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SAN FRANCISCO – , according to United Kingdom investigators.
The odds of remission – meaning a hemoglobin A1c below 6.5% on repeat testing, off all medications – were directly related to the amount of weight patients lost; 60% of subjects who lost 22-33 pounds were free of type 2 disease at 2 years, versus 29% who lost 11-21 pounds, and 5% who lost less than 11 pounds.
“If people lose” around 30 pounds “and keep it off for 2 years, there’s a two-thirds chance of them escaping type 2 [diabetes]. People want to understand their options, and this is an option. This is very good news for people with diabetes,” said senior investigator Roy Taylor, MD, a professor of medicine and metabolism at the University of Newcastle, Newcastle upon Tyne, England, who presented the findings of the Diabetes Remission Clinical Trial (DiRECT) at the annual scientific sessions of the American Diabetes Association (Lancet Diabetes Endocrinol. 2019 May;7(5):344-355).
A subgroup analysis he also presented found that beta cell function rebounds rapidly after weight loss and is pretty much normal at 2 years, so long as people keep the weight off.
The study is rooted in previous work by Dr. Taylor and his colleagues that found that very low-calorie diets normalized fasting plasma glucose in just 7 days in patients with type 2 diabetes due to a rapid fall in liver fat content and subsequent restoration of insulin sensitivity. That and other findings suggested that fast weight loss – instead of the traditional gradual approach – might help.
He and his team randomized 149 volunteers from primary care practices in the United Kingdom to standard care, and 149 others to rapid weight loss; more than a quarter of the patients who were asked agreed to participate.
Patients had diabetes for less than 6 years and were not insulin dependent. The baseline mean body mass index was 35 kg/m2, mean age 54 years, mean hemoglobin A1c 7.6%, and mean duration of disease 3 years; 176 subjects were men.
Diabetes drugs, anti-hypertensives, and diuretics were stopped in the weight loss group; the program consisted of three Optifast meal replacement shakes or soups per day – Optifast is one of many commercially available options – for a daily intake of 825-853 kcal. There was no other food, and alcohol was not permitted. The weight loss goal was 33 pounds or more over 3-5 months; almost 90% of the intervention group made it. The protocol did not include exercise.
Next came a 2-8 week stepped reintroduction to normal food, followed by counseling and other supportive care out to 2 years, plus some extra packets of Optifast, just in case.
“People [had] panic attacks when they [went] back into the kitchen, but that’s marvelous: we [had] a blank slate on which to write new dietary habits, building up knowledge of portion size and what to eat.” Dr. Taylor said.
At 1 year, 68 (46%) of the intervention participants were in remission off all drugs, and 36 (24%) had maintained at least a 33-pound weight loss. At 2 years, 53 (36%) were in remission, and 17 (11%) had maintained. Percent remission was linked to the extent of sustained weight loss.
Strokes, heart attacks, and other serious adverse outcomes were less common in the diet group, versus standard care, at both 1 and 2 years.
Among those who went into remission, the rapid initial response to a glucose bolus came back to near normal soon after food reintroduction, and “was sufficient to get nondiabetic blood glucose control,” with a mean hemoglobin A1c of 6% at 2 years. “We [also] saw, quite remarkably, was a slow steady return to almost completely normal” maximum beta cell capacity over the first 12 months, Dr. Taylor said.
The most likely explanation is that beta cells are overwhelmed and shut down in a milieu of too much fat and glucose, but are able to reconstitute their specialist function and come back online once it’s addressed, he added.
The study was funded by Diabetes UK. Dr. Taylor reported financial relationships with Self, Wilmington Healthcare, Lilly Diabetes, and Novartis AG.
SOURCE: Zhyzhneuskaya SV et al., ADA 2019 abstract 66-OR
Alvin Powers, MD, is director of the diabetes center and a professor of medicine at Vanderbilt University, Nashville. He moderated the presentation and had no relevant disclosures.
Alvin Powers, MD, is director of the diabetes center and a professor of medicine at Vanderbilt University, Nashville. He moderated the presentation and had no relevant disclosures.
Alvin Powers, MD, is director of the diabetes center and a professor of medicine at Vanderbilt University, Nashville. He moderated the presentation and had no relevant disclosures.
SAN FRANCISCO – , according to United Kingdom investigators.
The odds of remission – meaning a hemoglobin A1c below 6.5% on repeat testing, off all medications – were directly related to the amount of weight patients lost; 60% of subjects who lost 22-33 pounds were free of type 2 disease at 2 years, versus 29% who lost 11-21 pounds, and 5% who lost less than 11 pounds.
“If people lose” around 30 pounds “and keep it off for 2 years, there’s a two-thirds chance of them escaping type 2 [diabetes]. People want to understand their options, and this is an option. This is very good news for people with diabetes,” said senior investigator Roy Taylor, MD, a professor of medicine and metabolism at the University of Newcastle, Newcastle upon Tyne, England, who presented the findings of the Diabetes Remission Clinical Trial (DiRECT) at the annual scientific sessions of the American Diabetes Association (Lancet Diabetes Endocrinol. 2019 May;7(5):344-355).
A subgroup analysis he also presented found that beta cell function rebounds rapidly after weight loss and is pretty much normal at 2 years, so long as people keep the weight off.
The study is rooted in previous work by Dr. Taylor and his colleagues that found that very low-calorie diets normalized fasting plasma glucose in just 7 days in patients with type 2 diabetes due to a rapid fall in liver fat content and subsequent restoration of insulin sensitivity. That and other findings suggested that fast weight loss – instead of the traditional gradual approach – might help.
He and his team randomized 149 volunteers from primary care practices in the United Kingdom to standard care, and 149 others to rapid weight loss; more than a quarter of the patients who were asked agreed to participate.
Patients had diabetes for less than 6 years and were not insulin dependent. The baseline mean body mass index was 35 kg/m2, mean age 54 years, mean hemoglobin A1c 7.6%, and mean duration of disease 3 years; 176 subjects were men.
Diabetes drugs, anti-hypertensives, and diuretics were stopped in the weight loss group; the program consisted of three Optifast meal replacement shakes or soups per day – Optifast is one of many commercially available options – for a daily intake of 825-853 kcal. There was no other food, and alcohol was not permitted. The weight loss goal was 33 pounds or more over 3-5 months; almost 90% of the intervention group made it. The protocol did not include exercise.
Next came a 2-8 week stepped reintroduction to normal food, followed by counseling and other supportive care out to 2 years, plus some extra packets of Optifast, just in case.
“People [had] panic attacks when they [went] back into the kitchen, but that’s marvelous: we [had] a blank slate on which to write new dietary habits, building up knowledge of portion size and what to eat.” Dr. Taylor said.
At 1 year, 68 (46%) of the intervention participants were in remission off all drugs, and 36 (24%) had maintained at least a 33-pound weight loss. At 2 years, 53 (36%) were in remission, and 17 (11%) had maintained. Percent remission was linked to the extent of sustained weight loss.
Strokes, heart attacks, and other serious adverse outcomes were less common in the diet group, versus standard care, at both 1 and 2 years.
Among those who went into remission, the rapid initial response to a glucose bolus came back to near normal soon after food reintroduction, and “was sufficient to get nondiabetic blood glucose control,” with a mean hemoglobin A1c of 6% at 2 years. “We [also] saw, quite remarkably, was a slow steady return to almost completely normal” maximum beta cell capacity over the first 12 months, Dr. Taylor said.
The most likely explanation is that beta cells are overwhelmed and shut down in a milieu of too much fat and glucose, but are able to reconstitute their specialist function and come back online once it’s addressed, he added.
The study was funded by Diabetes UK. Dr. Taylor reported financial relationships with Self, Wilmington Healthcare, Lilly Diabetes, and Novartis AG.
SOURCE: Zhyzhneuskaya SV et al., ADA 2019 abstract 66-OR
SAN FRANCISCO – , according to United Kingdom investigators.
The odds of remission – meaning a hemoglobin A1c below 6.5% on repeat testing, off all medications – were directly related to the amount of weight patients lost; 60% of subjects who lost 22-33 pounds were free of type 2 disease at 2 years, versus 29% who lost 11-21 pounds, and 5% who lost less than 11 pounds.
“If people lose” around 30 pounds “and keep it off for 2 years, there’s a two-thirds chance of them escaping type 2 [diabetes]. People want to understand their options, and this is an option. This is very good news for people with diabetes,” said senior investigator Roy Taylor, MD, a professor of medicine and metabolism at the University of Newcastle, Newcastle upon Tyne, England, who presented the findings of the Diabetes Remission Clinical Trial (DiRECT) at the annual scientific sessions of the American Diabetes Association (Lancet Diabetes Endocrinol. 2019 May;7(5):344-355).
A subgroup analysis he also presented found that beta cell function rebounds rapidly after weight loss and is pretty much normal at 2 years, so long as people keep the weight off.
The study is rooted in previous work by Dr. Taylor and his colleagues that found that very low-calorie diets normalized fasting plasma glucose in just 7 days in patients with type 2 diabetes due to a rapid fall in liver fat content and subsequent restoration of insulin sensitivity. That and other findings suggested that fast weight loss – instead of the traditional gradual approach – might help.
He and his team randomized 149 volunteers from primary care practices in the United Kingdom to standard care, and 149 others to rapid weight loss; more than a quarter of the patients who were asked agreed to participate.
Patients had diabetes for less than 6 years and were not insulin dependent. The baseline mean body mass index was 35 kg/m2, mean age 54 years, mean hemoglobin A1c 7.6%, and mean duration of disease 3 years; 176 subjects were men.
Diabetes drugs, anti-hypertensives, and diuretics were stopped in the weight loss group; the program consisted of three Optifast meal replacement shakes or soups per day – Optifast is one of many commercially available options – for a daily intake of 825-853 kcal. There was no other food, and alcohol was not permitted. The weight loss goal was 33 pounds or more over 3-5 months; almost 90% of the intervention group made it. The protocol did not include exercise.
Next came a 2-8 week stepped reintroduction to normal food, followed by counseling and other supportive care out to 2 years, plus some extra packets of Optifast, just in case.
“People [had] panic attacks when they [went] back into the kitchen, but that’s marvelous: we [had] a blank slate on which to write new dietary habits, building up knowledge of portion size and what to eat.” Dr. Taylor said.
At 1 year, 68 (46%) of the intervention participants were in remission off all drugs, and 36 (24%) had maintained at least a 33-pound weight loss. At 2 years, 53 (36%) were in remission, and 17 (11%) had maintained. Percent remission was linked to the extent of sustained weight loss.
Strokes, heart attacks, and other serious adverse outcomes were less common in the diet group, versus standard care, at both 1 and 2 years.
Among those who went into remission, the rapid initial response to a glucose bolus came back to near normal soon after food reintroduction, and “was sufficient to get nondiabetic blood glucose control,” with a mean hemoglobin A1c of 6% at 2 years. “We [also] saw, quite remarkably, was a slow steady return to almost completely normal” maximum beta cell capacity over the first 12 months, Dr. Taylor said.
The most likely explanation is that beta cells are overwhelmed and shut down in a milieu of too much fat and glucose, but are able to reconstitute their specialist function and come back online once it’s addressed, he added.
The study was funded by Diabetes UK. Dr. Taylor reported financial relationships with Self, Wilmington Healthcare, Lilly Diabetes, and Novartis AG.
SOURCE: Zhyzhneuskaya SV et al., ADA 2019 abstract 66-OR
REPORTING FROM ADA 2019
Key clinical point: Type 2 diabetes patients can shed significant weight quickly and eliminate the disease.
Major finding: Seventy-percent of patients with type 2 diabetes who lost more than 33 pounds on a liquid diet over a few months, and kept it off, were free of the disease at 2 years.
Study details: Open-label, randomized trial with 298 patients
Disclosures: The study was funded by Diabetes UK. Dr. Taylor reported financial relationships with Self, Wilmington Healthcare, Lilly Diabetes, and Novartis AG.
Source: Zhyzhneuskaya SV et al., ADA 2019 abstract 66-OR