By Melanie Hinze
Weight loss needs to be our earliest and most important treatment for patients with type 2 diabetes in general practice, an Australian expert told Endocrinology Today.
Professor John Dixon, Professorial Fellow of Clinical Obesity Research at the Baker Heart and Diabetes Institute was commenting on a UK study published recently in Diabetic Medicine.
‘This study shows very nicely the effect of weight loss on diabetes remission and it is something we should be doing in general practice all the time,’ said Professor Dixon, who is also Adjunct Professor at both the Iverson Health Innovation Research Institute at Swinburne University and the Primary Care Research Unit at Monash University, Melbourne.
The community-based, prospective cohort study included 867 people, aged 40 to 69 years, with newly diagnosed type 2 diabetes from the ADDITION-Cambridge trial. Participants underwent assessment of weight change, physical activity, diet and alcohol consumption at baseline and one year later. Remission status was then assessed at five years.
The study authors found that weight loss of 10% or more early in the disease trajectory doubled the likelihood of remission at five years.
Professor Dixon said that diabetes responded extraordinarily well to weight loss. However, most primary care patients, particularly if they had type 2 diabetes, would not respond well to simple advice regarding diet and exercise.
‘As such, GPs could engage people who can generate an intensive behavioural modification program for their patients.’
Specifically, he said research from the DIRECT trial in the UK supported low calorie diets to achieve weight loss and disease remission. In this trial of a low-calorie diet replacement of 825 to 853 kcal daily, with stepped food reintroduction and support for long-term weight loss maintenance, the intervention group achieved a remission rate of 46%.
‘The DIRECT study has changed the endocrine world,’ he told Endocrinology Today.
‘We have got to use low calorie diets and we have got to use drugs,’ he said. ‘If we can switch off diabetes for five or even 10 years in people who have a very high risk, or who have just become diabetic, we can have great results.’
Diabet Med 2019; doi: 10.1111/dme.14122.