Type 2 diabetes remission

What is diabetes remission?

Diabetes remission can be achieved in people with type 2, it is when your blood glucose levels are within a normal healthy range and you are not taking any diabetes medication. The clinical definition of remission is when your HbA1c levels are less than 48mmol/mol on 2 occasions, at least 6 months apart, and you are not taking any diabetes medications.

Type 2 diabetes is normally treated with diet, exercise and/or medication. For many people, it’s a progressive condition, however achieving diabetes remission can have a huge impact on your overall health and well-being, both in the short and longer term.

It’s important to note that remission isn’t a cure, so if you go back to your old eating lifestyle and eating habits it may return. 

How can I put my diabetes into remission?

Research has shown that losing weight plays the biggest role in helping achieve remission from type 2 diabetes, either through diet and lifestyle or surgery.

If you would like to put your diabetes into remission by losing weight it’s important to get advice from your diabetes care team or health care professional. They can help you to do it safely, especially if you have any other health conditions, and increase your chances of successfully achieving remission. You can find out more information about different dietary approaches for weight management here. 

Why does losing weight help diabetes remission?

Many people who have type 2 diabetes are carrying extra weight around their stomachs. This leads to fat building up around vital organs such as the pancreas and liver which causes them to not work as effectively and results in diabetes.

Losing weight, and the fat around these organs, allow them to work properly again which can put your diabetes into remission.

The research surrounding remission is ongoing and we don’t fully understand all the factors that lead to diabetes remission. Not everybody will manage to put their diabetes into remission but losing as little as 5% of your body weight will have many positive impacts on your health.

These benefits include:

• Reducing your risk of developing complications from diabetes
• Improved blood sugar levels
• Reducing medications
• Lowering cholesterol levels
• Helps you to sleep better

What does the research say?

The DiRECT (Diabetes Remission Clinical Trial) trial has been looking at the impact of low-calorie diets on diabetes remission and has had some really exciting findings so far. Participants in the DiRECT trial will follow a Low-Calorie Diet (LCD) of 850 calories a day for between 8 and 20 weeks. After this, they will be gradually re-introduced to normal food and will receive expert support to help them maintain their weight loss.

The first-year findings published in 2017 showed that almost half of the participants achieved remission after twelve months. The most recent results published in 2019 showed that 70% of those participants are still in remission.

NHS Low Calorie Diet pilot

Following on from the success of the DiRECT study NHS England has begun a larger scale pilot programme called the NHS Low Calorie Diet programme which is being run in 10 pilot sites across England. We are delighted that Greater Manchester has been chosen as one of ten national pilot sites, find out more here.

Different diets for remission

For the DiRECT trial, participants followed a Low-Calorie Diet but that doesn’t mean to say that it’s the only method of losing weight quickly and safely to achieve diabetes remission. We’ve reviewed a couple of different diets below:

Low-Calorie Diet

• Eligible participants will be offered low calorie, total diet replacement (TDR) products including soups and shakes consisting of up to 900 calories a day for up to 12 weeks. Alongside this, participants will receive support for 12 months including help to re-introduce food after the initial 12-week period. Read more about the programme here. 
• Before starting an LCD it’s recommended that you speak to your healthcare team, especially if you are on insulin, sulphonylureas (such as gliclazide) or SGLT-2 medication (drug names ending in gliflozin), or you have any complications such as heart or kidney problems.
• For more information on low-calorie diets see our resource page here.

Low carbohydrate

• Carbohydrates are your body’s main source of energy and they exist in 2 forms; sugary and starchy. 
• When starchy carbohydrates are digested, they are broken down into sugar where they enter your bloodstream, which causes your blood glucose levels to rise.
• Limiting the amount of carbohydrate in your diet, either as sugar or starch, can have benefits on your health and it also limits the amount of glucose that your body stores as fat.
• This will help you manage your weight and reduce your risk of developing diabetes complications.
• Studies have shown that reducing your carbohydrate intake can help reduce your body’s need for insulin and diabetes medications.
• If you’re interested in a low carbohydrate approach then have a look at the Low Carb Program which is a behaviour change platform that provides educational resources and support.
• The Carbs and Cals website is also a great resource and they have a number of different books and smartphone app to help you track the carbohydrate content of different foods.
• Before starting a low carb diet, it’s recommended that you speak to your healthcare team, especially if you are on insulin, sulphonylureas (such as gliclazide) or SGLT-2 medication (drug names ending in gliflozin), or you have any complications such as heart or kidney problems
• If you take insulin for your diabetes you might find our eLearning course on carbohydrate counting helpful. 
• For more information on low carbohydrate diets see our resource page here. 

Intermittent fasting

• Intermittent fasting is an eating pattern that involves periods of food restriction followed by normal eating.
• There are two main approaches to intermittent fasting;
  • the 5:2 diet, where you eat normally for 5 days and 500 – 600 calories on the other 2 days, or
  • the 16:8 cycle which is time-restricted eating, which generally works out as only having an 8-hour window that you are allowed to eat in.
• During this diet, your body is either in the ‘fed’ or ‘fasted’ state.
• The fed state is when insulin is high and the body is in storage mode, so glucose gets stored as fat or as glycogen in the liver.
• The fasted state is when insulin is low and the body burns energy stores. Intermittent fasting makes the body burn fat in the absence of glucose.
• In the fasted state you essentially put your body through a metabolic workout. Extending the length of time in the fasted state helps your body to burn fat efficiently and quickly.
• If you choose to follow this diet, try to pick an evidence-based plan that has been written by a dietician such as the ‘2-day diet’.
• Before starting a fasting diet, it’s recommended that you speak to your healthcare team, especially if you are on insulin, sulphonylureas (such as gliclazide) or SGLT-2 medication (drug names ending in gliflozin), or you have any complications such as heart or kidney problems.
• For more information on intermittent fasting see our resource page here. 

What happens after remission?

At the moment there are no definite answers as to how long it will last or how it may affect your risk of developing diabetes in the future, but the results so far look very promising. What we do know is that achieving remission has huge benefits for your health. It lowers your blood glucose levels, and reduces your blood pressure and cholesterol levels, all of which will reduce your risk of developing complications associated with diabetes.

Even when you are in remission it’s important to still attend your normal check-ups as part of your diabetes care and continue to maintain your weight loss.

Tracking your Progress

Registering for My Way Diabetes will allow you to track your progress on your weight loss journey, you will be able to see your weight, BMI, waist measurement and HbA1c readings, click here to register.