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Remission of type 2 diabetes is a practical target for primary care

Study highlights the importance of reducing fat in the liver and pancreas and weight-loss maintenance 

Study highlights the importance of reducing fat in the liver and pancreas and weight-loss maintenance 


Nearly one quarter of study participants achieved weight loss of 15kg or more at 12 months. Picture: iStock

Type 2 diabetes affects almost one in ten adults in the UK. Guidelines for management focus on multiple drug treatments to reduce blood glucose and the associated risk of cardiovascular disease, but life expectancy remains substantially reduced. Type 2 diabetes is strongly related to weight gain in adult life and accumulation of excess fat in the liver and pancreas.

Insulin response

The importance of reducing fat in the liver and pancreas has been tested with a diet of 600-700kcal/day. Liver fat content returns to normal within seven days, with insulin response and pancreas fat content normalising over eight weeks.

This study focused on the need for long-term maintenance of weight loss. The intervention group consisted of 149 people and was compared with a control group of the same size who followed existing best practice guidelines. The intervention involved withdrawal of antidiabetic and antihypertensive drugs and an 825-853kcal/day formula diet for 3–5 months.

Individual flexibility is important, so initial weight loss and reintroduction of a maintenance diet could vary within reasonably wide boundaries. Participants were also encouraged to increase their daily activities. Elements of cognitive behavioural therapy were used to support participants in making long-term changes to their lifestyle.

Results and implications for practice

Findings confirm that type 2 diabetes of up to six years duration is not necessarily a permanent lifelong condition. Nearly one quarter of the participants achieved weight loss of 15kg or more at 12 months and almost half had remission of diabetes and came off antidiabetic medication. In addition, 68% were able to stop antihypertensive medication with no rise in blood pressure.


Reference


About the author

Ruth Sander is an independent consultant in care of older people

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