Metabolic health and type 2 diabetes remission diet

DiRECT study: Metabolomic profile of weight loss and remission.


A study based on data from the Diabetes Remission Clinical Trial (DiRECT), conducted in collaboration between the University of Bristol, University of Glasgow, and Newcastle University, has been published in Diabetologia.

According to Diabetes UK, there are more than 5 million people in the UK living with diabetes, and 90% of them have type 2 diabetes. Recent research has shown that weight loss is a crucial treatment for people with type 2 diabetes. This discovery was made possible through DiRECT, which found that a dietary weight loss program called Counterweight-Plus, provided in primary care settings, can reverse the condition and put it into remission. The NHS has adopted this program as a proven treatment for type 2 diabetes patients.

However, up until this point, it wasn’t clear how this program affected the overall health of these patients beyond just their diabetes.

Bristol Medical School researchers wanted to see if losing weight had broader health benefits. They studied the blood samples of 261 people in the DiRECT trial before and one year after starting the program. They looked at over 1,000 molecules in the blood, which are called ‘metabolites.’ This gave them a detailed picture of the participant’s health at those times.

They found that about 14% of the measured metabolites changed because of the program. Some of these changes were the opposite of what happens before someone develops type 2 diabetes. These changes continued even after the weight loss program ended, showing long-lasting benefits to health. 

This research supports the idea that extra weight plays a significant role in causing type 2 diabetes and should be a target for treatment. This idea is supported by recommendations from the American Diabetes Association and the European Association for the Study of Diabetes.

Most of the changes in metabolism were because of weight loss, but some were not related to weight loss. These other changes were probably due to ongoing changes in diet and medication. For instance, people in the Counterweight-Plus group had higher levels of omega-3 fatty acids (usually found in fish) after a year compared to those in the control group.

Dr Laura Corbin, the study’s lead author who is based at Bristol’s MRC Integrative Epidemiology Unit (MRC IEU), said: “Our findings show that in patients who have recently been diagnosed with type 2 diabetes, weight loss through calorie restriction appears to reverse at least some of the metabolic changes that occur before diagnosis. However, not all patients who lost weight saw this reversal.”

“In the future, we hope to use this approach to understand better the variation that exists across patients both in susceptibility to poor metabolic health and in treatment response.” she added.

The team is comparing the effects of this diet-based treatment with weight loss surgery. They also plan to include data from new weight loss drugs like semaglutide in their research.

Wellcome funded this study, and the DiRECT research was led by the Universities of Glasgow and Newcastle and funded by Diabetes UK.

This study shows that the diet for Type 2 diabetes remission positively impacts metabolic health. Weight loss is a critical factor in improving metabolism and managing diabetes. These benefits continue even after the weight loss phase ends. It also highlights that diet and medication play a role in these improvements. 

This research supports the importance of dietary interventions in diabetes management, and further studies will help us understand the best strategies for diabetes remission. Overall, it emphasizes the significance of long-term nutritional changes for better metabolic health in individuals with Type 2 diabetes.

Journal reference:

  1. Corbin, L.J., Hughes, D.A., Bull, C.J. et al. The metabolomic signature of weight loss and remission in the Diabetes Remission Clinical Trial (DiRECT). Diabetologia. DOI: 10.1007/s00125-023-06019-x.

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