DIABETES
IN THE PAST, TYPE 2 DIABETES WAS THOUGHT TO BE A LIFELONG CONDITION. NOW, HOWEVER, THERE IS INCREASING EVIDENCE TO SAY THAT, WHILE IT CAN’T BE CURED, IT CAN BE PUT INTO REMISSION THROUGH WEIGHT LOSS, LEADING TO BENEFITS FOR BOTH PATIENTS AND THE NHS.
REVERSING TYPE 2 DIABETES: A NEW APPROACH
T
here is no doubt that Type 2 diabetes is a national crisis and a massive challenge to the NHS. One in ten people over 40 is now living with diabetes and new figures from Diabetes UK suggest that, by 2030, around 5.5 million British people will have the condition.
But new research has shown real hope of turning the clock back and reversing Type 2 using a revolutionary diet.
The diet, which was developed by Professor Roy Taylor from Newcastle University in conjunction with colleagues from the University of Glasgow, sees participants live on a diet of just 800 calories per day for four weeks in order to see if they can shed more than two stones (15kg).
WHAT IS DIABETES REMISSION? Type 2 diabetes means that the body can no longer maintain healthy blood sugar levels through production of the hormone insulin. When blood sugar levels rise to harmful levels (ie, 6.5 per cent or 48mmol/moll HbA1c), people are diagnosed with diabetes.
Although many factors affect the development of Type 2 diabetes, it is often accompanied by weight gain. Over the last few years, however, doctors had noticed that some obese patients, who went on to lose a lot of weight, saw their blood sugar levels drop back to normal and, more importantly, remain at that low level without diabetes medicines. This evidence fuelled interest in the concept of ‘reversing’ diabetes through major weight loss.
12 - SCOTTISH PHARMACIST
THE DIRECT PROGRAMME As a result of these observations, Diabetes UK committed £2.8 million to their Diabetes Remission Clinical Trial programme, known as DiRECT. In the first twelve months, almost half of the 300 participants (45.6 per cent) were in remission of Type 2 diabetes.
The programme involves a low-calorie, nutrient-complete, liquid diet. After three to five months, food is then reintroduced and those taking part provided with long-term support to maintain their weight loss.
The study found that there was a close link between remission and total weight loss. Eighty-six per cent of those, who lost more than fifteen kilogrammes on the programme, put their Type 2 diabetes into remission, as did 57 per cent of those, who lost between ten and fifteen kilogrammes, and 34 per cent of those who lost between five and ten kilogrammes. In the comparison group, where people with Type 2 diabetes received standard care, only four per cent achieved remission.
While the results of the study are hugely promising, Dr Elizabeth Robertson, Director of Research at Diabetes UK, says that this is only the beginning of such research.
‘These findings of DiRECT demonstrate the potential to transform the lives of millions of people,’ she said. ‘The trial is ongoing, so that we can understand the long-term effects of an approach like this. It’s very important that anyone living with Type 2 diabetes considering losing weight in this
way gets support and advice from a healthcare professional.’
THE FINANCIAL PERSPECTIVE Professor Taylor and his colleagues also showed that rolling out a Type 2 diabetes remission programme in the NHS could cost around £1,067 per participant in its first year – or, factoring in the likelihood of success, £2,564 for each case of remission.
The economic analysis, which was published in the Lancet Diabetes and Endocrinology, was carried out by researchers at the University of Glasgow using data from the DiRECT programme.
The team compared the treatment costs of the two groups in DiRECT: those on the weight loss programme (the intervention group), and those receiving current standard NHS care (the control group).
They took into account the cost of healthcare professional training, providing the low-calorie formula diet, review appointments with healthcare professionals and supporting literature. The team also factored in the costs of any routine health care during the twelve months, including primary care, community care, hospitalisations, and anti-diabetes and anti-hypertensive medications.
The cost of the twelve-month programme, allowing for savings for reduced drug and medical needs, was £1,067.
The DiRECT remission programme is therefore relatively inexpensive when
compared to the serious and expensive complications of Type 2 diabetes.
‘This intervention is relatively inexpensive when compared to managing Type 2 diabetes,’ says Professor Andrew Briggs, Health Economist at the University of Glasgow, ‘and we anticipate that there will be cost-savings further down the line. If people can stay in remission and therefore reduce their chances of developing diabetes complications, the cost savings to the NHS could be substantial.
‘We can’t know this for certain yet, which is why the long-term follow- up of these participants – alongside those accessing any NHS remission pilots in the near future – is very important. However, these findings are encouraging, and – in our view – begin to make the case for shifting resources to offer remission-based models of care in the future.’
‘The cost of a year’s programme to achieve remission of Type 2 diabetes is less than the annual cost of continuing to treat this progressive and often debilitating condition – particularly at its later stages,’ adds Mike Lean, Professor of Human Nutrition at the University of Glasgow and consultant physician at Glasgow Royal Infirmary. ‘It is becoming hard to see why, ethically, people with Type 2 diabetes should not be offered the chance, and supported, to achieve remission if they can. This is no quick fix, but instead a promising medical treatment with potentially huge benefits. •
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