Type 2 Diabetes Remission via TDR?

An article titled “NHS soup and shake diet can beat type 2 diabetes” recently caught my eye on the BBC news site (Health section).

What is type 2 diabetes?

Type 2 diabetes is a condition that causes the level of glucose (sugar) in the blood to become too high.

A hormone called insulin controls blood sugar but diabetes patients cannot make enough or cannot efficiently use insulin in their body.

See the NHS website for more information.

It is a long-term condition the can result in serious problems to the patient’s eyes, feet, heart and nerves.

What is total diet replacement (TDR)?

NHS England is funding a programme that asks participants to replace their normal eating habits with a mainly liquid diet of soups, shakes and meal replacement bars. Solid foods are re-introduced gradually.

The Path to Remission Programme is a joint initiative between NHS England and the charity Diabetes UK.

Eligibility for the programme requires patients to be adults up to 65 years in age, to have been diagnosed with type 2 diabetes in the last 6 years and to have a body mass index above 27 (or 25 for certain ethnic groups).

Full eligibility criteria can be found on a dedicated NHS webpage.

TDR is not suitable for all patients as it involves a major dietary change and a sharp reduction in calorie consumption.

Is the programme successful?

The BBC article reports that a third of participants were able to lose a large amount (16 Kg on average) of weight and put their diabetes into remission.

The same article provides accounts from patients who have taken part in the TDR programme.

The NHS webpage referenced above concludes on a very positive note:

remission of type 2 diabetes is possible at scale through delivery of an NHS service.

The results are discussed in an article in The Lancet:

Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation

(click link for open access article and full reference card)

The Lancet adds a cautionary note in its conclusion: remission rates may not be easy to measure in the real world, i.e. outside of the current randomised controlled trial, and may be lower than those reported thus far.