Type 2 diabetes can be reversed with a modest weight loss of 10% or more

NIHR | September 2019 | Type 2 diabetes can be reversed with a modest weight loss of 10% or more

New research led by researchers at the University of Cambridge reports that individuals with a diagnosis of type 2 diabetes who reduced their  weight by one-tenth or more, were able to see their condition go into remission.

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The study followed a cohort (n=867) over time; and found that 257 participants (30%) participants were in remission at five-year follow-up. People who achieved weight loss of 10% or more within the first five years after diagnosis were more than twice as likely to go into remission compared to people who maintained the same weight. The participants in the study who achieved remission did so without intensive lifestyle interventions or extreme calorie restrictions.

“We’ve known for some time now that it’s possible to send diabetes into remission using fairly drastic measures such as intensive weight loss programmes and extreme calorie restriction,” says Dr Hajira Dambha-Miller from the Department of Public Health and Primary Care.

In order to clarify the best way to help patients with type 2 diabetes achieve sustained weight loss, the research team is currently undertaking a study called GLoW (Glucose Lowering through Weight management). The study compares the current education programme offered by the NHS to people after they have been diagnosed, with a programme delivered by WW (formerly Weight Watchers®) (Source NIHR & University of Cambridge)

Read the press release from NIHR 

See also: University of Cambridge Type 2 diabetes remission possible with ‘achievable’ weight loss, say researchers

 

Abstract

Aim

To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5‐year follow‐up.

 

Method

We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40–69 years from the ADDITION‐Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self‐report), and alcohol consumption (self‐report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1–5 years, as well as remission at 5‐year follow‐up.

 

Results

Diabetes remission was achieved in 257 participants (30%) at 5‐year follow‐up. Compared with people who maintained the same weight, those who achieved more than or equal to 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission. In the subsequent 1–5 years, achieving more than or equal to 10% weight loss was also associated with remission.

 

Conclusion

In a population‐based sample of adults with screen‐detected Type 2 diabetes, weight loss of more than or equal to 10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

Full reference: Dambha-Miller, H et al | 2019|  Behaviour change, weight loss and remission of type 2 diabetes: a community based prospective cohort study|Diabetic Medicine| DOI: 10.1111/dme.14122 

The article is available in full from Diabetic Medicine

Diabetes variation in inpatient activity (VIA) tool

Public Health England | September 2019 | Diabetes variation in inpatient activity (VIA) tool

Healthcare professionals can use the variation in inpatient activity (VIA) tool to explore the variation in inpatient activity (bed days in hospital, emergency re-admissions and day case admissions) for patients with diabetes compared to a similar patient population  without diabetes. This can help with planning and commissioning local services. 

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The briefing gives an overview of the tool and presents data from 2014 to 2015 up to 2017 to 2018, showing how inpatient activity for patients with diabetes varies between clinical commissioning groups (CCGs), and how it has changed over time (Source: Public Health England)

Variation in inpatient activity: diabetes tool

Summary of diabetes VIA tool results: 2014 to 2018

 

Risk of type 2 diabetes detectable at age 8, finds Bristol research

Bell, J.A., | 2019| Early metabolic features of genetic liability to type 2 diabetes: cohort study with repeated metabolomics across early life | | https://doi.org/10.1101/767756

A team of researchers from Bristol University, partly funded by Diabetes UK, used data from the  offspring from the Avon Longitudinal Study of Parents and Children cohort (n=4761) and measured their cholesterol, amino and fatty acids, among others for the same individuals across four stages of early life:

  • childhood (age 8),
  • adolescence (age 16),
  • young-adulthood (age 18),
  • adulthood (age 25)

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The team used a genetic risk score, which combines information from 160 genetic differences linked to Type 2 diabetes, to pinpoint participants who were at a higher risk of developing the condition. In addition they also took blood samples to look for changes in over 220 different chemicals and processes involved in metabolism.

 

This enabled them to to find out if having a high genetic risk of adult Type 2 diabetes was linked to changes inside the body early on in life (metabollic traits).  Those in the study with a high genetic risk had signs of problems with their metabolism (in their childhood and early adulthood. The researchers report that signs of type 2 diabetes liability are detectable in childhood, apparent as early as age 8, decades before the disease before the clinical onset of disease (Source: Bell et al, 2019; Diabetes UK).

The research is available in full from Biorxiv

Diabetes UK Early signs of Type 2 diabetes risk could be seen decades before a diagnosis

In the news:

Sky News Adult type 2 diabetes markers found in kids as young as eight

ITV News Early indications of adult type 2 diabetes found in children aged eight – study

OnMedica Signs of adult diabetes visible in young children

NHS spends around £3bn a year on ‘avoidable’ treatment for diabetes

ITV | September 2019 | NHS spends around £3bn a year on ‘avoidable’ treatment for diabetes

An analysis of hospital treatment in 2017/18 highlights that approximately £5.5bn each year is spent on treatment of diabetes, of this an estimated £3bn is on ‘potentially avoidable’ treatment. The authors of the research explain that this equates to around one-tenth of the NHS budget; compared to people without diabetes, the average annual cost of planned care was over twice as high for those with Type 2 diabetes and the average cost of emergency care was three times higher, once age was taken into account.

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Study author, Dr Adrian Heald from Salford Royal Hospital, said: “People with diabetes are admitted to hospital more often, especially as emergencies, and stay on average longer as inpatients.

“These increased hospital costs, 40% of which come from non-elective and emergency care, are three times higher than the current costs of diabetes medication.

“Improved management of diabetes by GPs and diabetes specialist care teams could improve the health of people with diabetes and substantially reduce the level of hospital care and costs.” (Source: ITV News)

The team’s finding will be presented this week at the European Association for the study of Diabetes (EASD)  annual meeting in Barcelona.

Read the full story from ITV News

See also:

BT NHS spends around £3bn a year on ‘avoidable’ treatment for diabetes

 

Obesity and poor lifestyle increase type 2 diabetes-risk independent of genetic predisposition

Jakupovic, H. et al | 2019| Obesity and unfavourable lifestyle increase type 2 diabetes-risk independent of genetic predisposition

Research that will be presented at this week’s Annual Meeting of the European Association for the Study of Diabetes (EASD), suggests that people with poor lifestyle and obesity are at greater risk of developing type 2 diabetes (via OnMedica). 

Favourable lifestyle was defined as having at least three of the following healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity, and a healthy diet; whereas an unfavourable lifestyle as no or only one healthy lifestyle factor; and the remaining participants were defined as having an intermediate lifestyle. They also assessed genetic risk score (GRS) according to 213 genetic loci robustly associated with T2D, and stratified people’s GRS as low (lowest 25%), intermediate (middle 50%), and high-risk (top 25%) groups.

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The abstract for the research is available from the European Association for the Study of Diabetes 

Research retrieved from: https://www.easd.org/virtualmeeting/home.html#!resources/obesity-and-unfavourable-lifestyle-increase-type-2-diabetes-risk-independent-of-genetic-predisposition-128e36e7-81ac-4126-960a-823559bb5c14

See also: OnMedica Obesity linked to nearly six-fold risk of developing type 2 diabetes

 

NHS England: Diabetes Prevention Programme – Information Governance and Data Flows Framework

NHS England | September 2019 | Diabetes Prevention Programme – Information Governance and Data Flows Framework

NHS England have published new guidance updates previous guidance to support organisations participating in the NHS Diabetes Prevention Programme (NHS DPP) in meeting their legal and contractual requirements relating to information governance.

Diabetes Prevention Programme – Information Governance and Data Flows Framework

Signs of a slowdown in new type 2 diabetes cases

Magliano, D., et al | 2019| Trends in incidence of total or type 2 diabetes: systematic review| 

Researchers employed a systematic approach to review trends in the incidence of diabetes, using a systematic review (SR) of literature using studies from the middle of the 1960s to 2014. The SR of 47 studies indicates that the incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. The study’s authors attribut this to preventive strategies and public health education and awareness campaigns could have contributed to the fall in diabetes incidence in recent years.

The findings have now been published in the BMJ . 

BMJ Trends in incidence of total or type 2 diabetes: systematic review

In the news:

BBC News  Signs of a slowdown in new type 2 diabetes cases

Abstract

Objective To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes.

Design Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines.

Data sources Medline, Embase, CINAHL, and reference lists of relevant publications.

Eligibility criteria Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year.

Results Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively.

Conclusions The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different.

 

Systematic review registration Prospero CRD42018092287.