Health chats with Dr.Leeds Achieving long term diabetes remission | Professor Mike Lean
In this interview Professor Lean describes the ‘DiRECT’ diabetes remission trial that was run in Scotland and northern England by teams lead by Prof Lean in Glasgow and Prof Roy Taylor in Newcastle. In the DiRECT trial he showed how with sufficient weight loss people, with a diagnosis of diabetes within the last six years, had a high chance of remission if they lost enough weight (10-15kg). He described how this was achieved using a specially formulated total diet replacement (TDR) program with support from health care professionals (dietitians and practice nurses) followed by gradual reintroduction of conventional food and a well-managed weight maintenance program afterwards.
Some of the participants in the trial maintained some of their weight loss and some remained in remission five years after starting their weight loss diet. Maintaining weight loss has proved challenging and Prof Lean describes ways in which people can help themselves to maintain a new lower body weight.
The evidence from several trials, the Direct trial (also discussed in episode one), the DIADEM2 trial undertaken in Qatar with participants from North Africa and the Middle East (see episode two) and the STANDBY trial undertaken in Glasgow on people from South Asia (see episode three) provides a solid foundation for changing type 2 diabetes management. Prof Lean believes that the time is right to now introduce weight loss as the first step in the management of type 2 diabetes not just in those who are overweight and obese, but also for those who may be within the ‘normal’ weight range but in whom, as shown in a study from Roy Taylor in Newcastle, weight loss reduces their excessive liver and pancreatic fat thereby improving their metabolic state, and leading to remission of diabetes in some participants.
Recently published guidelines on diet for type 2 diabetes for Europe emphasize the need for weight loss and state that the most effective way to achieve the needed 10-15kg weight loss is to use a formula total diet replacement (soups and shakes 800kcal/d diet) but Prof Lean points out that achieving that weight loss by any means including use of traditional conventional foods can be effective too.
Viewers and readers who are concerned about their family history of diabetes and their rising body weight can check their risk on-line by using risk calculators (see links below). Those at high or intermediate risk are advised to consult a doctor to ask for a blood test and discuss their concerns.
Web-links to useful sources of information are given below.
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Putting type 2 diabetes into remission
Long term (5 year) results of Diabetes remission trial:
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Diabetes prevention:
The Canadian Diabetes Risk calculator:
The Indian Diabetes risk score:
UK Type 2 diabetes – know your risk
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Earlier episodes:
EPISODE ONE How to get rid of diabetes | Health Chart | Episode 1 (bittertruth.uk)
Prof Mike Lean describes the diabetes remission trial in the UK.
EPISODE TWO Diabetes remission in | non-European populations (bittertruth.uk) Prof Shahrad Taheri describes a diabetes remission trial in people from North Africa and the Middle East and discusses this with Prof Mike Lean.
EPISODE THREE Diabetes remission in South Asians Prof Naveed Sattar, University of Glasgow, describes the study on diabetes remission in people of South Asian origin.
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