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What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss http://orcid.org/0000-0002-9950-254XDavid Unwin1,2, http://orcid.org/0000-0001-5163-1716Christine Delon3, Jen Unwin4, Simon Tobin4 and Roy Taylor5 Correspondence to Dr David Unwin; unwin5@btinternet.com Abstract

Background Type 2 diabetes (T2D) is often regarded as a progressive, lifelong disease requiring an increasing number of drugs. Sustained remission of T2D is now well established, but is not yet routinely practised. Norwood surgery has used a low-carbohydrate programme aiming to achieve remission since 2013.

Methods Advice on a lower carbohydrate diet and weight loss was offered routinely to people with T2D between 2013 and 2021, in a suburban practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations and personal phone calls as necessary. Those interested in participating were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters.

Results The cohort who chose the low-carbohydrate approach (n=186) equalled 39% of the practice T2D register. After an average of 33 months median (IQR) weight fell from 97 (84–109) to 86 (76–99) kg, giving a mean (SD) weight loss of −10 (8.9)kg. Median (IQR) HbA1c fell from 63 (54–80) to 46 (42–53) mmol/mol. Remission of diabetes was achieved in 77% with T2D duration less than 1 year, falling to 20% for duration greater than 15 years. Overall, remission was achieved in 51% of the cohort. Mean LDL cholesterol decreased by 0.5 mmol/L, mean triglyceride by 0.9 mmol/L and mean systolic blood pressure by 12 mm Hg. There were major prescribing savings; average Norwood surgery spend was £4.94 per patient per year on drugs for diabetes compared with £11.30 for local practices. In the year ending January 2022, Norwood surgery spent £68 353 per year less than the area average.

Conclusions A practical primary care-based method to achieve remission of T2D is described. A low-carbohydrate diet-based approach was able to achieve major weight loss with substantial health and financial benefit. It resulted in 20% of the entire practice T2D population achieving remission. It appears that T2D duration <1 year represents an important window of opportunity for achieving drug-free remission of diabetes. The approach can also give hope to those with poorly controlled T2D who may not achieve remission, this group had the greatest improvements in diabetic control as represented by HbA1c.

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I will save you all some time: this study had no control group or comparison group to another type of dietary intervention and is therefore not worth seeing in your feed. If you want to see some of the most compelling diebetes dietary intervention data, check here: https://nutritionfacts.org/video/benefits-of-a-macrobiotic-diet-for-diabetes/

Disclaimer: NutritionFacts.org is a vegan website.

For this study, you don't need a control group. This isn't comparing diets. It's saying that in the study group, before the intervention everyone had T2D. One year after intervention, 77% didn't have it. Ergo, low carb is an effective diet to put T2D into remission.

Which stands to reason. If your body has difficulty making enough insulin to process carbs, lowering your carb intake sounds like a good idea.

The reason you get insulin resistance in the first place is because of

1. Too many calories in diet (excessive weight gain)
2. High carb intake (particularly if you eat multiple meals spread through the day or snack all the time, which causes a cascade of metabolic problems due to constant insulin spikes)

So it stands to reason that lowering carbs and losing weight will reverse the damage in most cases, kind of like how quitting smoking also reverses a whole lot of damage. Obviously, some damage will remain, but it's better than the alternative, which almost always ends in an earlier death and lower quality of life.

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"No patients achieved remission without some weight loss"

"It is likely that weight loss by any means can induce remission[of 2 diabetes]. Other studies of remission have used a relatively high carbohydrate, low calorie approach and clinical studies of food-based approaches or bariatric surgery both achieve remission."

https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-2022-000544

I was dx T2D in 2018. I lost 48 pounds, reduced carb intake to ~ 150 per day, daily cardio (20 min) and resistance training 3x week. A1C went from 7.8 to holding at 6.9. Of course YMMV.

Amen There is a correlational study where divorce=margarine consumption.

If an independent butter company wanted to be clever....

If you’re going to take the time to correct someone’s comment, you should make sure the information in your comment is correct as well. At the end of the study, 77% of those who had T2D for less than a year achieved remission. It was 51% of the overall cohort, and 20% for those who have been diagnosed for >15 years.

Also worth noting psychosocial support and educational materials were only provided to the low-carb group. They also make reference to the fact that the only other low-carb study that showed similar results also had similar weight loss results. I mean it obviously makes sense for a T2 diabetic to limit carbs because of its direct effect on blood sugar, but glycemic index is far more important and it appears from the results that the effectiveness of a low-carb diet is dependent on early intervention, social support, and weight loss.

I would have loved to see this as a whole data set including people who lost weight without specifically focusing on carb reduction. It’s hard to tell from this data if this is just a general “losing weight might result in T2D remission” or if the low carb diet was advantageous in some way.

my hubby did the same exact thing by cutting out sugar and processed foods. His diabetes has not returned and it's been 5 years.

In Uni I did a couple research projects on T2D remission using high carbohydrate low fat diet... in the end as I followed the topic for several years thst followed my projects... there's so much research that

Fasting, High carb low fat, Low carb diet, Other intense lifestyle interventions, can all Lead to meaningful remission the big difference and key takeaway here is which if any of these are achievable and reach a sufficient level of compliance.

Eating a restrictive diet involves restrictions which can be difficult in every day situations.

In this study 1-year remission is 75% and 15-year is only 20%...

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You theoretically can get remission with any restrictive diet but carbs cause the greatest spike in insulin, followed by protein, then fat. To achieve remission you need to regain sensitivity to insulin. So think of someone taking a drug that builds up a resistance. Eating a diet high in the macro that releases the most insulin probably isn’t as effective so reducing carbs is usually the solution. This is why low carb high fat has generally proven to be the most effective approach as it reduces your insulin spikes the most. Just look into the work of Dr. Jason Fung who has made this his life work to cure T2D.

Is it really remission though?

It lowered their A1c but that would be expected in a low carb diet anyway would it not? I agree glycemic index is far more important but eliminating carbs by it's nature is going to eliminate the vast majority of things with a high glycemic index.

There are tons of recipes on line for low carb diets, as it's come in and out of fashion so many times. Look up "Atkins diet" recipes.

Critical to highlight the 15-year endpoint of 20% remission after 15 years.

If your interested, read up on the 2012 banting memorial lecture by Roy Taylor, and further reading on the Twin Cycle Hypothesis.

Type-2 diabetes is about adiposity, insulin resistance is a symptom, which carbohydrate reduction (elimination) some would say is not well treated by a low-carb strategy as it merely avoids learning the adaptation and drives further sensitivity to carbohydrates.

It goes to show that it's important to change the ship's coarse early in the process.

Though if 20% is a disappointing number (after one year of diet change), is there any other treatment more effective for long-term T2D sufferers?

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Im not saying 20% is dissapointing just that's where this benchmark for 15-years is.

I dont think other strategies have a significantly better adherence, while they may have similar outcomes.

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6.9? Do you use insulin?

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