The Overselling of Diet and Exercise for Diabetes Remission

Zeal is thrilling. “The solution is at hand” for type 2 diabetes, says Professor Roy Taylor. “If a person has T2DM, they have become too heavy for their own body.” Losing weight with his very low calorie diet will put that diabetes into remission, he says. “A simple bottom line.” Except that a new study in PLOS Medicine is suggesting that remissions might not be so simple to achieve in the real world. Maybe there’s a bit of overselling when zealous acolytes say remission of type 2 diabetes is “simple.”

In fact, say the authors of the PLOS study:

“The incidence of diabetes remission was low with only 6% of people achieving remission over 8 years, and half of those with initial remission returned to hyperglycaemia within 3 years, indicating poor sustainability of diabetes remission in real-world setting.”

A Surprising Finding?

Is this really a surprising finding? In a word, no.

In fact, the numbers from this new study are not so far out of line with the long-term data that Taylor has presented at medical meetings. At the EASD meeting last summer, he told an audience that the remission rate for his DiRECT study was only 13% at five years, before accounting for dropouts. After accounting for them, the number would drop to only six or seven percent, he said.

But these dismal numbers do not dim his zeal for promoting the simplicity of achieving remissions with diabetes. Just lose weight with diet and exercise.

Overselling

So objectively, it seems a little tough to deny that some of the claims for simple and lasting diabetes remission with diet and exercise amount to overselling something that is in fact challenging and often unsustainable.

Numbers from the new study in PLOS Medicine support a perspective entirely consistent with the intent-to-treat numbers that Professor Taylor presents. He says six or seven percent after five years. The PLOS study says six percent after eight years.

So no. The new paper in PLOS did not get low remission rates in the long term because “a supportive environment” was missing, as a recent commentary suggests. The low remission rates reflect the reality of how hard remissions are to sustain.

Diabetes control is possible. Even doable. But empty puffery and unrealistic expectations are not helpful. And quite often, it takes more than just diet and exercise.

Click here for the new study in PLOS Medicine, here, here, and here for further perspective.

Balloon Seller, painting by Boris Kustodiev / WikiArt

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January 27, 2024