- What is type 2 diabetes?
Type 2 diabetes (T2DM) is a condition where our body cannot properly regulate blood glucose (sugar) levels. T2DM is the most common form of diabetes and can develop at any age. Specifically, it accounts for 90-95% of all individuals with diabetes worldwide. During T2DM, our body stops responding properly to a very important hormone called insulin. This means that the pancreas is not functioning properly or is unable to produce enough insulin, resulting in increased blood glucose levels. How does insulin help manage blood glucose levels? Insulin is like a key that helps unlock the cells and allows glucose in the blood to move into the cells where it is used as energy.
- What are the causes of type 2 diabetes?
It has been known for many years that obesity increases the risk of developing type 2 diabetes. New research published in Diabetes Care revealed that having higher levels of fat in the liver and pancreas directly increases the risk of developing type 2 diabetes. Specifically, for every 5% increase in liver fat, the risk of type 2 diabetes increases by 27%. Additionally, high levels of the liver enzyme alanine aminotransferase (ALT) combined with high triglycerides, can also predict the progression to type 2 diabetes. ALT levels rise with increasing liver fat. Based on this data, Diabetes UK has funded a recent study called the Diabetes Remission Clinical Trial (DiRECT).
- What does remission of type 2 diabetes mean?
Type 2 diabetes remission is when your long-term blood sugars fall below the diabetes level and stay there for at least three months, without the need for glucose-lowering medication.
In medical terms, this means having a HbA1c below 48mmol/mol or 6.5%. This definition has been agreed by a team of international experts from here at Diabetes UK, the American Diabetes Association, and the European Association for the Study of Diabetes.
- How can type 2 diabetes be put into remission?
Recent research results have shown that weight loss plays a significant role in this, specifically, a weight loss of about 15kg, followed by long-term maintenance and support from healthcare professionals.
This can be achieved through a low-calorie diet under the supervision of a dietitian. This significant weight loss results from the reduction of fat in both the liver and the pancreas. About 46% of individuals who lost 10-15 kilograms managed to achieve remission. It is important to note that this weight loss must be done safely. Remission is more likely if you lose weight as soon as possible after your T2DM diagnosis, especially in the first 5 years. However, there are some people who have put their diabetes into remission 25 years after their diagnosis (Diabetes UK). If you want to start losing weight to work towards diabetes remission, it is important to talk to a healthcare professional team beforehand to ensure it is appropriate for you.
Additionally, you may need to reduce or stop any medications – insulin or sulfonylureas, for example – before you start losing weight or even during the process to avoid any hypoglycaemic episodes. Thus, your medical team must be informed, and there should be communication among the entire team. Rapid weight loss is not recommended if you have a healthy weight, are under 18 years old, pregnant, breastfeeding, or have ever been diagnosed with an eating disorder.
- What other benefits does weight loss have?
Weight loss has many benefits, even if it does not lead to remission. Individuals with obesity have an increased risk of serious health conditions, such as cardiovascular diseases, stroke, heart attack, and an increased risk of certain cancers. Research has shown that losing even 5% of body weight can lower blood pressure, cholesterol levels, and improve blood glucose levels, which can lead to fewer medications.
