Achieving Diabetes Remission

According to the American Diabetes Association, in 2015 30.3 million Americans -- 9.4% of the population -- had diabetes. 90-95% of people with diabetes have type 2 diabetes where insulin resistance develops slowly over several years, leading to increasing blood sugar levels that damage blood vessels and nerves and which can lead to heart disease, vision loss, and kidney disease.Healthy food choices, regular physical activity, and weight loss are key strategies to manage blood sugar levels and reduce the risk of developing diabetes complications. While it’s impossible to cure diabetes, researchers continue to look for strategies for remission, where blood sugar levels drop to healthy, non-diabetic ranges.The Diabetes Remission Clinical Trial (DiRECT) aimed to determine if treating people with type 2 diabetes with current best practices that include medications, or focusing on weight loss, lead to diabetes remission. People were enrolled into the study if they were between 20 and 65 years old, had a BMI of between 27 and 45 kg/m2, had type 2 diabetes for a maximum of 6 years and were not receiving any forms of insulin therapy.The weight loss group used a low-calorie liquid diet of 825-853 calories per day for 3 months, which was followed by reintroducing whole foods over the next 2-8 weeks and an ongoing monthly program to promote weight loss maintenance. After the liquid diet phase, participants used step counters to reach up to 15,000 steps per day. The control group followed the current best practice recommendations to manage type 2 diabetes, including using oral medications.Complete remission of diabetes, as defined by an HbA1c of <6.5% after withdrawal of all antidiabetic medications for at least 2 months and fasting blood sugars <126 mg/dL, was observed in 46% of participants in the weight management group and only 4% of patients in the control group. Two years of ongoing follow-up showed that about half of the people who originally gained remission of type 2 diabetes remained in remission. After 12 months, 24% of the participants in the weight loss group lost at least 33 pounds compared to no participants in the control group. The more weight participants lost, the higher the remission rate:

• No one who gained weight achieved remission.
• 7% of participants who maintained their weight or lost up to 10 pounds achieved remission.
• 34% of participants who lost 11- 22 pounds achieved remission.
• 57% of participants who lost 23-33 pounds achieved remission.
• 86% of participants who lost more than 33 pounds achieved remission.

Take away tips:

• It’s possible for people with type 2 diabetes to lower blood sugar levels to healthy, non-diabetic levels with weight loss and exercise when these changes are made soon after the initial diabetes diagnosis.
• The longer people stick with a weight loss program, including a maintenance phase, the more weight they tend to lose.
• Losing weight rapidly with a very low-calorie liquid diet program monitored closely by a physician can set the stage for diabetes remission.

By Lynn Grieger, RDN, CDE, CPT, CHWCReferences

1. American Diabetes Association. Statistics About Diabetes. http://www.diabetes.org/diabetes-basics/statistics/  last edited 3-22-18. Accessed 7-28-19.
2. Centers for Disease Control and Prevention. Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/type2.html  last reviewed 5-30-19. Accessed 7-28-19.
3. Lean ME et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140-6736(17)33102-1. Epub 2017 Dec 5.
4. Diabetes in Control. The DiRECT Study: Analysis of Patients with Type 2 Diabetes Remissioin – ADA 2019. Author: Adam Chalela.  http://www.diabetesincontrol.com/the-direct-study-analysis-of-patients-with-type-2-diabetes-remission-ada-2019/ published 6-18-19. Accessed 7-28-19