Type 2 diabetes can be reversed with very low-calorie diet

Study shows that it is possible to achieve remission from type 2 diabetes by dieting | The Lancet | via National Institute for Health Research

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Type 2 diabetes is a growing epidemic, costing the NHS £23.7 billion per year. By 2016 there were nearly 3.6 million people diagnosed with diabetes in the UK and a further one million estimated to have undiagnosed type 2 diabetes. Rates of diabetes appear to be increasing.

This study aimed to see if a very low-calorie diet program delivered in primary care could lead to at least 15kg weight loss and remission of type 2 diabetes.

The study found that by 12 months:

  • Weight loss of 15kg or more was achieved by 24% of the intervention group compared to none of the usual care group. Average weight loss was 10kg in the intervention group versus 1kg in the usual care group.
  • Diabetes remission occurred in 46% of the intervention group compared to 4% of the usual care group. It only occurred in people who had lost weight.
  • Remission was 20 times more likely with the intervention.
  • Better adherence to the regime increased the amount of weight loss and the chance of diabetes remission.
  • Diabetes medication did not need to be reintroduced for 74% of the intervention group. This was compared to 18% of the usual care group who were able to stop them. Blood pressure tablets were also no longer required for 68% of the intervention group compared to 39% of the usual care group.

Full reference: Lean MEJ, Leslie WS, Barnes AC, et al. |  Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.  | Lancet. 2017. [Epub ahead of print].

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NICE recommends ‘lifestyle tips’ for 1.7m at risk of type 2 diabetes

People at the highest risk of type 2 diabetes should be given intensive exercise and weight loss help by the NHS, NICE has recommended.

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Healthcare professionals, from GPs to community nurses and pharmacists, should refer people with elevated blood sugars to exercise classes and nutrition courses, NICE has said in updated guidance.  Lifestyle-change programmes, such as NHS England and Public Health England (PHE)’s ‘Healthier You: NHS Diabetes Prevention Programme’, provide personalised help for patients to change their diet and increase their physical activity.

NICE has identified 1.7 million people as having the highest risk of developing type 2 diabetes, and  recommends that GPs should see specific groups of patients for a diabetes risk assessment.

Full guidance: Type 2 diabetes: prevention in people at high risk

Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes

Barry, E. et al. BMJ. 356:i6538

Objectives To assess diagnostic accuracy of screening tests for pre-diabetes and efficacy of interventions (lifestyle or metformin) in preventing onset of type 2 diabetes in people with pre-diabetes.

 

Conclusions: HbA1c is neither sensitive nor specific for detecting pre-diabetes; fasting glucose is specific but not sensitive. Interventions in people classified through screening as having pre-diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial populations. As screening is inaccurate, many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention. These findings suggest that “screen and treat” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes.

Read the full article here

 

A Structured Transition Program Among Young Adults With Type 1 Diabetes

Pyatak, E. et al. Journal of Adolescent Health. Published online: November 23 2016

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Purpose: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care.

Conclusions: Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.

Read the full abstract here

NICE guidance update: Diabetes (type 1 and type 2)

NICE has updated its guideline Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NG18).

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Image source: http://www.nice.org.uk

This guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18.  It has been amended to add information to recommendations 1.2.115 and 1.3.52 on when eye screening should begin and referral for eye screening should happen.
Related:  NICE Pathway – Diabetes in children and young people

3.8 million people had diabetes in 2015

New data from Public Health England reveals that 3.8 million people in England aged over 16 had diabetes in 2015, around 9% of the adult population.

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Image source: https://www.gov.uk/

The new Diabetes Prevalence Model, produced by the Public Health England (PHE) National Cardiovascular Intelligence Network estimates the total number of adults with both Type 1 and Type 2 diabetes in England.

Whilst 3.8 million people are estimated to have both types of diabetes, approximately 90% of diabetes cases are Type 2; this is largely preventable or manageable by lifestyle changes and also provides additional benefits for health and wellbeing. The likelihood of developing Type 2 diabetes is increased by being overweight (although family history, ethnicity and age can also increase risk).

Based on current population trends, by 2035 4.9 million people will have diabetes. Type 2 diabetes currently costs the NHS £8.8 billion each year and tackling the rise in the disease is vital to the sustainable future of the health service.

To help tackle the problem, the Healthier You: NHS Diabetes Prevention Programme (NHS DPP) was launched by PHE, NHS England and Diabetes UK earlier this year. The programme, now available to nearly half the country, will help those at high risk of Type 2 diabetes reduce their risk of developing the condition, by being offered a referral to an improved diet, weight loss and increased physical activity programme. The NHS DPP will have full coverage across England by 2020. By then, up to 100,000 people will have access to its services each year.

Read more about the Diabetes Prevalence Model here

Read more about Healthier You: Diabetes Prevention Programme here

Read the Public Health England press release here

 

Diabetes guidance updated

NICE has published updated guidance concerning diabetes in adults

  • NG17      Type 1 diabetes in adults: diagnosis and management: This guideline updates and replaces the sections for adults in NICE guideline CG15.  In July 2016, recommendation 1.15.1 has been reworded to clarify the role of GPs in referring people for eye screening and also to add information on when this should happen.

 

  • NG28     Type 2 diabetes in adults: management: This guideline updates and replaces NICE guideline CG87, NICE guideline CG66, NICE technology appraisal guidance 248 and NICE technology appraisal guidance 203. In July 2016, recommendation 1.7.17 has been reworded to clarify the role of GPs in referring people for eye screening and also to add information on when this should happen.