Low-calorie diet and exercise put diabetes in remission for 60% of patients: Qatar RCT

By Guan Yu Lim contact

- Last updated on GMT

After 12 months, the intervention group observed a significant mean weight loss of 12 kg compared to 4kg in the control group ©Getty Images
After 12 months, the intervention group observed a significant mean weight loss of 12 kg compared to 4kg in the control group ©Getty Images

Related tags: qatar, RCT, diet, Diabetes

An intensive lifestyle intervention comprising a low-calorie diet and physical activity led to significant weight loss and diabetes remission in 61% of patients.

The study, funded by the Qatar National Research Fund, also found that the one-year lifestyle intervention improved glycaemia levels in 30% of patients.

Current type 2 diabetes care focus on drugs to control blood sugar, cholesterol, and blood pressure, with the assumption that insulin-secreting cells in the pancreas are irreversibly damaged by the time of diabetes diagnosis.

However, researchers in Qatar proposed that abdominal fat accumulation, which harms insulin-producing cells, may be reversible through weight loss.

The findings were published in The Lancet Diabetes & Endocrinology​.

Study design

Researchers conducted a randomised controlled trial comparing the effects of an intensive lifestyle intervention with usual medical care on weight loss and glycaemic outcomes in individuals with type 2 diabetes, who were overweight or obese.

A total of 147 participants were included in the study, 70 in the intervention group and 77 in the control group. The study was conducted in a primary care center and a community care center in Doha, Qatar, with access to dieticians and trainer’s supervision.

Participants were between 18 to 50 years old, and diagnosed with diabetes for less than three years.

The intervention group was given a low-calorie Cambridge Weight Plan diet for 12 weeks, followed by a gradual reintroduction of a more usual but healthy and calorie-restricted diet. This diet plan was meant to force participants to burn fat stores for energy and thus lose weight rapidly.

This group was also encouraged to walk at least 10,000 steps per day and spend at least 150 minutes per week of physical activity. Participants were also tasked to stop taking their diabetes medication (cholesterol, blood pressure lowering etc) throughout the course of the study, although doctors adjusted dosages if necessary.

The control group received usual diabetes care which was based on clinical guidelines.

The primary outcome was weight loss at 12 months. Secondary outcomes were diabetes control and remission.

Findings

After 12 months, the intervention group observed a significant mean weight loss of 12 kg compared to 4kg in the control group (p<0.0001).

Researchers also reported that 21% of participants in the intervention group achieved more than 15% weight loss after 12 months, compared to just 1% in the control group (p<0.0001).

In terms of secondary outcome, diabetes remission was observed in 61% of participants in the intervention group compared with 12% of those in the control group (p<0.0001).  This meant that participants were no longer considered diabetic.

In addition, 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (p<0.0001), which meant that their blood glucose levels returned to normal.

The intervention group also managed to bring their total medication count down to two, compared to five in the control group.

Researchers said this was the first such intensive lifestyle intervention trial in the Middle East and North Africa region.

As of 2020, 15.5% of adults in Qatar are diabetic according to the International Diabetes Federation (IDF). This number is projected to grow where one in four adult Qataris will be diagnosed with diabetes by 2050, driven by the ageing population and high obesity rates.

The Ministry of Public Health reported that 41.4% of the Qatari population were obese.

Commenting on the findings, Professor Shahrad Taheri, first author of the study said: “I think it’s a real game-changer for the management of type 2 diabetes. It shows that if you lose weight early enough in the disease process, you can actually reverse the disease, and thus avoid all the other health issues and quality of life reductions that come with it​.”

In addition, Taheri added that participants of the current study had access to dieticians and trainers, which may help explain why participants were able to sustain their weight loss.

Taheri added the team was continuing to track the study participants’ weight loss and diabetes status, and planning studies of similar interventions in different populations with different diet plans.

We’re hoping that studies such as these can bring about a big change in the clinical approach to type 2 diabetes across the world, so that we will combine early screening with lifestyle interventions essentially to get rid of this condition straightaway, instead of putting people on multiple medications for life​,” Taheri said.

 

Source: The Lancet Diabetes & Endocrinology

https://doi.org/10.1016/S2213-8587(20)30117-0

“Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial”

Authors: Shahrad Taheri , et al​.

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