Weight loss may be enough to treat some type 2 diabetics
New research suggests that non-pharmacological treatment may be a good alternative to many patients suffering from recent type 2 diabetes. Weight loss should be the primary goal in the treatment of type 2 diabetes, estimates Professor Emeritus Matti Uusitupa from the University of Eastern Finland in a comment editorial published in The Lancet on 5 December.
Uusitupa comments on the new findings of the DiRECT trial, which was carried out by the universities of Glasgow and Newcastle and published in the same issue of The Lancet, investigating the effect of a weight management programme on diabetes remission in patients with type 2 diabetes with 0 – 6 years duration of disease. Patients’ antidiabetic and antihypertensive medicines were discontinued, and weight loss of a minimum of 15 kg was set as a goal. 86 per cent of the patients who achieved this goal and 46 per cent of all patients participating in the weight management programme had a good glucose balance in one year’s time, i.e. their glucose metabolism returned to non-diabetic level without antidiabetic medication.
Little evidence from large-scale randomised trials on the effects of non-pharmacological treatment and especially weight loss on patients with type 2 diabetes is available. The Finnish Diabetes Prevention Study, DPS, has shown that in persons with an elevated risk of type 2 diabetes i.e. having pre-diabetes, weight loss, physical exercise and a healthy diet can prevent or postpone the onset of diabetes by up to 15 years.
Uusitupa notes that the findings published in The Lancet provide support for the idea of setting weight loss as the primary goal in the treatment of type 2 diabetes. There are indications that weight loss results in improved insulin sensitivity in muscles and liver, decreases intra-organ fat content, and might improve insulin secretion. According to Uusitupa, the time of diabetes diagnosis is the best point to encourage weight reduction and lifestyle changes. More importantly, disease prevention should be maintained as the primary goal that requires both individual-level and population-based strategies, including taxation of unhealthy food items to tackle the epidemic of obesity and type 2 diabetes.
For further information, please contact:
Matti Uusitupa, matti.uusitupa (a) uef.fi, tel. +358 40 0615661
Uusitupa, M. Remission of type 2 diabetes: mission not impossible. The Lancet 2017, published online 5.12.2017. http://dx.doi.org/10.1016/S0140-6736(17)33100-8
Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet 2017, published online 5.12.2017. http://dx.doi.org/10.1016/S0140-6736(17)33102-1