40 VOLUME 19 NUMBER 2 • November 2022 diabetes news SA JOURNAL OF DIABETES & VASCULAR DISEASE Stringent diet puts diabetes into remission and cuts need for blood pressure medication Achieving and maintaining substantial weight loss allowed eight out of 10 people remission from type 2 diabetes, as well as lowering blood pressure and reducing the need for antihypertensive medications, found the Diabetes Remission Clinical Trial (DiRECT) published recently in Diabetologia. The weight-loss phase is followed by support to choose foods and eat wisely for maintenance of weight loss. Maintaining the 15-kg weight loss allowed eight out of 10 people to become free from type 2 diabetes, without the need for diabetes medications, for at least two years. A weight-management programme was developed by researchers at the Universities of Glasgow and Newcastle for the Diabetes UK-funded DiRECT trial. It involved an initial 12 weeks on a nutritionally complete formula diet (lowcalorie soups and shakes), which induces weight loss of over 15 kg if followed fully. Diabetes and blood pressure drugs were stopped at the start, and only re-started if blood sugar level or blood pressure rose. This study, published in the journal Diabetologia [the journal of the European Association for the Study of Diabetes (EASD)], looked at 143 people who started the diet programme, with more than half (78 people) on tablets for high blood pressure at the start, and 44 on two or more drugs. The researchers found that, overall, average blood pressure fell steadily as people lost weight. And blood pressure remained lower after the formula diet period finished, and then at 12 and at 24 months. For those not previously treated for high blood pressure, blood pressures fell sharply from week one. For those who had stopped their blood pressure tablets, blood pressure still fell, although more slowly. Just over a quarter (28%) needed to reintroduce a blood pressure tablet during the formula diet period. However, researchers also found that the same proportion of participants (28%) were able to remain off their medications for at least two years. Prof Mike Lean, from the University of Glasgow, said: ‘We wanted to evaluate the safety and efficacy of withdrawing blood pressure medication when beginning our specially designed weight-loss programme for type 2 diabetes patients, and we are really pleased with the results. Our study shows that, in addition to possible remission of type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks. ‘Currently, over half of all the 4.5 million people with type 2 diabetes in the UK also require tablets for hypertension to reduce serious vascular complications. Being overweight is the main cause, and losing weight can bring a remission of hypertension for many, as well as a remission of diabetes. Withdrawing blood pressure medications was safe, provided people lost weight and blood pressure was checked regularly, in case tablets needed to be reintroduced. ‘The DiRECT trial was done entirely in primary care. The evidence shows that GPs can safely offer an evidencebased intensive weight-management intervention, aiming for substantial weight loss and remission of type 2 diabetes. The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain weight loss is vital.’ Professor Roy Taylor, from Newcastle University, said: ‘Guidelines encourage doctors to start tablets but there have been few demonstrations of how tablets can be stopped. My patients, like so many, do not like swallowing multiple tablets, and this study is important as we can now reassure them that stopping blood pressure tablets is not only safe but also good for their health. We’ve shown that when substantial weight loss is achieved and maintained, patients can effectively manage both their blood pressure and type 2 diabetes without drugs.’ Dr Wilma Leslie, University of Glasgow, said: ‘The potential to no longer need medications for blood pressure and diabetes is a big incentive for people. We hope our results will reassure health professionals that this is possible, and encourage the wider provision of diabetes remission services.’ Dr Elizabeth Robertson, director of Research at Diabetes UK, said: ‘These important results show that the Diabetes UK-funded DiRECT low-calorie, weightmanagement programme not only helps some people put their type 2 diabetes into remission, but can also lower blood pressure, allowing some people to safely stop taking their blood pressure medication. ‘We’re delighted to see more evidence of the life-changing impact of the DiRECT programme on people’s health. This makes us even more determined to make sure as many people as possible have access to type 2 diabetes remission services.’ Source: MedicalBrief 2021 diet recommendations for weight loss, and results may have been different if participants were actively trying to lose weight. Further, all meals were prepared and provided for participants in an inpatient setting, which may make results difficult to repeat outside the lab, where factors such as food costs, food availability, and meal preparation constraints can make adherence to diets challenging. The tightly controlled clinical environment, however, ensured objective measurement of food intake and accuracy of data. ‘To help us achieve good nutrition, rigorous science is critical and of particular importance now, in light of the COVID-19 pandemic, as we aim to identify strategies to help us stay healthy,’ said NIDDK director Dr Griffin P Rodgers. ‘This study brings us closer to answering long-sought questions about how what we eat affects our health.’ Source: MedicalBrief 2021
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