Type 2 diabetes – it’s easy to get
Type 2 diabetes (high blood sugars) happens when we gain more fat and move less than our ‘personal’ programming (genetics) demands. It’s easy to get. There are lots of ‘fast’ tasty, high-calorie foods around. It’s also easy to spend lots of hours sitting. Around 1 in 10 people have diabetes.
People with diabetes have higher chances of heart attack, stroke, vision loss, kidney damage, and a host of other complications after years of disease. Shortening the number of years of disease could reduce the chances of developing complications.
Shortening the number of years of disease is called ‘diabetes remission’. This means not being on diabetes medication and not having diabetes-level blood sugars for at least 3 months (Canada and UK guidelines). Bariatric surgery can lead to remission. Two large studies (DiRECT and DIADEM-I) also showed that a low-calorie diet for a couple of months under the supervision of health professionals could lead to weight loss and remission. We are now seeing what happens when we combined a low-calorie diet with supervised exercise, in our RESET trial (protocol).
Our RESET for REMISSION trial
When we lose weight by lowering calories, we lose both fat and some muscle. Exercise can help us hang onto muscle. Lowering weight and exercising can work together to make our hearts healthier. Besides looking at diabetes remission through blood tests, we will also look at heart function with a cardiac MRI.
We are involving young people 18 to 45 years old who are not on insulin who have had type 2 diabetes for less than 6 years. If you are young when you develop diabetes, you could be young when you could develop complications. People who have not had diabetes for as long and do not need insulin are the most likely to go into remission. We do a ‘computer coin flip’ to decide whether a person goes into the experimental group or the comparison group.
This group gets a low-calorie diet (900 calories per day) for 12 weeks of shakes, bars, and other ‘meal replacement products’ plus a bit of food. Starting in week number 3 they also exercise under supervision with treadmills, weights, machines, and bands. We stop all blood sugar-lowering pills and most high blood pressure pills because blood sugars and blood pressure could go too low on a low-calorie diet with exercise. After this, for another 12 weeks, they eat foods at a ‘weight maintenance’ calorie level and they exercise on their own. They get more supervision and even a return to meal replacements if they gain weight or don’t exercise enough. They do not restart their medications unless their blood sugar or blood pressure levels are at abnormal levels.
The comparison group performs tests and answers questionnaires like the experimental group (at the beginning, middle, and end) and manages their diabetes as usual. After the final tests, they are offered the low-calorie diet in thanks for participating.
What are we looking for?
We will compare how many in the experimental group and in the comparison group go into remission. We will also compare the groups in terms of cardiac MRI results, time and intensity of walking on a treadmill, percent of muscle and fat in their body, and many other factors.
What’s the big picture?
If it looks like our strategy works, we will organize a larger and longer study to see how long the differences last. The more people that go into remission and the longer that they are in remission, the more justification there will be to organize permanent programs.
A word of caution
It’s important to remember, though, that diabetes may not go away forever even in people who get into remission, so it is important to have blood tests a couple of times a year to check for it. It is also important to continue to eat in a healthy way and be physically active to help prevent diabetes from coming back.
Would you like to join us?
We are recruiting 100 people across the cities of Montreal and Edmonton in Canada and Leicester in the United Kingdom. If you live in one of these cities and think you might qualify, please contact us.
Who pays for this?
We are grateful for funding for this study from the Canadian Institutes of Health Research and the UK Medical Research Council. Additional funding is provided by the John R McConnell Foundation.