Predictors of Drug-Free Type 2 Diabetes Remission Explored

In 2021, the British Diabetic Association published a review of dietary strategies for non-drug type 2 diabetes (T2D) remission, which stated that "total dietary replacements and low-carbohydrate diets have been shown to be effective for facilitate weight loss and T2D remission.’ However, meta-analyses do not always support a focus on low-carbohydrate diets to achieve weight loss or diabetes remission. Concrete data on the outcomes of this approach are needed. and examine what clinical aspects help it to be successful.

In this article, we examine real-world data from a UK primary care clinic-based cohort offering a low-carbohydrate approach to people with T2D from 2013 to 2021. The physiological mechanisms behind weight loss-induced remission Dietary weight were first demonstrated in 2011. Since then, the idea of ​​medication-free remission of type 2 diabetes has gained international momentum.

We now have an international consensus on the definition of remission; a glycosylated hemoglobin (HbA1c) <48 mmol/mol sustained for >3 months in the absence of diabetes medication. 8 Previous practice audits showed significant improvements in: HbA1c, 9 10 lipids and blood pressure (BP) (this despite ’deprescribing’ 20% of antihypertensive medications), kidney function and liver function. Not only were significant improvements in health demonstrated, but also substantial savings in the medication budget.

This analysis of our 8-year data set explores what factors predict remission, its durability, and the glycemic control of those who do not achieve remission.

Background

Type 2 diabetes (T2D) is often considered a lifelong, progressive disease that requires an increasing number of medications. Sustained remission of T2D is now well established, but not yet routinely practiced. Norwood Surgery has used a low-carb program with the goal of achieving remission since 2013.

Methods

Between 2013 and 2021, low-carbohydrate diet and weight loss counseling was routinely offered to people with T2D, in a suburban practice with 9,800 patients.

Conventional ’one-to-one’ GP consultations were used, supplemented by group consultations and personal telephone calls as necessary. Those interested in participating were computer coded for an ongoing audit to compare “baseline” to “last follow-up” for relevant parameters.

Results

The cohort choosing the low-carbohydrate approach (n=186) equaled 39% of the T2D practice registry. After an average of 33 months, median (IQR) weight fell from 97 (84–109) to 86 (76–99) kg, giving a mean (SD) weight loss of −10 (8.9) kg . Median (IQR) HbA1c fell from 63 (54–80) to 46 (42–53) mmol/mol.

Diabetes remission was achieved in 77% with T2D duration less than 1 year, falling to 20% with duration greater than 15 years. Overall, remission was achieved in 51% of the cohort. Mean LDL cholesterol decreased by 0.5 mmol/L, mean triglycerides by 0.9 mmol/L, and mean systolic blood pressure by 12 mm Hg.

There were significant prescription savings; Norwood’s average surgery spend was £4.94 per patient per year on diabetes medication compared to £11.30 at local practices. In the year ending January 2022, Norwood surgery spent £68,353 a year less than the area average.

Number of patients divided between those who achieve remission and those who do not, versus weight change (in kg). NA, not applicable.

Conclusions

A practical primary care-based approach to achieving T2D remission is described. A low-carbohydrate diet-based approach was able to achieve significant weight loss with substantial health and economic benefit. It resulted in 20% of the entire practice population with type 2 diabetes achieving remission.

It appears that T2D duration <1 year represents an important window of opportunity to achieve drug-free diabetes remission. The approach may also give hope to those with poorly controlled type 2 diabetes who may not achieve remission, this group had the greatest improvements in diabetes control represented by HbA1c.