What is diabetes remission?

Diabetes remission in people with type 2 is when your blood glucose levels are at a normal healthy range without having to take any diabetes medication. The clinical definition of remission is when your HbA1c levels are less than 48mmol/mol on 2 occasions, at least 6 months apart, and you are not taking any diabetes medications.

Type 2 diabetes is normally treated with medication and/or diet and exercise and for many, it’s a condition that gets worse over time. Achieving diabetes remission can have a huge impact on both your diabetes and your overall health and well-being.

It’s important to note that remission isn’t a complete cure, so diabetes may still come back. It’s crucial to continue with the healthier diet and lifestyle that you adopted to achieve remission.

How can I put my diabetes into remission?

Research has shown that losing weight plays the biggest role in helping achieve remission from type 2 diabetes, either through diet and lifestyle or surgery.

Losing around 15kgs within 3 – 5 months significantly increases your chances of remission.

If you would like to put your diabetes into remission by losing weight quickly it’s important to get advice from your diabetes care team or health care professional. They can help you to do it safely, especially if you have any other health conditions, and increase your chances of successfully achieving remission.

Why does losing weight help diabetes remission?

Many people that have type 2 diabetes are carrying extra weight around their stomach. This leads to fat building up around vital organs such as the pancreas and liver which causes them to not work as effectively and results in diabetes.

Losing weight, and the fat around these organs, allows them to work properly again which can put your diabetes into remission.

The research surrounding remission is ongoing and we don’t fully understand all the factors that lead to diabetes remission. Not everybody will manage to put their diabetes into remission but losing as little as 5% of your body weight will have many positive impacts on your health.

These benefits include:

• Reducing your risk of developing complications from diabetes
• Improved blood sugar levels
• Reducing medications
• Lowering cholesterol levels
• Helps you to sleep better

What does the research say?

The DiRECT (Diabetes Remission Clinical Trial) trial has been looking at the impact of low-calorie diets on diabetes remission and has had some really exciting findings so far. Participants in the DiRECT trial will follow a Very Low-Calorie Diet (VLCD) of 850 calories a day for between 8 and 20 weeks. After this, they will be gradually re-introduced to normal food and will receive expert support to help them maintain their weight loss.

The first-year findings published in 2017 showed that almost half of the participants achieved remission after twelve months. The most recent results published in 2019 showed that 70% of those participants are still in remission.

Almost nine out of ten people who lost more than 15kg were in remission at one year. The results from this study have been so encouraging that NHS England has committed to a pilot type 2 diabetes remission programme, and NHS Scotland already have programmes that are being rolled out.

Different diets for remission

For the DiRECT trial, participants followed a Very Low-Calorie Diet but that doesn’t mean to say that it’s the only method of losing weight quickly and safely to achieve diabetes remission. We’ve reviewed a couple of different diets below:

Very Low-Calorie Diet

• Normally lasts for 24 weeks; the first 12 weeks you replace all of your meals with soups, shakes and snacks from a specially formulated diet plan. The next 12 weeks you will gradually start reintroducing food back into your diet.
• The plan generally works out at 800 calories per day.
• Before starting a VLCD it’s recommended that you speak to your healthcare team, especially if you are on insulin, sulphonylureas (such as gliclazide) or SGLT-2 medication (drug names ending in gliflozin), or you have any complications such as heart or kidney problems.
• Some commercial plans that are available include the 1:1 Diet (formerly known as the Cambridge Weight Plan), Exante, Lighterlife and Optifast.
• If you don’t like the sound of a soup and shakes plan, there are real food options that also stick to the 800 calorie limit. Have a look at the fast800 website or the Carbs & Cals Very Low-Calorie Recipes & Meal Plans.

Low carb

• Carbohydrates are your body’s main source of energy and it exists in 3 forms; sugar, starch and fibre.
• When starch is digested it is broken down into sugar where it enters your bloodstream, which causes your blood glucose levels to rise.
• Limiting the amount of sugar in your diet, either as sugar or starch, can have benefits on your health and it also limits the amount of sugar that your body stores as fat.
• This will help you manage your weight and reduce your risk of developing diabetes complications.
• Studies have shown that reducing your carb intake can help reduce your body’s need for insulin and diabetes medications.
• If you’re interested in a low carb approach then have a look at the Low Carb Program which is a behaviour change platform that provides educational resources and support.
• The Carbs and Cals website is also a great resource and they have a number of different books and smartphone app to help you track the carbohydrate content of different foods.

Intermittent fasting

• Intermittent fasting is an eating pattern that involves periods of food restriction followed by normal eating.
• There are two main approaches to intermittent fasting;
  • the 5:2 diet, where you eat normally for 5 days and 500 – 600 calories on the other 2 days, or
  • the 16:8 cycle which is time-restricted eating, which generally works out as only having an 8-hour window that you are allowed to eat in.
• During this diet, your body is either in the ‘fed’ or ‘fasted’ state.
• The fed state is when insulin is high and the body is in storage mode, so glucose gets stored as fat or as glycogen in the liver.
• The fasted state is when insulin is low and the body burns energy stores. Intermittent fasting makes the body burn fat in the absence of glucose.
• In the fasted state you essentially put your body through a metabolic workout. Extending the length of time in the fasted state helps your body to burn fat efficiently and quickly.
• If you choose to follow this diet, try to pick an evidence-based plan that has been written by a dietician such as the ‘2-day diet’.

What happens after remission?

At the moment there are no definite answers as to how long it will last or how it may affect your risk of developing diabetes in the future, but the results so far look very promising. What we do know is that achieving remission has huge benefits for your health. It lowers your blood glucose levels, reduces your blood pressure and your cholesterol levels, all of which will reduce your risk of developing the complications associated with diabetes.

Even when you are in remission it’s important to still attend your normal check-ups as part of your diabetes care and continue to maintain your weight loss.