Berry Shake

Shaking Diabetes into Remission

Professor Roy Taylor has a passion for shaking diabetes into remission. Two year results are in for the DiRECT trial of an intensive weight management program using meal replacement shakes. The goal is to put type 2 diabetes into remission. The program met the goal in 36 percent of patients after two years.

Thus, we have a glass that is either two-thirds empty or one-third full, depending on how you look at it. But it’s getting a lot of enthusiastic press.

Taking Weight Management Seriously

On one hand this is great. Professor Taylor is showing the the U.K.’s National Health Service (NHS) that they can help patients by taking weight management seriously in primary care practices. It’s an intensive program delivered by specially trained providers. It makes a difference that’s measurable, producing healthier lives. It’s helping the NHS to consider the value of aiming to put type 2 diabetes into remission.

In fact, Taylor and his colleagues are even making the case that it can be reasonably cost effective. All of this is good.

Looking Right Past Bariatric Surgery

On the other hand, the the seeming determination to look right past the value of bariatric surgery for reversing type 2 diabetes is mystifying. We have data out to 12 years telling us that as many as half of gastric bypass patients can maintain a remission in type 2 diabetes after all those years.

In Taylor’s DiRECT study, remission was achieved in only 46 percent in the first year. A quarter of the patients dropped out. And by the second year, the remission rate was down to 36 percent.

So it’s pretty clear that if you really want to put type 2 diabetes into remission, metabolic bariatric surgery is the best bet. By far.

Falling Short of Ideal Options

All of this is progress. We have better options and better data than ever before for treating both obesity and type 2 diabetes. If you have both, intensive obesity care can take you a long way toward controlling or even reversing the diabetes.

But the fact is that it takes a lot of work and a lot of commitment. The total meal replacement strategy that Taylor used isn’t easy. And as the relapse rates show, maintaining the initial benefits when you go off the shakes is really hard.

Likewise, bariatric surgery is intimidating. As many as 90 percent of the patients who could benefit simply aren’t ready to consider it as an option.

Stop Making It So Hard

Given these facts, all we can do is support patients in making informed choices about maximizing their health. Unfortunately the NHS presently makes it very hard for people who choose the already challenging path to bariatric surgery. It’s well past time to stop that nonsense.

Click here for the study and here for a companion commentary. For more coverage, click here and here. For further perspective on surgery to reverse type 2 diabetes, click here. And finally, if you really want to learn about interventional therapies for type 2 diabetes, join us at WCITD2019 in New York next month.

Berry Shake, photograph © Isabelle Boucher / flickr

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March 7, 2019

2 Responses to “Shaking Diabetes into Remission”

  1. March 07, 2019 at 12:30 pm, Bryan said:

    It is important to add that it isn’t the surgery per se that leads to remission of type-II diabetes. The remission is caused by the weight loss, regardless of having surgery or not.

    Pucci A, Tymoszuk U, Cheung WH, et al. Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores. Diabet Med. 2018 Mar;35(3):360-367

  2. March 07, 2019 at 4:01 pm, Ted said:

    Actually, that’s not true. It’s clear that diabetes remissions after bariatric surgery are the result of metabolic and hormonal changes independent of weight loss. Remissions begin before patients actually lose weight. See: https://doi.org/10.1146/annurev.med.051308.105148