Setting a Goal to Reverse Type 2 Diabetes

Sensational headlines have been hiding a serious story this week. NBC tells us that diet shakes and dropping sodas can reverse diabetes. But behind those headlines lies an important study and an even more important concept. Obesity care specialists and researchers are finding ways to reverse type 2 diabetes through better clinical care.

To be clear, reporting about this study from NBC and other sources is misleading. It wasn’t diet shakes that reversed diabetes for some of the patients in this new study. Rather, it was a careful program of intensive weight management. The program was delivered by specially trained providers. And it required a full year of carefully planned care.

Intensive Weight Management

Researchers conducted this study through primary care practices in Scotland and England. It was a cluster randomized, controlled study. That means that individual patients didn’t get a random assignment to treatment or a control group. Instead, a whole medical practice got the assignment.

In the practices that delivered actual treatment, a nurse or dietitian received eight hours of training and ongoing support in how to deliver a structured weight management program. Patients used a low-calorie liquid diet for three to five months. After that, they gradually returned to eating regular food and received monthly coaching for weight maintenance.

Patients in the control group practices received nothing other than routine medical care and an Amazon gift certificate.

At the end of a year, a quarter of the patients in the treatment group dropped out. It’s not an easy program to follow. But on average patients lost 22 pounds on the program and 46% of them reversed their diabetes. Patients in the control group lost an average of 2 pounds and only 4% reversed their diabetes.

Quality of Life

Notably, quality of life was significantly improved for the people who participated in this program. People feel better and function better when they lose weight. But life quality was unchanged for the control group.

From Managing Blood Sugar to Seeking Remission

When a person with obesity develops type 2 diabetes, they typically receive advice to lose weight. Such brief advice typically is utterly ineffective. So clinicians move on to managing blood sugar. Medications can do a pretty good job of reducing A1C levels. Those levels are the key measure for keeping blood sugar under control.

But what this study suggests is that a different path is possible. With a more careful and intensive weight management program, diabetes remission can be possible in some patients.

However, this will require a significant shift in clinical practices. Obesity Society President Caroline Apovian explains:

This study demonstrates something that I see in obesity care delivered by skilled providers. Most primary care providers simply do not have the resources and training to translate this into routine practice. But the Obesity Medicine Education Collaborative and obesity medicine fellowship programs will help over the next several years.

The global burden of diabetes is growing at an unprecedented rate. Around the world, it affects 425 million adults. In the U.S. alone, we are on a path toward 100 million people with diabetes. This is a consequence of untreated obesity. Can we afford to continue giving mere lip service to obesity care?

This study suggests we should aim higher.

Click here for the study. For further perspective, click here and here.

Blood and Tears, photograph © Joey Gannon / flickr

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December 8, 2017