Diet replacement can lead to diabetes remission in real-world settings, study finds
A diet intervention from the National Health Service in England resulted in 27% of participating type 2 diabetes patients achieving remission, with mean weight loss of 14.8 kg, and even better results among patients who finished the year-long program.
Remission of type 2 diabetes with diet changes is possible outside of research settings, albeit at lower rates, a study found.
England's National Health Service established a total diet replacement interventional program that used a micronutrient-complete but low-energy diet, typically in the form of soups and shakes. It included a 12-month behavioral intervention to support weight loss with an initial three-month period of total diet replacement. Patients in England who were ages 18 to 65 years and had type 2 diabetes in the previous six years were referred to the program between Sept 1, 2020, and Dec 31, 2022. The primary outcome was remission of type 2 diabetes at one year, defined as two HbA1c levels less than 6.5% recorded at least three months apart with no glucose-lowering medications prescribed from three months before the first measurement. Study results were published in the September The Lancet Diabetes & Endocrinology.
The mean weight loss for 1,710 participants who started the program and had no missing data was 8.3% (95% CI, 7.9% to 8.6%) or 9.4 kg (95% CI, 8.9 to 9.8 kg), and the mean weight loss for the 945 participants who completed the program was 9.3% (95% CI, 8.8% to 9.8%) or 10.3 kg (95% CI, 9.7 to 10.9 kg). Of the 710 participants who had two HbA1c measurements recorded, 190 (27%) had remission, with mean weight loss of 13.4% (95% CI, 12.3% to 14.5%) or 14.8 kg (95% CI, 13.4 to 16.3 kg). Of the 945 participants who completed the program, 450 (48%) had two HbA1c measurements, with 145 (32%) experiencing remission (mean weight loss, 14.4% [95% CI, 13.2% to 15.5%] or 15.9 kg [95% CI, 14.3 to 17.4 kg]).
The study shows that remission of type 2 diabetes is possible outside of research settings through at-scale service delivery, even if remission rates are lower and data assessment is more limited in real-world settings than trial settings, according to the authors.
“The evolution of the programme is iterative, and the results of these analyses have informed a new programme specification now available across the whole of England,” the authors wrote. “Future analyses will continue to monitor remission rates in addition to mortality and complication rates.”