Reversing Type 2 Diabetes is Possible - Results From the DiRECT Trial
I've noticed something interesting. When someone is diagnosed with type 2 diabetes, the doctor thinks about controlling risk factors. Control the blood sugar. Control the blood pressure. Control the cholesterol. All of this to reduce the risk of developing problems related to diabetes.
Most people when diagnosed, however, think about reversing diabetes. Make it go away. Get off medications. Punch diabetes in the face so it never comes back.
Unfortunately studies and experience have not suggested that people are likely to make and sustain the changes needed to reverse type 2 diabetes.
But could diabetes reversal be possible?
The "Twin Cycle" Hypothesis
Dr. Roy Taylor from Newcastle, UK, developed an interesting hypothesis about the cause for diabetes which gives hope that it can be reversed commonly, especially within the first 4-6 years after diagnosis. He published about the twin cycle hypothesis in 2012 after performing preliminary studies showing support for the idea.
Basically, in very simplistic terms, the concept goes like this:
- When someone eats more calories than they use over a long time, the excess calories are stored as fat
- Eventually the fat cells can't store any more, and the fat will "spill" into the system and accumulate in the organs, mainly the liver, which creates and worsens insulin resistance, and causes the blood sugar to rise slowly
- When this continues for years, the fat can start to accumulate in the pancreas, causing the pancreas to stop producing insulin, causing the blood sugar to rise rapidly, leading to the diagnosis of diabetes
A key observation is that with rapid calorie reduction and weight loss, the cycles appear to run in reverse, fat is removed from the liver and the pancreas, and the blood sugar returns to normal.
The DiRECT Trial
Originally published in 2017, the DiRECT trial from Scotland and England recruited over 300 people with type 2 diabetes diagnosed in the preceding 6 years, who were not on insulin therapy. They were divided into an intervention group and a control group, with the control group receiving "usual care."
The intervention group was taken off of diabetes and blood pressure medications, and placed on a liquid diet, which supplied approximately 850 calories per day, for 3-5 months. Food was then slowly reintroduced over 2-8 weeks and they received support to help them maintain weight loss.
Summary of key findings:
- 24% of participants in the liquid diet group were able to lose 33 pounds, and 86% of these folks were in remission from diabetes after 12 months
- Overall 46% of people in the intervention group achieved remission of diabetes, compared with 4% in the usual care group
- For those losing at least 22 pounds, the remission rate was 73%
- Quality of life improved in the intervention group and decreased in the control group
- The two-year results of this study showed that for people who maintained at least a 22 pound weight loss, 64% remained in remission (with only 24% of the intervention group able to maintain this level of weight loss)
Take Home Points
The results of this study teach several important points:
- Diabetes remission is possible. Folks in this study were relatively new to diabetes, with diagnosis in the last 6 years. With robust weight loss, almost half were able to come off of medication. Most of my clients would love to come off of medication, and this study showed one potential path where it was possible (and even likely).
- These results can be obtained in the "real world." The study was carried out in primary practices, suggesting specialized research support was not needed to achieve good results.
- Results decrease if weight is regained. This is not unusual for any program of lifestyle and behavior change, and reinforces the need for systems and support to help people make the "healthy choice" more consistently. The best would be to lose weight then successfully maintain that weight loss over the long term.
We have been so excited about these results at The Alpine Center that we've started to recruit a group of interested people to develop a program like this here in Colorado. Our preliminary results are extremely encouraging. More to come...
Cheers,
Dr. Topher Fox