Is There an Easy Route to Remission of Type 2 Diabetes?

Article by Charlotte Burnett-Armstrong

What is type II diabetes?

Type II diabetes (T2D) occurs when an individual has high blood sugar levels as a result of their body not producing enough of the hormone insulin, or the insulin not working properly, which is known as insulin resistance (1).

Although T2D is not curable, it is possible to go into remission, and pre-diabetes (when one’s blood sugar levels are reaching a dangerous point, but not at the level of diabetes diagnosis – which is blood sugar levels above 48 mmol/mol) is reversible (2). Weight loss is a key recommendation for those diagnosed with pre-diabetes or diabetes, with a loss of 7-10% recommended for those living in obese bodies with a pre-diabetes diagnosis (3), and 15% recommended for those with a diabetes diagnosis, to have more of a chance of remission (4).

Weight loss is not something that is easily achieved for everyone and can negatively impact mental health in some cases (5), so must be approached carefully.

A solution?

In 2020 the NHS rolled out a programme called the ‘Soup and Shake’ diet, specifically for patients with T2D. This programme consists of low-calorie meal replacements in the form of soups and shakes made up of no more than 900kcal/day. The participants are to adhere to the programme for 12 weeks, at which point real food will gradually be introduced, with help from coaches and clinicians. The eligibility for the programme consists of the following: participants must have been diagnosed with T2D in the last six years, they must be between 18 and 65 years old and have a BMI of over 27kg/m2 in white individuals, and 25kg/m2 in Black, Asian and other ethnic groups (6).

Between September 2020 and the end of 2022, 7,540 people were referred to the programme, of which 1,740 started the programme before January 2022, and 945 completed the year-long programme. Of the 945, 32% put their T2D into remission, with an average weight loss of 16kg (7).

Comparing this to randomised control trials (RCTs) that implemented fasting as a means for participants to achieve remission of T2D, remission rates never reached over 50%. One RCT consisting of 72 participants, who also had a mean diabetes diagnosis of six years, put the intervention group on a Chinese medical nutrition therapy diet. This consisted of six sets of 15 days of intermittent fasting over a 3-month period, during which time their calories were restricted to 840kcal/day. It was found after the 12-month follow up, 44.4% of participants had achieved, and sustained, remission (8).

The DiRECT Trial, which the NHS Soup and Shake was based on, consisted of a 12-20 week low calorie diet replacement, and participants had to have a diabetes duration of up to 6 years, as well as a BMI of at least 27kg/m2 . The trial has recently published its 5 year follow up results, divulging that the original DiRECT intervention group still had an average weight loss of about 6kg (9).

The idea behind each of these studies is to help participants lose weight - as a way of lowering their blood glucose levels, and hopefully to push their diabetes into remission. It is known that remission is not easy to sustain - as blood sugar levels are always at risk of rising again (10). Although these studies did show a percentage of the participants to reach remission, this was never above 50% which could be indicative of a restricted diet regime not being sustainable for all individuals.

Sustainability

Losing weight as a result of a drastic dietary change is hard to sustain; your body will always look to ensure the prevention of starvation. Once you start to decrease your calories, the hormone leptin, released when we have reached satiation, will decrease, leading to an increase in appetite (11). The hormone ghrelin, which tells your brain you’re hungry, will increase (12). Both factors make it tough for someone to sustain a lower calorie diet.

If someone has gone through a restrictive period as a means to help them achieve remission of T2D, it might be helpful for them to have a plan to follow after the period of restriction is over. This could be in the form of following a particular diet, such as the Mediterranean diet, which consists largely of plant foods such as nuts, fruit, vegetables, wholegrains, beans, pulses and olive oil. It also includes lean protein such as chicken, fish, eggs and some dairy like milk and yoghurt. This diet has seen people put their T2D into remission (13) and looks at the nutritional benefits of the foods rather than just the caloric value.

Summary

Although a drastic restriction in caloric intake can be helpful in kick-starting someone’s journey to remission of T2D, the mental effects of this must be considered, as well as the sustainability of such a method. If possible, a food-first approach is always the best option, which is where a specific diet consisting of fresh, plant-based foods, such as the Mediterranean diet, can be helpful. Everyone’s journey to remission will look different, and managing this will differ from person to person.

References

  1. Type2diabetes(nodate)DiabetesUK.Availableat: https://www.diabetes.org.uk/about-diabetes/type-2-diabetes?gad_source=1 (Accessed: 07 December 2024).

  2. Type2diabetes(nodate)DiabetesUK.Availableat: https://www.diabetes.org.uk/about-diabetes/type-2-diabetes?gad_source=1 (Accessed: 07 December 2024).

  3. Gregg,E.W.etal.(2012)‘Associationofanintensivelifestyleinterventionwith remission of type 2 diabetes’, JAMA, 308(23), p. 2489. doi:10.1001/jama.2012.67929.

  4. Ko,J.H.andKim,T.N.(2022)‘Type2diabetesremissionwithsignificantweight loss: Definition and evidence-based interventions’, Journal of Obesity & Metabolic Syndrome, 31(2), pp. 123–133. doi:10.7570/jomes22001.

  5. Chaitob,A.etal.(2019)‘Associationsbetweenunhealthyweight-lossstrategies and depressive symptoms’, American Journal of Preventive Medicine, 56(2), pp. 241–250. doi:10.1016/j.amepre.2018.09.017.

  6. (2024)NHSchoices.Availableat:https://www.england.nhs.uk/2024/05/nhs- expands-soup-and-shake-diets-to-thousands-more-patients-with-type-2- diabetes-across-england/ (Accessed: 07 December 2024).

  7. Valabhji,J.etal.(2024)‘EarlyfindingsfromtheNHStype2diabetespathto remission programme: A prospective evaluation of real-world implementation’, The Lancet Diabetes & Endocrinology, 12(9), pp. 653–663. doi:10.1016/s2213-8587(24)00194-3.

  8. Yang,X.etal.(2022)‘Ebectofanintermittentcalorie-restricteddietontype2 diabetes remission: A randomized controlled trial’, The Journal of Clinical Endocrinology & Metabolism, 108(6), pp. 1415–1424. doi:10.1210/clinem/dgac661

  9. Diabetesremissionclinicaltrial(2024)DirectTrial.Availableat: https://www.directclinicaltrial.org.uk/ (Accessed: 07 December 2024).

  10. Diabetes UK (2024) Diabetes UK - Know diabetes. Fight diabetes. | Diabetes UK. Available at: https://www.diabetes.org.uk/ (Accessed: 07 December 2024).

  11. Evert, A.B. and Franz, M.J. (2017) ‘Why weight loss maintenance is dibicult’,

    Diabetes Spectrum, 30(3), pp. 153–156. doi:10.2337/ds017-0025

  12. Cleveland Clinic (2024) Why people diet, lose weight and gain it all back,

    Cleveland Clinic. Available at: https://health.clevelandclinic.org/why-people-

    diet-lose-weight-and-gain-it-all-back (Accessed: 07 December 2024).

  13. Lucye (2024) Mediterranean diet for type 2 diabetes remission, Diabetes UK.

    Available at: https://www.diabetes.org.uk/about-diabetes/type-2- diabetes/remission/mediterranean-diet-for-remission (Accessed: 07 December 2024).

This article was written by Charlotte Burnett-Armstrong. Charlotte is currently studying her MSc in Human Nutrition. Charlotte has previously worked in the food industry on the social media side, writing copy, creating content and designing marketing assets as well as customer service. Charlotte has a Leith’s Nutrition in  Culinary Practice Accreditation. 

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