The best way to achieve type 2 diabetes remission

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A recent study from the University of Glasgow and elsewhere found that low-energy diets with formula meal replacements are the most effective methods of weight management and remission in adults with type 2 diabetes (T2D).

The team analyzed published meta-analyses of which type of diet is best for achieving and then maintaining weight loss in adults with T2D.

The onset of T2D is primarily driven by weight gain to the point that it becomes unhealthy. The amount of weight gain needed varies widely between individuals.

The development of the disease involves a complex interaction of gut hormones, low-grade inflammation and possibly metabolites from the gut microbiota.

It develops in susceptible individuals and families who tend to have large waists and who accumulate fat in their liver, pancreas and muscles.

This impairs organ functions, resulting in hyperglycemia (abnormally high blood sugar), commonly associated with hypertension (high blood pressure) and abnormal blood fats.

Previous research found adherence to any energy-reduced diet will lead to sustained weight loss, provided that energy (calorie) use exceeds intake.

However, in practice, adherence rates and weight losses vary widely, even within the same diet program, and some comparisons between diets appear to show conflicting results.

In this study, the researchers found that the greatest weight loss was achieved with very low-energy formula diets, used as ‘Total Diet Replacement’ at 1.7-2.1 MJ/day [400-500 kcal/day] for 8-12 weeks.

It led to an average of 6.6kg more weight loss compared to food-based low-energy diets (4.2-6.3 MJ/day [1000-1500 kcal/day]).

Formula meal replacements were also found to be superior to food-based low-energy diets alone, achieving 2.4kg greater weight loss over 12-52 weeks.

The evidence showed that low-carbohydrate diets were no better than higher-carbohydrate (low-fat) diets for weight loss.

For remission of T2D, published studies showed the best remission rates of 46-61% at 12 months with programs that include a formula ‘Total Diet Replacement’ of 830 kcal/day for 12 weeks, followed by a relatively low-fat high carbohydrate diet and meal replacements for long-term maintenance.

With low carbohydrate diets, reported remission rates are much lower at 4%-19% of those who tried the diet.

In addition, the Mediterranean, high-monounsaturated-fatty-acid, vegetarian and low-glycaemic-index diets all achieved minimal (0.3-2 kg) or no difference from conventional relatively low-fat/high-carb control diets.

The team says very low-energy diets and formula meal replacement appear the most effective approaches, generally providing less energy than self-administered food-based diets.

If you care about diabetes, please read studies about high vitamin D level linked to lower dementia risk in diabetes, and green tea could help reduce death risk in diabetes.

For more information about nutrition, please see recent studies that blueberries strongly benefit people with metabolic syndrome, and results showing vitamin D could improve blood pressure in people with diabetes.

The study was published in Diabetologia and conducted by Professor Mike Lean et al.

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