Heart Benefits Follow T2D Remission With Rapid Weight Loss

Liam Davenport

April 21, 2021

Calorie-restricted diets followed by gradual food reintroduction may not only lead to remission of type 2 diabetes but also normalise cardiovascular disease risk and heart age, the results of a UK analysis suggest.

Moreover, the approach is transferable to a community setting, where the reduced need for diabetes and blood pressure medications can offer healthcare cost reductions, shows a real-world implementation study.

Commenting, Eddie Johnston, research communications officer at Diabetes UK, said that the research is an "important step towards widening access to low-calorie weight management programmes, so that as many people as possible have the chance to put their type 2 diabetes into remission".

He added: "With almost a third of adults with type 2 diabetes living with cardiovascular disease, it is critical that people have access to the support they need, such as weight management services, to reduce their risk of future heart attacks and strokes", alongside managing their diabetes.

The research was presented at the Diabetes UK Professional Conference 2021 on April 20.

DiRECT Approach

Studies such as DiRECT, co-led by Prof Roy Taylor, Newcastle University, have shown that type 2 diabetes patients who achieve rapid weight loss via a calorie-restricted liquid diet can achieve and maintain diabetes remission.

However, that "raises the possibility" that a "clinically useful" reduction in cardiovascular risk may follow, argues Shaden Melhem, Centre for Cardiovascular Science, University of Edinburgh, and colleagues.

To investigate further, they studied 29 individuals from the Counterbalance study with type 2 diabetes of either short duration, defined as less than 4 years, or long duration, defined as lasting more than 8 years.

All the participants, who were aged 25–80 years, had all anti-diabetic drugs discontinued before undergoing a calorie-restricted diet for 8 weeks, followed by a stepwise return to an isocaloric diet and weight maintenance for 6 months.

Among the 15 individuals with short duration diabetes, eight were female and the mean age was 52.1 years. Their average weight at baseline was 99.0 kg, and their baseline body mass index (BMI) was 34.1.

After 6 months, the participants saw their weight decrease to an average of 84.7 kg (p<0.001), and their HbA1c levels decrease from 55.1 mmol/mol to 46.1 mmol/mol (p<0.001).

Total cholesterol levels decreased from 4.6 mmol/l to 4.2 mmol/l (p<0.01) over the same period, while their high-density lipoprotein cholesterol levels increased from 1.1 mmol/l to 1.3 mmol/l (p<0.05).

A similar pattern was seen in the 14 patients with type 2 diabetes of long duration.

T2D Remission

Overall, there were 12 responders, defined as those who achieved remission of diabetes with an HbA1c <48 mmol/mol and a fasting plasma glucose of <7.0 mmol/mol, and 17 non-responders.

Responders had a substantial and significant reduction in their 10-year cardiovascular disease risk (p<0.001), and they saw their heart age decrease by 15.0 years (p<0.001) over the 6 months of the study.

Smaller reductions were seen in non-responders.

While plasma levels of leptin, adiponectin, growth/differentiation factor 15 and fibroblast growth factor 21 were associated with weight loss, they did not correlate with type 2 diabetes remission.

"Weight loss markedly decreases cardiometabolic risk particularly when remission of diabetes is achieved," the team writes.

They add: "Normalisation of 10-year cardiovascular risk and heart age is possible after substantial dietary weight loss and remission of diabetes."
 

Real-world Setting

For the second study, Tara Abi-Chahine, a dietician at Xyla Health and Wellbeing, London, and colleagues, employed a similar model to that used in DiRECT to attempt type 2 diabetes remission in a real-world setting.

They recruited 23 individuals, following an initial assessment with 12 weeks of total diet replacement with 800 kcal daily supplementation, 8 weeks of gradual food reintroduction and 28 weeks of culturally sensitive nutrition, exercise, and behavioural change support to maintain weight loss.

These were supplemented with regular phone calls with a registered dietician, as well as 26 e-learning models related to the programme.

The results showed that the average weight loss at 12 weeks of total diet replacement was 13.5 kg, while the mean weight loss after 24 weeks was 12.5 kg and at 12 months was 11.8 kg.

At week 24, 74% of patients had stopped taking their diabetic medication, 13% were prescribed reduced doses, and 13% remained on the same dose.

In addition, 50% of patients were no longer prescribed any blood pressure medications by week 24, while 17% were receiving reduced doses, and 33% remained on the same dose.

The team says that the results are "in line" with those of DiRECT, "with good self-reported improvements in participants’ quality of life".

Moreover, "system-wide financial benefit was also achieved through de-prescribing of diabetes and blood pressure medication".

No funding declared.

Abi-Chahine is an employee of Xyla Health and Wellbeing.

No other relevant financial relationships declared.

Diabetes UK Professional Conference 2021: Abstract P25. Presented 20 April.

Diabetes UK Professional Conference 2021: Abstract P142. Presented 20 April.

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