Health expert shows diabetes remission is possible with TDR diet

Posted On: 31st July 2024

TDMR Europe has recently organised an online seminar to demonstrate the role of total diet replacement (TDR) in tackling obesity and in improving type 2 diabetes (T2DM) and osteoarthritis.

Moderated by the Chair of TDMR Europe Professor Anthony R Leeds, the webinar featured Professor Mike Lean from Glasgow University and Professor Henning Bliddal, Director of the Parker Institute, a clinical research unit of rheumatology at Frederiksberg University Hospital in Copenhagen.

Prof Bliddal showed that TDR can help people with obesity and knee osteoarthritis lose weight and improve their health, providing an insightful presentation on “Weight loss and medical management of osteoarthritis” the conclusions of which can be found here.

Prof Lean presented the results of a study that he co-directed, the Diabetes Remission Clinical Trial (DiRECT), a ground-breaking five-year research, which showed that weight loss and T2DM remission in people with obesity is possible with a TDR diet.

In this trial participants recruited from general practices (GPs) used a TDR diet for 12 weeks which was followed by a food reintroduction programme focused on weight maintenance for up to two years combined with GP appointments. “Importantly, for the weight loss maintenance phase, we did allow them to use a meal replacement once a day, if they wanted to, as a way of maintaining weight loss and we offered relapse management if they should gain over 2kg in weight – we offered a short period back on TDR to get them back on track” Prof Lean explained, emphasising that “the TDR programme was nutritionally complete and safe”.

According to Prof Lean, the pilot results of DiRECT showed that “almost half of the participants who did exactly what they were asked to do lost over 15kg and most of them did that early on and did well in the long term – they had better maintenance of their weight loss”.

At one year, 46% of participants achieved diabetes remission with mean weight loss 10kg. The second year of the study, the remission rate was 36% and the mean weight loss 8kg. “The effect of weight loss on remissions was well sustained over a two-year period: 15kg weight loss at one and two years both resulted in over 80% remissions. So, nearly nine out of 10 at one year were free from diabetes” explained Prof Lean. “With 15kg weight loss, only 14% failed to get remission and of those, 11% did show improvement in their diabetes” he added.

Discussing participants’ medical treatment for T2DM Prof Lean said “on day one we asked our patients to stop their diabetes and bloop pressure medications” claiming that “TDR and weight loss is a very potent treatment for blood pressure”.  Prof Lean showed that the participants that had not been in medication for blood pressure before the trial saw a reduction in their blood pressure of 15 millimetres of mercury. “That is way greater that any medication can achieve” he emphasised. According to Prof Lean, participants receiving one medication before the study “had slightly less acute drop in blood pressure… for people who were on two or three or in some cases four medications…at the end of the TDR period blood pressure was roughly 10 milometers of mercury below baseline for everybody and that is way greater that can be achieved by any medication for hypertension”.

The conclusions from the DiRECT trial were augmented with a publication of five-year follow up results looking also at clinical outcomes. The researchers found that the weight loss was 6.1kg on average in the intervention group compared to 8kg at two years and the total remissions at five years were 13%. “Many participants had been in remission for large parts of the five years” stressed Prof Lean.  He added: “We found that people who had been through the intervention had half the number of serious adverse events over five years. That’s admissions to hospital for serious problems and free from diabetes related clinical events and that related to longer periods in remission, lower haemoglobin A1c during the five years and sustained weight loss”.

 DiRECT is reproducible in different populations worldwide

Following the study several trials used the DiRECT principle to help T2DM patients with overweight and obesity, providing the same diet programme using TDR for 8 to 12 weeks followed by food reintroduction and weight loss maintenance.

Among others, the STANDBY study recruited individuals of South Asian ethnicity showing 40% T2DM remissions. In Newcastle, the RETUNE trial was conducted on people with 23 – 27% Body Mass Index (BMI) resulting in 70% remissions. The DiRECT trial was carried out also in Australia with 56% remission rate. “This (DiRECT) is a very reproducible intervention in different populations worldwide” commented Prof Lean.

Public health services adopt TDR programme

Prof Lean also presented the pilot results of the NHS Type 2 Diabetes Path to Remission Programme, which was launched in 2020 based on the DiRECT trial, to tackle obesity and improve T2DM via a TDR programme. As Prof Lean explained, pilot data in over 7.000 individuals showed 28% remission rate at 12 months, while weight loss between 15kg and 20kg or more resulted in a 50% remission rate. Following these results, the programme is now being rolled out nationally to benefit patients across the whole of England, doubling its capacity this year.

Prof Lean argued that “the use of formula diets is kind of ratified for medical use” referencing the recommendations from the European Association for the Study of Diabetes (EASD) published last year. According to EASD, a low energy TDR programme is the best way to induce the weight loss necessary to achieve remission of T2DM. Furthermore, EASD recommends that nutritionally complete low energy formulas can be used as a partial diet replacement for weight loss maintenance.

The prevalence of T2DM and its link with overweight

Prof Lean discussed the latest research showing the prevalence of T2DM in Europe. He said that that T2DM affects over 4 million people in the UK, where the rate of diagnosis has increased by 40% in the last six years. “The numbers are rising rapidly in Western countries” he added. According to Prof Lean, in Europe, T2DM is the second most expensive disease. “That is, putting all cancers together, is a close second and it’s overtaken heart disease” he stressed.

Explaining the mortality rate of T2DM, Prof Lean said “it shortens lives by on average about five to six years but if you develop your diabetes under the age of 40 you’ll die 15 years younger than people who don’t have diabetes”.

Discussing the link between overweight and T2DM Prof Lean commented: “we know very well that weight gain is the main cause of the disease. Worldwide most people with T2DM have a BMI between 23 and 27 and that is where the risk is rising really quite dramatically, up to tenfold, by the time they have a BMI of 25”.You can watch the online event here and previous webinars organised by TDMR Europe here.

Find out more information about TDR here.

Here you can find a list of references to studies on TDRs.

Read more about the DiRECT trial here