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- There are many ways to manage type 2 diabetes.
- Healthcare professionals can help to get your condition into remission.
- It will, however, take several months before you see any progress.
Being diagnosed with a medical condition generally leads to the question of what we can do to correct or improve the situation. Many people diagnosed with type 2 diabetes would, therefore, like to know if there is any way to reverse the condition.
There is ample evidence to prove that weight loss, achieved with or without surgery, can lead to a permanent remission of type 2 diabetes.
Definition
According to the EASD (European Association for the Study of Diabetes), a patient is in remission if they have been experiencing normal blood glucose levels – i.e. an HbA1C (average blood glucose levels over three months) of less than 6.5%.
This needs to be maintained for a minimum of three months while taking no medication to lower blood glucose levels.
The following may affect diabetes remission:
1. Abdominal fat loss
Research has shown diabetes remission may be achieved with a weight loss of 10 to 15 % over three months. This can be achieved through bariatric surgery or diets that strictly reduce calories, involving macro-nutrient manipulation (low carbohydrate, low fat or low protein).
2. The mechanism
The abdominal fat cells release hormone-like substances (adipokines, cytokines) and inflammatory markers that create low-grade inflammation and cause body cells to become resistant to insulin. Excess abdominal fat causes excess visceral fat that infiltrates the liver and pancreas. Losing this fat improves insulin sensitivity, beta cell function and subsequent insulin secretion, which leads to a lowering of blood glucose levels
3. The evidence
The DIRECT (Diabetes Remission Clinical Trail) trial involved 306 individuals diagnosed over six years from different diabetes centres in Scotland.
They divided the individuals into an intervention group and a control group. The intervention group followed a VLCD (very low-calorie diet) of 3 480 kJ (840kcal) in the form of meal replacements for 12 weeks, followed by an energy-controlled eating plan for the following six weeks.
The subjects were then put on a healthy diet to maintain their weight loss, and received coaching on how to change their behaviour around food. They were also encouraged to walk 15 000 steps a day.
The results obtained were significant and profound. At the end of 12 months, 24% of the intervention group lost 15 kg or more. (No weight loss was recorded in the control group.) Additionally, 46 % of the individuals in the intervention group achieved complete remission of type 2 diabetes, compared to only 4% in the control group.
The HbA1c levels in the intervention group dropped by 0.9 % compared to zero in the control group. The triglyceride levels (a type of fat produced by the liver) were 20% lower in the intervention group. Additionally, they experienced a significant improvement in their quality of life.
4. Additional important facts
4.1 Duration and control
Additional factors that contribute to achieving remission are the duration of the condition and the level of blood glucose control. The individuals with a lower HbA1c upon entering the study achieved a higher rate of remission. The sooner a person starts losing weight after diagnosis, the higher their chances of remission.
4.2 Weight loss
Remission was closely related to the amount of weight lost (and kept off) for 12 to 24 months. In the trial, 86% of the individuals who achieved a weight loss of 15 kg or more, remained in remission at 12 months.
At 24 months, 36% of the intervention group and only 3% of the control group remained in remission, and 70% of the individuals who lost more than 15 kg remained in remission at 24 months.
4.3 Sustaining the weight loss
The study emphasises the importance of not regaining weight. A nutritionally balanced, individualised, energy-controlled eating plan needs to be followed in conjunction with physical activity and medication if necessary. A health professional can help to establish behaviour changes (e.g. healthy eating habits).
4.4 Cost savings
Diabetes remission saves money by eliminating the need for medication, and 68% of the intervention group also no longer required hypertension drugs.
4.5 Which diet is the best?
A meta-analysis of different dietary approaches to achieving remission found that no diet stood out above the rest. What is important is that an adequate energy (kilojoule) deficit is achieved, significant and consistent enough to achieve a minimum of 10 % of initial weight loss over three months
5. Conclusion
Achieving diabetes remission is not something you should try on your own. You need to consult with your doctor regularly to monitor your medication. You also need the services of a specialised dietitian to make sure your nutritional needs are met.
Dietitians who specialise in diabetes nutrition can structure an individualised, energy-controlled eating plan to ensure weight loss.
They are also able to design easy and practical meals by taking into consideration your lifestyle, budget, culture and food preferences. Additionally, they can help keep you on track and focused on achieving success. You can contact the Association for Dietetics in South Africa (ADSA) to find a dietitian who can help you kick-start your journey.
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