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Diabetes Week 2019: Redefining type 2 diabetes

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Diabetes Week is taking place between the 10-16 June and our goal for this year is to redefine diabetes by improving understanding and tackling misconceptions.

In this blog we’re shifting the focus to misconceptions surrounding type 2 diabetes in particular. It has long been believed that type 2 diabetes is a chronic, progressive disease that will eventually become worse over time. However, thanks to emerging research it is now known that there are several strategies that can be employed to place type 2 diabetes into remission and reduce the risk of complications.

Here we discuss three of these strategies including what they entail and how each can lead to remission.

  1. Low Carb Lifestyle

A low carbohydrate diet involves restricting the intake of carbohydrates to typically fewer than 130g per day. Although depending on the individual’s goal some people prefer to reduce this amount to below 50g per day, also known as a very low carb, ketogenic diet.

Going low carb comprises limiting starchy foods such as bread, rice, pasta and potatoes and increasing foods containing healthy fats such as avocado, fish and nuts. The emphasis of a low carb lifestyle is consuming ‘real’ foods and limiting those containing processed and refined carbohydrates.

Type 2 diabetes is believed to be caused by insulin resistance, which occurs when the body stops producing or responding to insulin effectively, resulting in a rise in blood glucose levels. A low carb lifestyle is beneficial as it can help to lower both blood glucose and insulin levels, enabling the person to achieve remission. Indeed, results from our own Low Carb Program have shown that after 12 months, 1 in 4 people have been able to reduce their HbA1c to below the threshold for type 2 diabetes, putting the condition into remission.

A love carb lifestyle can be beneficial for many reasons such as quick results with minimal side effects, however it does require the initial motivation and willpower to change your eating habits.

  1. A Very Low Calorie Diet

A very low calorie diet (VLCD) or very low energy diet involves restricting calories to between 600-800 kcals per day. For reference, the standard recommended intake is 2000 kcal per day for women and 2,500 kcal per day for men.

A VLCD can be achieved through following a predominately liquid diet consisting of commercial, specially formulated, nutritionally complete meal replacement shakes, soups and bars. Or, through using real foods, taking into careful consideration that the meals contain the recommended essential nutrients.

Professor Roy Taylor at Newcastle University led the DiRECT study which investigated the effects of a VLCD for type 2 diabetes and found that 50% of participants achieved remission after the first year. Magnetic resonance imaging showed that fat loss around the liver and pancreas, which is associated with insulin resistance predicted remission.

A VLCD can produce rapid weight loss and little preparation is needed for meals, however some people may find it difficult to stick to and may experience side effects such as low energy, cramps and dizziness.

  1. Bariatric Surgery

Bariatric (weight loss) surgery is a treatment used for people who are obese or have obesity-related type 2 diabetes. There are several types of bariatric surgery which vary in effectiveness. One example is gastric banding which involves an inflatable silicone device being fitted around the top of the stomach to restrict food entry.

Bariatric surgery can result in rapid weight loss which is thought to be one of the mechanisms behind achieving remission as its known to be associated in obesity-related type 2 diabetes. It is not yet well known what the other mechanisms are but it is believed that changes to the gut microbiome and bile salts might also play a role.

Only certain people with obesity-related type 2 diabetes are eligible for bariatric surgery, which produces the highest rates of remission, but it is a life-changing surgery and in some cases, is not completely irreversible.

 

What’s the take-home message?

Initially, type 2 diabetes used to be thought of as a chronic, progressive disease, but ground-breaking research has now proved that it can be placed into remission. While there are pros and cons to each strategy for remission, this news provides hope for many and shows that we are far ahead on our journey to redefining type 2 diabetes.

Note that if you are considering trying any of these strategies for remission, you should consult your healthcare team for information and clinical advice.

 



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