Our work has shown that type 2 diabetes is not inevitably progressive and life-long. We have demonstrated that in many people who have had type 2 diabetes for up to 10 years, major weight loss returns insulin secretion to normal.
It has been possible to work out the basic mechanisms which lead to type 2 diabetes. Too much fat within liver and pancreas prevents normal insulin action and prevents normal insulin secretion. Both defects are reversible by substantial weight loss.
A crucial point is that individuals have different levels of tolerance of fat within liver and pancreas. Only when a person has more fat than they can cope with does type 2 diabetes develop. In other words, once a person crosses their personal fat threshold, type 2 diabetes develops. Once they successfully lose weight and go below their personal fat threshold, diabetes will disappear.
Some people can tolerate a BMI of 40 or more without getting diabetes. Others cannot tolerate a BMI of 22 without diabetes appearing, as their bodies are set to function normally at a BMI of, say 19. This is especially so in people of South Asian ethnicity.
In October 2013, Diabetes UK announced the award of its largest research grant ever. It builds upon the breakthrough in understanding the pathophysiology of diabetes and the related demonstration that short term type 2 diabetes could be reversed to normal. This is brought together with work conducted in Glasgow on use of low calorie liquid diets in primary care.
The study will answer two main questions:
The study will be known as DiRECT (DIabetes REmission Clinical Trial). Participating general practices in Newcastle and Glasgow will be randomised either to use the low calorie diet followed by an intensive weight maintenance 2 year phase, or to best possible care according to current guidelines. In order to deliver the low calorie diet, together with the critically important backup and support, primary care staff will be trained by the study team. The expertise of Professor Ashley Adamson, Professor of Human Nutrition in Newcastle and Dr Falko Sniehotta, Reader in Health Psychology, will be combined with previous experienced specialist dieticians from Counterweight Ltd. Counterweight was formed as a company in order to keep together the expertise developed during the Counterweight Project which has been highly successful in achieving and maintaining weight loss in the primary care setting.
Study volunteers in the Newcastle area will also undergo detailed magnetic resonance investigations coupled with metabolic tests to examine further the basic mechanisms which bring about the return to normal blood glucose control. Additionally, detailed psychological assessments will be carried out to understand the response of individuals to this management approach and identify factors which effect adherence.
The phase of appointing and training staff is now underway, and the first volunteers will be joining the study in April 2014. All recruitment will be via participating general practices.
The protocol for the DiRECT study has recently been published.
This study is a collaboration between Professor Mike Lean, Professor of Human Nutrition at Glasgow University and also Professor Roy Taylor, Professor of Medicine and Metabolism at Newcastle University, as the Chief Investigators. The Principal Investigators are Professor Ashley Adamson, Professor Falko Sniehotta, Dr Kieren Hollingsworth and Professor John Mathers, Professor Ian Ford and Professor Naveed Sattar.
It is important that people with diabetes discuss their management with their own doctor. It will take years for this new knowledge to become incorporated into textbooks and guidelines, so your doctor may be wary of information from the internet.
Newcastle University researchers have written some notes for you to take to your doctor. Download our information sheet for doctors on the practical management of type 2 diabetes in respect of reversal (PDF: 220KB).
See Professor Taylor's recent lecture on the state of the research on reversing type 2 diabetes, delivered to the Diabetes UK meeting in March 2016.
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