Type 2 diabetes

People with T2D can diet their way to remission: DA position statement

Type 2 diabetes remission is possible through weight loss achieved following intensive dietary changes or bariatric surgery, according to a new Diabetes Australia position statement.

The position statement said remission is most likely in people with a duration of diabetes less than five years, a lower HbA1c when attempting remission, and those not requiring insulin therapy.

“New research has shown it is possible for some people with type 2 diabetes to reduce their average glucose level to achieve an HbA1c of under 6.5% (48 mmol/mol) and sustain them at that level for a prolonged period of time (at least three months) – without the need for glucose lowering medication,” it said.

“Best estimates show one third of people are in remission at two years following intensive dietary changes, and up to half of people who have had bariatric surgery remain in remission seven to 10 years later.”

It said people are likely to achieve remission if they lose around 10% – 15% of their body weight – for example on a very low energy diet or ketogenic diet.

The position statement follows Diabetes Australia, and Dietitians Australia, being called out late last year for a lack of leadership on the issue.

Speaking at the National Press Club in December 2020, eye surgeon and Australian of the Year 2020 Dr James Muecke said people were being “needlessly blinded by an avoidable, man-made dietary disease such as type 2 diabetes.”

Dr Muecke said health practitioners “continue to bandaid type 2 diabetes with medications which don’t put people into remission, which don’t extend life and which can potentially hasten the devastating complications of this disease.”

“Why not take a dietary approach to a dietary disease?” he said.

Part of Dr Muecke’s speech was featured on Australian TV last week in a SBS documentary Australia’s Health Revolution with Dr Michael Mosley.

Dr Mosley is a high profile proponent of intermittent fasting such as the 5:2 diet.

In line with a recent American Diabetes Association (ADA) Consensus Report on remission in type 2 diabetes, the Diabetes Australia statement said remission may not be a “permanent reversal of the underlying cause of pathology.”

“As there is insufficient evidence on the impact of remission on diabetes complications, everyone who is in remission should continue to receive regular diabetes monitoring at least annually and keep up their Annual Cycle of Care health care checks. This includes timely diabetes eye checks and ongoing support for self management tailored to their needs.”

It also said people with type 2 diabetes who want to attempt diabetes remission need to do so in close consultation with their diabetes healthcare team, as intensive dietary and weight changes need careful management, monitoring and support.

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