights in different races that may have less weight to lose.

Mellor added, “Not everyone will be able to achieve remission, but people who are younger (under 50), male, have had type 2 diabetes for less than six years, and are more likely to lose weight are more likely successfully.

“This could be because these people are able to fight the root causes of their diabetes, regaining the pancreas’ ability to produce insulin and the ability of the liver to use it. However, that does not mean that others will not be successful if they improve. ”Change their diet and lifestyle and lose weight.

“Whether a person is in remission or not, lowering blood sugar levels is important in managing the negative effects of type 2 diabetes and reducing the risk of complications. But when it comes to dieting, the most important thing is to choose one that suits you – one that you are likely to stick to for the long term. “

The first meeting that led to the writing of this paper was sponsored by the British Dietetic Association and Diabetes UK.

Source:

Journal reference:

Brown, A., et al. (2021) Dietary Strategies for Type 2 Diabetes Remission: A Narrative Review. Journal of Human Nutrition and Dietetics. doi.org/10.1111/jhn.12938.

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