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Weight Loss and Type 2 Diabetes Remission
abstract
This abstract is available on the publisher's site.
Access this abstract nowType 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.1 Around half of people who are within the first 10 years of diagnosis and manage to follow food energy restriction can stop all diabetes medication and return to non-diabetic glucose control.2 3 Remission is achieved when haemoglobin A1c concentrations of 48 mmol/mol are recorded after weight loss and at least six months later without any anti-diabetic medications (box 1).4 Here we summarise the new understanding of type 2 diabetes and consider how different changes to food intake can achieve the necessary weight loss and maintenance required for remission of diabetes.
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Nutritional Basis of Type 2 Diabetes Remission
BMJ 2021 Jul 07;374(xx)n1449, R Taylor, A Ramachandran, WS Yancy, NG ForouhiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Type 2 Diabetes Can Be Reversed
As recently as 15 years ago, there was a medical belief that type 2 diabetic progression was inevitable. Research since that time has proven this belief wrong. The authors of one of the seminal studies showing remission in those who lost 15 kg explains the pathophysiology in this BMJ review.
Type 2 diabetes that has been present up to 10 years can be reversed with sustained weight loss. Remission is defined as having two HbA1c readings below 7 mmol/L separated by 6 months and being off all diabetes medications.
The sustained weight loss reduces fat accumulation in the liver and the pancreas, resulting in a reactivation of the beta cells with a return to optimal insulin sensitivity and function. Bariatric surgery has been found to do the same thing, but it requires bariatric surgery.
The challenge is how to initiate and sustain weight loss. The DiRECT trial1 helped people lose 15 kg through a low-calorie liquid diet with the support of a nutritionist. The authors discussed using a low-fat diet versus a low-carbohydrate diet. Both work if the diet is sustained. They also suggest an intermittent fasting diet, which may have benefits that extend beyond weight loss, including neuro-protection and longevity.
The most important factor in successfully sustaining weight loss is the support of family and friends, according to the author. Although it is challenging to maintain these healthy habits, reversing type 2 diabetes is attainable and requires lifelong support through ongoing therapeutic relationships found in primary care.
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