• Alzheimer's disease has been referred to as Type 3 diabetes. (Getty Images)Source: Getty Images
Type-2 diabetes used to be seen as an incurable condition that only got worse over time. A promising study suggests otherwise.
By
Dr Michael Mosley

13 Nov 2018 - 8:03 AM  UPDATED 13 Nov 2018 - 8:08 AM

The results from a recent study could revolutionise the treatment of Type 2 diabetes. The details were published in December last year in The Lanceta leading medical journal.

The project, called DiRECT (Diabetes Remission Clinical Trial), was funded by Diabetes UK, a charity that aims to improve the health of people living with the condition. The three-year study found that almost half of the patients who tried a rapid weight-loss diet were able to put their Type 2 diabetes in remission and keep it there.  

The study involved 308 patients who had had Type 2 diabetes for less than six years. When the patients agreed to take part, they were randomly allocated to either getting standard diabetes care from their GP, or going on a rapid weight-loss diet. On this diet, they were asked to stick to 800 calories a day for up to 20 weeks, then switch to a program of long-term support to maintain weight loss.

One in four people who had been allocated to the rapid weight-loss side of the trial had lost more than 15kg, which was impressive, and they kept it off for a year, which was even more impressive.

A key finding of the study showed that the more weight people lost, the more likely they were to get their blood sugars under control without medication. 86 per cent of participants who lost 15kg or more put their diabetes into remission. This fell to about 7 per cent in patients who lost less than 5kg.

Nearly half the patients (46 per cent) on the rapid weight-loss regime managed to get their blood sugars back to normal, without medication, compared to only 4 per cent of participants getting standard diabetes care.

Isobel Murray, who took part in the study, lost 25kg in 17 weeks and is no longer on any diabetes drugs. “I was on increasing doses of medication and becoming more and more ill every day,” she said. “Now I feel amazing and, though I still get my diabetic checks done, I no longer think of myself as a diabetic.”

I have been eagerly awaiting the results of this study ever since the publication of my book, The 8-Week Blood Sugar Diet, two years ago. This book, which includes recipes and a detailed program for reversing pre-diabetes and Type 2 diabetes, was based exactly on this rapid weight-loss approach.

Since the book was published, I have received thousands of letters and emails from people who have lost lots of weight and are back to full health, but I was obviously keen to see how well the claims I made in my book would stand up to a rigorous scientific trial carried out in some of the most economically deprived parts of the UK.

Professor Roy Taylor, a top diabetes expert and one of the lead authors of the new study, was obviously delighted by their findings. They confirm his previous research, which had been carried out with smaller numbers and in a controlled clinical setting. This was a trial done in general practice, run mainly by practice nurses.

A key finding of the study was the more weight people lost, the more likely they were to get their blood sugars under control without medication.

“These findings really could revolutionise the way Type 2 diabetes is treated,” he told me. “This builds on our previous work, so it is very satisfying.”

There is an urgent need to do something more to hold back the epidemic of diabetes than simply dishing out more and more pills. According to Diabetes Australia, diabetes (and in particular, Type 2 diabetes) is the fastest growing chronic condition in this country and presents the biggest challenge to Australia’s healthcare system.

Around 1.7 million Australians have diabetes. Some have Type 1 diabetes, an autoimmune condition which typically develops when you are young and does not respond to weight-loss treatments. The vast majority, however, have Type 2 diabetes, which can have a genetic cause but is influenced by lifestyle factors, too - such as carrying a bit too much fat around the waist. You don’t have to be overweight to have Type 2 diabetes, but it certainly contributes to your risk.

On top of the 1.2 million confirmed diabetics, there’s an estimated 500,000 people who have it and don’t know they have it, plus 2 million people who have pre-diabetes, where blood sugar levels are raised but are not yet in the diabetic range. Very few people with pre-diabetes are aware they have it, let alone realise they'll probably develop the full-blown disease.

The main risk factors for having abnormal blood sugar levels include having a family history of diabetes, being male, being overweight and being over 60.

The number of people over 60 with diabetes has more than tripled over the last two decades and is expected to double again in the next decade. 

Complications of diabetes include an increased risk of going blind, having a heart attack, going into kidney failure, getting dementia and losing a limb. There are around 4400 amputations performed in Australian hospitals every year because of diabetes - mainly toes, feet and limbs.

It’s also a very expensive disease, costing the country around $14.6 billion a year

I’m particularly interested in diabetes because five years ago I discovered, after a routine blood test, that I was a Type 2 diabetic. This was a particularly nasty shock to me as my father had died at the relatively early age of 74 from complications of diabetes. Rather than start on medication, which is what my doctor advised, I decided to find something I could do to overcome diabetes without drugs.

In the course of my research, I discovered “intermittent fasting”, where instead of dieting every day, you cut your calories a few days a week. After talking to experts, I ended up creating what I called the 5:2 diet, where I cut my food intake to around 600 calories a day, two days a week, and ate as healthily as possible on the other five days. Using this approach, I rapidly lost 10kg and returned my blood sugars to normal, where - thanks to my maintaining this weight loss - they have stayed ever since. I later wrote a book, The Fast Diet, all about the benefits of intermittent fasting. It became an international bestseller.

“These findings really could revolutionise the way Type 2 diabetes is treated,” he told me.

But why did losing weight make such a big difference to my blood sugar levels? Soon after writing The Fast Diet, I met leading diabetes expert Roy Taylor, Professor of Medicine and Metabolism at Newcastle University. He said the main reason so many people develop blood sugar problems later in life is because we put on too much visceral fat - fat around the gut. This not only makes us look chubbier, but clogs up our liver and pancreas. “Get rid of that fat,” he told me, “and most people can get their blood sugar levels back to normal without medication.”

This was a remarkable claim because the accepted wisdom is that Type 2 diabetes is incurable and invariably progressive. Most of the doctors I spoke to were sceptical that patients would start a rapid weight-loss diet, let alone stick to it. One man I spoke to said he’d been told by his GP that it would never work and he should not be worried “when you fail”.

Well, it turns out they were wrong and Professor Taylor was right. I can only hope, following this new study, that more doctors will start recommending this approach to patients. As Professor Taylor said to me, last time we met,  “What doctors in general haven’t recognised is how much people with Type 2 diabetes hate having it. In my experience people will jump for [this new approach], given the chance.”

Dr Michael Mosley is author of The 8-Week Blood Sugar Diet

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