Diabetes remission possible with 15% weight loss

Major potential impact on health and costs
  • Deborah Condon

People who are obese and have type 2 diabetes can reverse, or put their diabetes into remission, if they lose 15% of their body weight, experts have advised.

According to the Irish Society for Clinical Nutrition & Metabolism (IrSPEN), this even applies to people who are already on insulin and have poor diabetes control.

IrSPEN made its comments based on findings from a number of studies including the DiRECT trial, which was recently published in the medical journal, The Lancet.

Currently in Ireland, one in four adults is obese and one in four children are overweight or obese, which makes them more likely to become obese adults. According to the World Health Organization (WHO), 65% of the diabetes burden, 23% of the heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity.

However, according to IrSPEN, the latest findings suggest that remission is possible in half of obese people with type 2 diabetes if they can lose 15% of their body weight. This is independent of starting body mass index (BMI), making it relevant to any person with type 2 diabetes who is classified as obese (BMI over 30).

IrSPEN pointed out that aside from the health benefits of those affected, this could also have major implications for the health budget.

The current cost of treating all obesity-related diseases is approximately €1.16 billion per annum. Some 35% of this cost is allocated to hospital care and medication costs, while 65% is spent on indirect costs including productivity losses from work absenteeism.

However, a clinical audit showed that the treatment of an obese person with difficult-to-control diabetes in Donegal was approximately €4,000 per year. After more than 15% weight loss following treatment at Letterkenny University Hospital, this cost reduced to approximately €500 per year in direct healthcare costs relating to diabetes.

When applied to the number of people living with diabetes for whom this is possible, the State would make back all the money spent on diabetes treatment within three to five years, and start saving money each year after that.

Commenting on the research, Prof Carel le Roux of IrSPEN said that it is ‘now apparent that there is no single silver bullet' to solve this issue.

"Multiple approaches have to be used to optimally treat patients who have complications of obesity. For people living with diabetes as a result of obesity, the disease usually requires the combination of specialist diets, specialist exercise and medication and/or surgical treatments.

"Not every patient responds equally to these treatments, however reversal of complications such as diabetes can be achieved in two in 10 people with the use of specialist diets, another three in 10 with the use of medication and another five in 10 with the use of surgical treatments," he explained.

According to consultant metabolic surgeon at the Mater Hospital in Dublin, Mr John Conneely, this is ‘a really positive message' for people living with type 2 diabetes.

"A lifetime dependency on medicine can be removed and the person effectively will no longer experience symptoms associated with the disease," he noted.

Laura Sloan from Letterkenny was diagnosed with type 2 diabetes in 2004. She required a lot of medication, including oral medication and insulin injections. The total cost of this was over €4000 per year.

Despite best medical care, Ms Sloan's diabetes was still poorly controlled, until she lost more than 15% of her body weight after a gastric bypass operation. Her diabetes has now been in remission for almost a year and she requires no medication anymore.

"This has been not just life changing, but rather life saving for me. Since the day after my surgery, I have been off all diabetic medicine, which is beyond words for me to be able to explain what that really means. I used to worry about my health and the possibility of losing my eyesight. I will be forever grateful to the team in Letterkenny," she said.

IrSPEN is encouraging people with type 2 diabetes and obesity to re-engage with their healthcare professional team to discuss ways that they may achieve a 15% weight loss. It made this call ahead of European Obesity Day (May 19).

Responding to this, the national diabetes charity, Diabetes Ireland, said that if you are carrying excess weight, 'any weight loss is beneficial as it will assist blood glucose, blood pressure and blood cholesterol control'.

"Weight loss is best done as a combination of healthy eating with attention to portion size and regular physical activity. A weight loss of 15% will make substantial changes in these parameters and for any person with diabetes, this would be best undertaken under medical supervision, as medication change will be warrented as weight reduces," it said. 

For more information on European Obesity Day, click here


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