Type 2 diabetes has reached epidemic proportions worldwide. According to the World Health Organisation (WHO), over 400 million people are living with diabetes globally, with type 2 diabetes comprising the majority of cases.1 Diabetes UK data indicates that over 3.8 million people in the UK are living with the condition.2
The impact on the individual living with the disease is profound, with the challenges of self-monitoring requirements, frequent clinic attendances, and polypharmacy, to name but a few. Poor disease control leads to an increased risk of both acute and chronic disease-related complications, from hyperosmolar hyperglycaemic state (HSS) to cardiovascular disease. Research also demonstrates that those living with diabetes are also significantly more likely to have depression than those without the condition.3
The burden of type 2 diabetes extends beyond the individual, with a wider impact on families, healthcare systems and society through health and care costs, lost productivity and disability. However, amidst the challenges, there’s a new glimmer of hope: the possibility of disease remission.
Defining Remission
Traditionally, type 2 diabetes has been viewed as a chronic, lifelong disease requiring continuous management through lifestyle modification and medication. However, research in recent years has challenged this notion, and disease remission has emerged as an attainable goal for many patients.
There have been historical differences in how remission has been defined, but a new consensus statement in 2021 produced by a panel of international diabetes experts agreed on a simplified definition of remission as: achieving a HbA1c of less than 48mmol/mol (<6.5%) sustained for at least 3 months without the use glucose-lowering medication.4
Our understanding of the potential for type 2 diabetes remission was propelled forward by landmark clinical trials such as DiRECT (The Diabetes Remission Clinical Trial). This provided compelling evidence that intensive lifestyle intervention, involving low calorie diet and behaviour change support could lead to sustained remission in a significant proportion of patients with type 2 diabetes. Almost half (46%) of the trial participants achieved remission at 12 months, and 36% remained in remission at two years.5
Remission is thought to be driven by weight loss, specifically, reduction in fat deposits within the pancreas, which in turn allows restoration of function of insulin-secreting pancreatic beta cells.
The NHS Pilot: A Path to Remission
Building upon the insights gained from such trials, healthcare systems worldwide are exploring innovative approaches to support type 2 diabetes remission. One such initiative is the UK NHS’s rollout of the ‘Type 2 Diabetes Path to Remission’ (T2DR) programme.6 This pioneering programme offers tailored support and guidance to individuals diagnosed with type 2 diabetes, empowering them to make sustainable lifestyle changes and potentially achieve remission. It incorporates a period of low calorie total diet replacement (TDR) followed by food reintroduction and dietary guidance, plus physical activity and behaviour change support – a holistic approach grounded in the successful strategies of the clinical trials. This programme is not just about treating diabetes but transforming lives through empowering individuals to take control of their health.
The Importance of Remission
The significance of type 2 diabetes remission cannot be overstated. Beyond the immediate benefits of improved blood sugar control and reduced requirement for medication, remission offers a pathway to longer-term health and well-being.
One of the most notable benefits of remission is the reduction in the risk of diabetes-related complications. A recent cohort study following over 60,000 patients with type 2 diabetes for an average of seven years found that those who achieved remission from type 2 diabetes, even if only for a short period with subsequent relapse, had a much lower risk of both macrovascular and microvascular complications.7
Additionally, by reducing the prevalence of the disease and its associated complications, remission helps alleviate the strain on healthcare resources and lowers the economic burden of chronic disease.
A Path Forward
In conclusion, the concept of type 2 diabetes remission has opened up new horizons in diabetes care. Through the lessons learned from clinical trials such as DiRECT, and initiatives such as the NHS’s T2DR programme, we are seeing a shift from managing symptoms, to tackling the root cause and potentially reversing the disease process.
New clinical guidelines internationally, including those from the European Association for the Study of Diabetes, now recommend weight loss and remission as a primary management target for people living with type 2 diabetes.8
As healthcare providers, our role is pivotal in guiding and supporting our patients on their journey, ensuring they are offered the opportunity and supported in developing the skills and behaviours they need to achieve and maintain remission.
References:
- WHO stats
- Diabetes UK stats
- Diabetes & depression https://www.diabetes.org.uk/for-professionals/improving-care/good-practice/psychological-care/emotional-health-professionals-guide/chapter-6-depression
- https://link.springer.com/article/10.1007/s00125-021-05542-z
- DiRECT trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/abstract
- T2DR https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/
- ‘Recent cohort study’ https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290791
- https://www.easd.org/guidelines/statements-and-guidelines.html
