Type 2 diabetes in a very common health condition in the UK, particularly among people who are overweight or obese. It is estimated to cost the health service £10 billion a year, and around one in ten prescriptions is for diabetes treatment. The current coronavirus pandemic has also put diabetes in the spotlight – it is thought that people with diabetes are twice as likely to die from Covid-19, and that around a third of Covid-19 deaths are people with diabetes.
It has always been thought that once you have been given a diagnosis of type 2 diabetes, that’s it for life. However, there is emerging evidence to suggest that diabetes could be reversed by following a very low calorie diet (VLCD). VLCDs (of which the Slim & Save plans are examples of) cause rapid weight loss by restricting carbohydrate intake to a level that induces ‘ketosis’ – a state where the body breaks down fat into ‘ketones’ to provide energy, causing rapid weight loss. Back in 2018, results from the DiRECT trial suggested there may be a role for using VLCDs as a first-line approach to weight loss, particularly upon diagnosis of type 2 diabetes. This resulted in plenty of media coverage. The BBC aired ‘The Big Crash Diet Experiment’ (which followed four volunteers who all lost significant weight over nine weeks on the diet, with one person losing 20% of their body weight, and putting their diabetes into remission) and ITV featured ‘Fast-Fix Diabetes’ (which followed five volunteers who all significantly reduced their blood sugar levels, with one person reversing their diabetes, after eight weeks on the diet).
The NHS has now enrolled 5000 people in a new trial, where patients are restricted to a diet of 800 kcal a day, using VLCD products like soups, shakes and bars (similar to those consumed on our Slim & Save plans). The trial aims to assess whether following a calorie restricted diet can reverse diabetes.
Key points about the new trial
- It is a large trial, involving 5000 patients, all of whom have had a diagnosis of type 2 diabetes within the last six years
- There are seven NHS sites across England taking part
- The trial is split into two phases – phase one involves patients following an 800kcal restricted diet for three months
- The second phase involves a healthy diet and exercise routine being reintroduced for the following nine months. This is being done through the support of ‘nutritionists’, who have received training from a specialist multi-disciplinary team (including dietitians)
- Patients will be supported via virtual one-to-one sessions, group sessions and digital support
So… Can diabetes be reversed?
Research has shown us that type 2 diabetes can be put into ‘remission’, which is when blood sugar levels remain below the diabetic range and the person no longer needs to take medication. To be classed as ‘in remission’, the person should have normal blood sugar control and be free of medication for at least six months. Research also shows us that losing 15kg significantly increases your chances of remission, and doing this closer to the time of diagnosis also increases chances.
The term ‘reversal’ is not a particularly helpful term, as it implies that diabetes can be cured. If a person whose diabetes is in remission starts gaining weight again, or eating a poor diet, their diabetes is likely to come back.
This new trial will help to increase the evidence base for diabetes remission, and may lead to VLCDs being available on prescription in the future.
What does this all mean for me?
If you have been diagnosed with type 2 diabetes, and are currently following (or are considering starting) a Slim & Save programme, here are our main take-home points:
- To see a mass trial like this being run by (and funded by) the NHS, provides confidence to people wondering if following a Slim & Save plan will have beneficial effects for them, both in terms of weight loss and also diabetes control – if positive results are seen from this trial, it’s likely that it would be rolled out further
- If you are overweight or obese (BMI over 25) and have diabetes or another significant weight related health condition, a VLCD may be the best solution for you (especially if you have tried conventional diets in the past)
- Always consult with your GP to check your suitability prior to starting a VLCD
- It appears that to have the best chance of putting your diabetes into remission, you should lose weight (through following a VLCD) as soon as possible after diagnosis. Current evidence suggests that the longer you have had diabetes, the less likely you will be able put it into remission
- Losing weight on Slim & Save may mean you need to reduce your diabetes treatment (medication or insulin). Don’t forget to regularly check your blood glucose control and seek advice from your GP or specialist nurse (check out our other article Considerations for people with diabetes.
- Following a VLCD requires a huge amount of support – make sure you enlist support from family and friends, as well as making use of Slim & Save’s support team and forums to help you stay motivated and on track
- Once you come off Slim & Save, it’s really important that you don’t just go back to your previous diet, as this will cause you to regain the weight you’ve lost. You will also need to increase your physical activity (exercise) levels to keep the weight off. Support and advice are also really important for this stage. Check out our weight maintenance plans and other articles on weight maintenance
Written by Annemarie Aburrow RD BSc (Hons) PGDip, Slim & Save Dietitian.