Reverse Diabetes Using Diet and Lifestyle – Is It Possible?

On 20 March, IMU’s Center of Transformative Nutrition & Health (CTNH) organised a webinar with speakers from Ministry of Health (MOH), Malaysia and University of Oxford on “Diabetes in Malaysia and South-East Asia: Is Remission Possible?”. The webinar was co-organised with the Malaysian Endocrine and Metabolic Society (MEMS) and the Malaysian Dietitians’ Association (MDA). The webinar was attended by over 550 participants who were physicians, dietitians, diabetes eduucators, nurses and other healthcare professionals from Malaysia, Singapore, Middle-East and the UK. The moderator was Prof Winnie Chee from Division of Nutrition & Dietetics, IMU.

The objective of the webinar was to discuss proven dietary approachers for diabetes remission, defined as achievement and maintenance of blood glucose levels back to normal after weight loss and discontinuation of diabetes medication over 6 months or longer.

Datuk Dr Zanariah, Head of Endocrinology Services, MOH, and past-President of MEMS highlighted that Malaysia has become the epicenter of diabetes in South East Asia with a prevalence of 18.3% from the latest National Health & Morbidity Survey in 2019. She emphasised the importance of diet and lifestyle in reducing the risk of diabetes and improving outcomes among people living with diabetes to improve their quality of life.

She identified that the unmet needs in current diabetes care include lack of optimal nutritional intervention and weight loss programmes for those with Type 2 diabetes mellitus.

Dr Anthony Leeds who hold adjunct positions at the University of Copenhagen and International Medical University gave an update on current evidence on use of lifestyle management for diabetes remission. He highlighted that compared with low-fat diets, a low carbohydrate diet (< 130g/d) can be beneficial for weight management and diabetes remission in the short term (6 months) but the benefits diminished at 12 months.

Studies in the UK and the Middle-East showed that dietitian-led enabled weight loss programmes using Total Diet Replacement (TDR) achieved more than 15 kg of weight loss in a year which led to diabetes remission. Participants had a greater reduction in liver fat and reduced inflammation and their pancreas reverted to normal morphology in the UK study called the DIRECT trial. Among those who maintained weight loss, the individuals remained in remission for more than 2 years in DIRECT. Compliance with TDR is high with good safety profile and a maintenance diet will help ensure continued weight loss and remission.

Prof Susan Jebb from the University of Oxford highlighted that 75% of individuals who lose 10kg will have remission. Prof Jebb informed the audience that physicians in the UK primary care settings currently approach patients to discuss possible intervention about their weight at the end of their consultation. Among the intervened patients, 40% agreed to attend weight loss programmes and 20% of them had significant weight loss.

She emphasised that language and sensitivity in how physicians broach weight issues with their patients are important. Prof Susan summarised that obesity should be recognised as a chronic relapsing condition and may need repeated interventions.

Prof Paul Aveyard highlighted that weight loss often diminished over time and programmes with greater weight loss lead to longer retention. However, Prof Paul’s research showed that any weight loss even though temporary have long-term benefits in terms of cardiometabolic effects. So, there is a legacy effect of these intervention programmes.