The possibility of achieving a permanent remission from diabetes is a topic of intense debate. On one hand, there are studies suggesting success, while on the other, doubts about long-term effectiveness and the current definition of remission persist.
At the European Association for the Study of Diabetes (EASD) Annual Meeting in Hamburg, Germany, this topic was a focal point of discussion.
Professor Roy Taylor from Newcastle University, UK, presented arguments in favor of the possibility.
Professor Taylor demonstrated through various studies that people with type 2 diabetes can achieve lasting remission by following a low-calorie diet. His research began with the Counterpoint study in 2011, revealing that a very low-calorie diet can reverse type 2 diabetes. This study also identified excess liver and pancreas fat as a cause of diabetes, emphasizing fat loss in these organs as critical for remission.
However, to confirm these findings, further studies like Counterbalance and DiRECT were necessary. The 2016 Counterbalance study involved 30 individuals with type 2 diabetes on an 800-calorie diet for eight weeks. The results showed that maintained weight loss could reverse diabetes for at least six months.
The DiRECT trial, conducted in primary care settings, involved 298 participants on a similar diet, followed by weight management support. After one year, participants in the intervention group averaged a 10 kg weight loss, and nearly half were in remission. At two years, they maintained an 8.8 kg weight loss with 36% in remission. The study extended for another three years, showing that those who avoided weight regain continued in remission.
Professor Taylor’s research also highlighted the biological mechanisms of type 2 diabetes and remission, focusing on excess liver fat and its impact on insulin function and beta cell operation in the pancreas.
The DiRECT trial’s success has led to a national remission program in England. Early results align with the trial’s outcomes, reinforcing the feasibility of remission through sustained weight loss.
In contrast, Professor Kamlesh Khunti from the University of Leicester, UK, argued against the practicality of lasting remission. He cited the difficulty in maintaining lifestyle changes, including low-calorie diets. He highlighted the limited long-term success of such interventions and questioned their cost-effectiveness and ability to prevent diabetes-related complications.
A significant concern raised by Professor Khunti was the current definition of remission. For example, while GLP-1 receptor agonists show promise in reversing diabetes, they don’t meet the remission criteria as patients continue needing glucose-lowering medication.
Bariatric surgery presents the most robust data for long-term remission, with a third of patients in remission after 15 years. However, Khunti noted the impracticality and risks of such surgery for the wider population.
In conclusion, while there is evidence supporting the possibility of remission through diet and weight management, challenges in long-term maintenance and differing definitions of remission complicate the issue.
Table of Contents
Frequently Asked Questions (FAQs) about Diabetes Remission Debate
Can Type 2 Diabetes Be Permanently Reversed?
Type 2 diabetes can potentially be reversed through strict dietary interventions and sustained weight loss, as evidenced by studies like Counterpoint and DiRECT. However, maintaining such lifestyle changes in the long term is challenging, and the definition of ‘remission’ itself is subject to debate among experts.
What Did the Counterpoint and DiRECT Studies Reveal?
The Counterpoint study, conducted in 2011, demonstrated that a very low-calorie diet could reverse type 2 diabetes by reducing excess fat in the liver and pancreas. The DiRECT trial, involving primary care settings, showed that sustained weight loss can lead to remission in a significant proportion of participants after one and two years.
What Are the Challenges in Achieving Lasting Remission of Type 2 Diabetes?
Maintaining long-term behavior changes, like a strict low-calorie diet, is difficult for many people. Additionally, there are questions about the cost-effectiveness of such interventions and their ability to prevent diabetes-related complications.
What Are the National Implications of These Studies?
The success of the DiRECT trial has inspired national programs like England’s Type 2 Diabetes Path to Remission, which employs a very low-calorie diet to promote weight loss and potential reversal of type 2 diabetes.
What Is the Debate Around the Definition of Diabetes Remission?
The current definition of remission, involving maintaining an HbA1c below 6.5% for three months without glucose-lowering therapies, is considered stringent by some experts. This definition impacts the classification of remission in studies and real-world applicability of interventions like GLP-1 receptor agonists.
More about Diabetes Remission Debate
- Diabetologia Study on Beta Cell Function
- Diabetes Care Study on Pancreatic Triacylglycerol
- The Lancet Diabetes & Endocrinology on DiRECT Trial
- NHS England’s Diabetes Remission Program
- JAMA Study on Bariatric Surgery Outcomes
4 comments
Great article! but you missed a point about how realistic it is to follow such strict diets, people have busy lives and its not always easy to stick to 800 calorie diets.
good job on covering both sides of the debate but, there’s a bit of repetition in the explanation of the studies. Could’ve been more concise i think.
interesting read but i think more emphasis on the long term effects of such diets would be helpful. Also, its hard to believe that just diet can reverse diabetes completely?
I’m not convinced about the remission part, diabetes is a complex disease and it seems like the studies have very small sample sizes? Need more comprehensive research here.