Type 2 diabetes: is losing weight enough to get well?

Type 2 diabetes: lose weight to get well?

Type 2 diabetes, one of the most prevalent diseases in the West, can be defeated through significant weight loss. According to a new study, following a severely low-calorie diet for 8 weeks can reverse the disease, returning blood glucose concentration to normal levels. An incredible result that challenges the idea that type 2 diabetes is a chronic and irreversible condition.

The research, conducted by a team of researchers from Newcastle and Glasgow Universities (UK) and Lagos State University (Nigeria), was published in the journal Diabetes Care.

Type 2 diabetes: the most common form of the disease

Diabetes mellitus is a chronic metabolic disease caused by a defect in the production or action of insulin. The most common forms of diabetes are type 1 and type 2 diabetes. Type 1 diabetes is caused by destruction of the cells of the pancreas that produce insulin and is characterized by an absolute deficiency of this hormone. 

Type 2 diabetes, also called non-insulin-dependent diabetes, is caused by insufficient insulin production by the pancreas or inadequate response to it. In both cases, the cells of the various organs are deprived of the energy they need to function; in addition, the rise in blood glucose, that is, the level of glucose in the blood, causes a range of damage to various organs and systems. Type 2 diabetes accounts for 90-95% of all cases of diabetes. It usually occurs in adulthood, and in particular the disease affects people over 60 years of age. 

In the United States, 9.2% of the population has type 2 diabetes. Italians affected exceed 3 million. A number of genes may favor the onset of diabetes, in addition to other conditions that increase the risk of its occurrence, including:

• gestational diabetes
• Unhealthy diet too high in fat and sugar
• cigarette smoke
• excessive alcohol consumption
• sedentariness
• age

Diabetes can give complications that can also be disabling or life-threatening; this risk can be minimized by consistently maintaining good control of blood glucose and other risk factors, such as hypertension and high cholesterol. 

In the treatment of type 2 diabetes, a key role involves diet and physical activity. Most cases of type 2 diabetes, in fact, may be attributable to obesity and too sedentary a lifestyle. When lifestyle correction is not enough to control the disease, drug therapies are necessary. 

Many of these drugs, such as metformin, serve to sensitize the body to respond more effectively to insulin, or stimulate insulin secretion by the pancreas. Although with these measures blood glucose can be kept under control, type 2 diabetes is generally regarded as an incurable chronic condition.

Is type 2 diabetes reversible?

According to the new 5-year study, "The Diabetes Remission Clinical Trial," a very low-calorie diet could reverse type 2 diabetes mellitus and return blood glucose concentration to normal. Disease remission was observed in 40 percent of the research participants who followed a diet program for eight weeks and remained stable for at least another six months. 

As one of the study authors, Professor Roy Taylor, explained, the results clearly indicated that when total body fat appeared to have decreased due to the diet, the patients had stored a normal amount of fat under the skin and blood glucose had returned to normal. Keeping weight under control even after the weeks of treatment, glucose had not risen again. 

The importance of these findings is critical, especially when taking into account not only the impact on people's health, but the impact on health care spending, as the researchers pointed out in the journal of the American Diabetes Association.

How much does the disease cost?

Diabetes has been chosen by the World Health Organization (WHO) as the 2016 theme on World Health Day. In a recently published report, WHO urged more action to halt the rise of the disease whose cases have quadrupled since 1980 to 422 million worldwide. 

Currently, the U.K. National Health Service spends about 97 million euros a year on drugs needed to regulate blood glucose levels in type 2 diabetics, in addition to the cost of invasive and potentially risky medical practices of surgeries, such as gastric banding, while strategies to help patients lose weight quickly are ignored. 

Similarly, the disease cost the United States an estimated 283.00 billion in 2012 alone. It is, in addition, enormous the personal cost that diabetes complications can cause, such as loss of vision, lower limb amputation and early cardiovascular disease.

Some details of the research

The study, supported financially by a charitable grant from Diabetes UK, involved 30 subjects with type 2 diabetes (for a few months or years) who followed a very low-calorie diet for 8 weeks. Specifically, participants were given a product, created a well-known food company, to take three times a day, containing 43% carbohydrate, 34% protein, and 19.5% fat, with a calorie content such that it provided 624 kcal per day. 

After 8 weeks of treatment, patients followed a normal isocaloric diet. At the beginning of the study, each subject discontinued the use of all oral medications. Twelve of the participants achieved a fasting blood glucose value below 7mmol per liter immediately after returning to the isocaloric diet, and 13 subjects achieved this after six months. The average weight had decreased from 98 kg to 83.8 kg during the treatment period and remained 84.7 kg after six months.

Type 2 diabetes is curable if you lose weight

According to Professor Taylor, the findings show that type 2 diabetes can now be interpreted as a potentially reversible metabolic syndrome through substantial weight loss, and this is an important shift of a paradigm, especially in an era when diabetes has reached epidemic proportions. 

The next step would be to see what percentage of people with type 2 diabetes would want to avail themselves of such treatment, and whether the diet can have long-term benefits. In fact, again according to Professor Taylor, not all people with the disease would be willing to change their diet, but for those who would, metabolic health stands a good chance of being recovered.  

Source: S. Steven, K. G. Hollingsworth, A. Al-Mrabeh, L. Avery, B. Aribisala, M. Caslake and R. Taylor "Very-Low-Calorie Diet and 6 Months of Weight Stab ility in Type 2 Diabetes: Pathophysiologic Changes in Responders and Nonresponders" Diabetes Care, April 2016, 39 (4)