The Telegraph
Thursday , September 14 , 2017
 
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Diabetes reversal hope

- Drastic & sustained weight loss through diet control can lead to long-term remission: Doctors

New Delhi, Sept. 13: Some patients with diabetes may reverse the disease and celebrate long-term remission through drastic weight loss, a team of British doctors said today, challenging the conventional management of diabetes practised for decades.

The doctors said there is significant evidence that the reversal of diabetes is now "clearly attainable" for some, possibly many, but most patients and doctors remain oblivious to these developments and still consider the diagnosis of diabetes a permanent label.

Well-designed, diet-based strategies have been shown to lead to rapid and substantial weight loss and get patients to maintain a 12kg to 15kg weight loss for periods of a year and sustain it beyond, the doctors said, citing studies in the UK over the past five years.

"It is not easy to achieve this, but every person diagnosed with diabetes should get a chance to try it," Mike Lean, professor of human nutrition at the University of Glasgow who is involved in such weight loss studies told The Telegraph over telephone.

"Unfortunately, most patients and many doctors still misleadingly view diabetes as an irreversible condition. A lot of people are being misled into believing that once diagnosed with diabetes, they'll remain diabetic forever."

Lean and his colleagues are questioning a core concept in diabetes management which currently is focused entirely on controlling blood sugar through a mix of drugs and lifestyle management to avoid complications - cardiovascular diseases, kidney damage, vision problems, among others.

The researchers, in a commentary published today in the British Medical Journal, said the scale of the diabetes market is illustrated by the existence of 488 drugs, excluding insulin, currently licensed worldwide for diabetes.

They all lower blood glucose, but no trials have examined the drugs combined with diet and weight loss.

Studies by Lean's collaborator and co-author Roy Taylor at the University of Newcastle have since 2011 shown that weight loss of about 15kg can produce "total biochemical remission" of diabetes and restore adequate functioning of insulin-secreting cells of the pancreas.

"There is sufficient evidence now to show that such remission can be achieved through general practice settings - without hospital admissions," Lean said. "What it does require is professional diet and nutrition advice and a well-structured regimen to achieve and sustain the weight loss."

Doctors in India who are already encouraging patients with pre-diabetes - a precursor to diabetes - to adopt diet and lifestyle modifications to reverse their condition and prevent diabetes say the British findings are encouraging and warrant exploration in India.

"We should attempt major weight loss to reverse diabetes in any such patients - our recent diet studies involving high protein and low carbohydrate content have shown encouraging results," said Anoop Misra, the chairman of the New Delhi-based Fortis Centre for Diabetes Obesity and Cholesterol.

Doctors caution that the weight-loss strategy may not work for diabetes patients who already have a low body mass index (BMI) - a measure of body fat calculated by dividing the weight in kilograms by the square of the height in metres. Weight loss is unlikely to help patients with low muscle mass.

"Most Indians with diabetes are likely to have BMI above 23 or so. They would probably be better with BMI of about 20 - that means losing eight to 10 kilograms, permanently," said Lean who is set to start a study involving Indian-origin and Pakistani-origin people in the UK.

However, maintaining the loss of even 10kg may pose a challenge to most patients. "The human brain is programmed to eat more - people tend to eat beyond their hunger levels. It is difficult for people to stick to low calorie diet for long periods of time and this makes most people to regain the lost weight within years," said Satinath Mukhopadhyay, an endocrinologist at the Institute of Post-Graduate Medical Education and Research, Calcutta.

Achieving remission will help patients avoid the complications of diabetes that are expensive to treat and, at times, life-threatening. Across populations, remission will mean savings in national health expenditures, the researchers said, calling for a global consensus for guidelines to document remission of diabetes.

"The economic burden on diabetes patients and their households can be considerable," Parikshit Gogate, a Pune-based ophthalmologist who had three years ago estimated the costs diabetes can impose on patients, calculating that medicines make up more than half the cost, surgery for complications 12 per cent.

Doctors say the treatment of serious complications of poorly-controlled diabetes - ranging from heart disease to kidney failure to eye damage - could cost tens of thousands to lakhs of rupees.

The World Health Organisation has estimated through health surveys that India had about 60 million patients with diabetes in 2015.

The Glasgow-Newcastle team has proposed two normal blood sugar test results at least two months apart and annual reviews of glycosylated haemoglobin - a biomarker of long-term sugar levels - which may be used to detect and confirm remission of diabetes.

Taylor and his colleagues had two years ago disclosed at a meeting of the American Diabetes Association that an extremely low calorie diet can help patients with diabetes remove fat in the pancreas and allow restoration of normal insulin secretion.

In their clinical trial, 11 diabetes patients were prescribed an extreme diet of 600 calories a day consisting of liquid diet drinks plus 200 calories of non-starchy vegetables. Magnetic resonance imaging scans showed the pancreas lost fat and the patients achieved blood sugar control. Blood sugar levels were normal within a week.


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