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Nutritional basis of type 2 diabetes remission

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1449 (Published 07 July 2021) Cite this as: BMJ 2021;374:n1449

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  1. Roy Taylor, professor1 ,
  2. Ambady Ramachandran, professor2 3,
  3. William S Yancy Jr, physician4,
  4. Nita G Forouhi, professor5
  1. 1Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  2. 2India Diabetes Research Foundation, Chennai, India
  3. 3Dr A Ramachandran’s Diabetes Hospitals, Chennai, India
  4. 4Duke Lifestyle and Weight Management Center, Duke University Health System and Department of Medicine, Duke University Medical School, Durham, NC, USA
  5. 5MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  1. Correspondence to R Taylor Roy.Taylor{at}ncl.ac.uk

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain

Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.1 Around half of people who are within the first 10 years of diagnosis and manage to follow food energy restriction can stop all diabetes medication and return to non-diabetic glucose control.23 Remission is achieved when haemoglobin A1c concentrations of 48 mmol/mol are recorded after weight loss and at least six months later without any anti-diabetic medications (box 1).4 Here we summarise the new understanding of type 2 diabetes and consider how different changes to food intake can achieve the necessary weight loss and maintenance required for remission of diabetes.

Box 1

Definition of remission*

The consensus guideline from UK Primary Care Diabetes Society and Association of British Clinical Diabetologists lays out three criteria for remission of type 2 diabetes4:

  • Weight loss

  • Fasting plasma glucose <7 mmol/L or HbA1c <48 mmol/mol (WHO diagnostic thresholds) on two occasions separated by at least six months

  • Attainment of these glycaemic parameters after complete cessation of all glucose lowering therapies

  • *Remission is sometimes used to describe meeting glycaemic targets even though hypoglycaemic drugs have not been stopped. Care must be taken in the interpretation of stated rates of remission.

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What causes type 2 diabetes and remission?

In 2008 the twin cycle hypothesis postulated that there were vicious cycles of fat accumulation in the liver and pancreas that lead to the development of type 2 diabetes over at …

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