Type 2 diabetes is a progressive condition that can lead to heart disease, nerve damage, kidney disease and blindness. However, it is possible to beat it into remission. The pancreas can begin again making insulin, the hormone that regulates levels of glucose in the blood. The liver can reassert itself as the body’s reservoir for glucose and stop pumping out unwanted sugar. And many people who have been taking tablets to control their type 2 diabetes can potentially throw them away. This is good for the NHS, because 5% to 10% of people have type 2 diabetes. However, to beat it, you would need to lose about 10% of your body weight – and keep it off.
The solution
In an analysis paper in the BMJ, Mike Lean, professor of nutrition at Glasgow University, argues that giving tablets to reduce blood sugar (the main treatment for type 2 diabetes) only addresses the symptom. “Virtually everyone with type 2 diabetes is two or three stone [12-19kg] above their ideal weight,” says Lean. “One of the great tragedies is that we’ve known this for about a hundred years and all the treatments have ever done is reduce the blood sugar – this is the consequence, but what drives it is the weight.”
Lean says the easiest indicator of someone at risk of type 2 diabetes is a fat tummy. A man with a waist over 91cm (36in) or a woman with a waist over 81cm (32in) could both be on the path to the condition. Another paper in Frontiers in Endocrinology describes a programme of high-intensity exercise as a way of preventing type 2 diabetes developing in people with risk factors. But: “You can’t run off diabetes,” says Lean. He says evidence suggests most people need to lose more than 12kg. But studies show woeful remission rates (0.14% of 120,000 US patients who were followed up for seven years).
Lean is more optimistic, as his team is involved in a programme called Counterweight Plus, which a pilot study showed led to a third of people losing more than 12kg. The programme involves drinking formula shakes with a total of 820 calories for six to eight weeks, before reintroducing food that includes a lot less fat, and ideally no alcohol. The programme is being further evaluated and Lean says he is not pushing his own Counterweight Plus solution – people should ask their GPs for any evidence-based weight-loss programme. The rewards of weight loss are high. Not having type 2 diabetes any more (as long as you don’t regain weight) means not only no tablets for diabetes and no complications, but often the reversal of any high blood pressure, too.
