Northern Territory GP Sam Heard sees the damage type 2 diabetes is causing in indigenous communities; in some places up to 40 percent of the population is affected by the disease.
Important points:
- General Practitioners in the Northern Territory and southwest Sydney are running a pilot low-calorie weight loss program to help manage those with type 2 diabetes
- The programs are based on a UK study that found that a low-calorie diet could help people with type 2 diabetes who do not use insulin
- While the program can potentially help a large number of people, it may not be for everyone
“‘Dire could be a good word. The outcome for people who get diabetes when you are 40 is not good and when you are very young it is terrible,” said Dr. Heard.
“When you tell an Aboriginal person that they have diabetes, they are pretty devastated and there is a stigma involved.
“It’s a really serious disease that affects everyone – their families and their children.”
But dr. Heard sees some promising results in his patients testing a low-calorie weight management program.
“Everyone managed to move on [the program] are very, very positive about it, “said Dr. Heard, the medical director of the Central Australian Aboriginal Congress.
“A guy in his 40s who described it to a large group of Aboriginal people at a meeting got a standing ovation and they could see the difference in his overall behavior and see how much weight he had lost.
“Some people have lost nearly 30 kilograms. We now have a great need to make this more widely available.”
The program is based on the UK Diabetes Remission Clinical Trial – known as DiRECT – which challenges the convention that type 2 diabetes is always an irreversible lifelong disease.
“A Really Big Deal”: What the UK Trial Found
Half of the study participants on the low-calorie diet went into remission. (
Getty / Chris Fertnig
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British researchers started the DiRECT study in 2014 to find out if controlled weight loss would help people with type 2 diabetes.
They recruited 300 people who had been diagnosed with type 2 diabetes in the past six years but were not using insulin.
Under the supervision of their family doctor, half of the group were fed around 830 calories per day (3469 kilojoules) for three months with the aim of losing 15 kilograms.
Participants were prescribed nutritionally complete soups and shakes and guided through food reintroduction at the end of the program.
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The other half of the group was looked after by their family doctor in accordance with the current best practice guidelines for type 2 diabetes.
A year later, about half of those on a low-calorie diet lost significant amounts of weight and went into remission, compared to 4 percent in the group who followed the guidelines, according to the first results published in the Lancet.
“Achieving remission from diabetes, being able to tell a patient that you are no longer diabetic, is a really big deal,” said lead study author Mike Lean, professor of human nutrition and a doctor at the University of Glasgow.
“About half of our patients were able to reach this point after a year and about a third of them are still there after two years,” he said.
Study sees fat loss, high blood pressure
After the initial results of the UK study, the researchers followed up the participants.
In addition to some patients who went into remission, the DiRECT study also found that patients who had lost significant amounts of weight had a number of other health changes.
“One of the other things we got into [the trial] was to measure the fat in the liver and pancreas using magnetic resonance imaging, “said Professor Lean.
Professor Mike Lean from the University of Glasgow said people need to understand “what a serious disease type 2 diabetes is”.
Delivered: Mike Lean
)
“We were able to show that people who start out as type 2 diabetics have a lot of fat in the wrong places; they have fat in the liver, they have fat in the pancreas, they have fat in the pancreas heart, and it damages the organs.
“Those who are able to lose those 15 or 20 kilograms and keep them off have lost all of the excess fat, and the organs – the liver, the pancreas, the heart – all seemed to function better.”
And some participants also reported that they no longer need medication to control their high blood pressure – a condition that is often associated with type 2 diabetes.
“Hypertension is another deadly disease that we shouldn’t ignore,” said Professor Lean.
“About a third of our patients have been able to stop taking their blood pressure pills and have not taken them for at least two years.”
One of these patients was Kathleen Brough from northern England, who took part in the study five years ago.
Kathleen Brough took part in the DiRECT study in the UK and her type 2 diabetes is now in remission. (
Delivered to: Newcastle University, UK
)
At the time, she had type 2 diabetes, high blood pressure, and high cholesterol, but after participating in the study, her BMI fell within the healthy range and her blood pressure stabilized.
“Five years later and I’m in remission,” she said.
“I think I did really well, even if I say it myself. I was able to skip the blood pressure pills until last year and was introduced to the lowest dose of [these tablets]. “
“But it’s still a lot better than what I played.”
Diet program also tested in Southwest Sydney
The NT isn’t the only place in Australia where the low calorie program is tested.
The strength of the DiRECT results convinced David Simmons, a medicine professor at Campbelltown Hospital, to start a pilot project in southwest Sydney via local GP networks.
“We felt there was enough evidence that this should be up and running already,” he said.
“We tried to translate what was done in the UK into Australian clinical practice.
“Of course we have the final evaluations ahead of us because we are at the end of [the project] But we find that it works very well and that is very exciting for us in the diabetes services. “
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Professor Simmons said the low-calorie program worked because the patients were given adequate support.
“We know that people do these things on their own [but] This is a much more systematic approach and we know people need support, “he said.
“The other thing is that it is very accessible. It goes through the primary care; through the general practitioners who are supported by our nutritionists. We train the general practitioners, we work with the general practitioners to do this.
“We realize that this will potentially help a large number of people significantly.”
Low-cal may not be for everyone
However, the Heart Foundation’s senior medical advisor and cardiologist Professor Garry Jennings cautioned that the program may not be for everyone.
He said the size of the UK study was small and the weight loss measures not necessarily achievable.
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“Study participants were closely monitored and given intensive support to maintain a low-calorie diet, which is not a viable or sustainable option for many people,” he said.
He also noted that some participants had to resume their blood pressure medication after a while.
“Around two-thirds of people had to take their blood pressure medication again,” said Professor Jennings.
“Maintaining healthy blood pressure is a very important part of managing diabetes.”
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