Remission

Four health boards in Wales are piloting Remission for Type 2 Diabetes:

Cardiff and Vale UHB

Helen Nicholls, Dietetic Lead
Cath Washbrook, Senior Community Dietitian

Hywel Dda UHB

Zoe Paul-Gough, Head of Nutrition and Dietetic Service
Glenys Jones, Clinical Lead Diabetes Dietitian

Aneurin Bevan UHB

Julie Morris, Professional Lead Dietetics

Betsi Cadwaladr UHB

Elaine Jennings, Community Dietitian

Remission of Type 2 Diabetes (T2D)

T2D has long been regarded as a chronic progressive condition. It is strongly related to weight gain in adult life and accumulation of excess fat within the liver and pancreas.

Beta cell mass decreases steadily during course of T2D, therefore it has been thought that insulin therapy will eventually be required. However T2D is found to be reversible following bariatric surgery.

The study carried out by Roy Taylor et al hypothesised that sudden negative energy balance decreased intracellular fatty acid concentration in the liver, which then released the beta cells from the chronic inhibitory effects of excess fat.

Diabetes Remission in Type 2 Diabetes is defined as HbA1c <48mmol/mol and off ALL antidiabetes drug therapy

The DiRECT study concluded:

T2D of up to six years duration is not necessarily a permanent lifelong condition
T2DM is a complication of weight gain and excess body fat, and it is not necessarily a permanent condition
Almost half of people with early T2DM can achieve remission
Nine out of ten people who lost more than 15kg achieved remission
Effective long term weight management with a resetting of long term energy consumption is essential
Individual flexibility is important to optimize results

Ref: Lean, M et al. (2018). "Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster randomised trial"

"Our findings show that at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care."

Lean, M et al (2018). DiRECT study