Researchers from the University of Glasgow and the University of Newcastle, both in the United Kingdom (UK), recently developed a diabetic weight management program derived from a study called the Diabetes Remission Clinical Trial (DIRECT), proving to be effective at not only lowering blood pressure and reducing the need for anti-hypertensive medications but also bringing remission of type 2 diabetes. The research reveals that if people achieve and maintain substantial weight loss to manage their type 2 diabetes, many can also effectively control their high blood pressure and stop or cut down on anti-hypertensive medication. This underlying study was recently published in the journal Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) titled “Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT).” The study was funded by Diabetes UK.
The DiRECT study led to the resulting program, which represents profound implications as those that follow up may be able to not only cut pharmaceutical drug dependency but also possibly bring their type 2 diabetes into remission.
Weight is a Key Issue in the UK
Presently a crisis is building in the UK with over 4.5 million people combating type 2 diabetes while also prescribed hypertension medication to reduce major vascular issues and complications. The problem of too much weight is a major one in the UK and represents an underlying root cause of hypertension and type 2 diabetes.
This program involves an initial 12 weeks on a nutritionally complete formula diet (low-calorie soups and shakes), which will induce weight loss of over 15 kg (over 2 stones) if followed fully. Diabetes and blood pressure drugs were stopped at the start, and only re-started if blood sugar or blood pressure rose.
The weight loss phase is followed by support to choose foods and eat wisely for weight loss maintenance. Maintaining the 15 kg weight loss allowed 8 out of 10 people to become free from type 2 diabetes, without the need for diabetes medications for at least two years.
Study Conducted in Primary Care
This study (ISRCTN03267836) involved 143 people who started the diet program, with more than half (78 people) on tablets for high blood pressure at the start (and 44 on two or more drugs). The researchers found that, overall, average blood pressure fell steadily as people lost weight. And blood pressure remained lower after the formula diet period finished, and then at 12 and 24 months.
As reported in the recent press release by Professor Mike Lean, principal investigator, “The DiRECT trial was done entirely in primary care. The evidence shows that GPs can safely offer an evidence-based intensive weight management intervention, aiming for substantial weight loss and remission of type 2 diabetes. The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain weight loss is vital.”
For those not previously treated for high blood pressure, blood pressures fell sharply from week one. For those who had stopped their blood pressure tablets, blood pressure still fell, although more slowly. Just over a quarter (28%) needed to reintroduce a blood pressure tablet during the formula diet period. However, researchers also found that the same proportion of participants (28%) were able to remain off their medications for at least two years.
Principal Investigator Point of View
The study was led by Professor Mike Lean from the University of Glasgow who went on the record in a press release “We wanted to evaluate the safety and efficacy of withdrawing blood pressure medication when beginning our specially-designed weight-loss program for type 2 diabetes, and we are really pleased with the results.
Our study shows that, in addition to possible remission from type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks.”
Professor Roy Taylor from Newcastle University reports, “My patients, like so many, do not like swallowing multiple tablets, and this study is important as we can now reassure them that stopping blood pressure tablets is not only safe but also good for their health. We’ve shown that when substantial weight loss is achieved and maintained, patients can effectively manage both their blood pressure and type 2 diabetes without drugs.”
That’s right, according to this study, the possibility exists that at least some patients that participate in this program can actually eliminate the need for both blood pressure and type 2 diabetic medication, reports Dr. Wilma Leslie with the University of Glasgow. And she notes that this is a “big incentive for people. We hope our results will reassure health professionals that this is possible, and encourage the wider provision of diabetes remission services.”
The Director of Research at Diabetes UK, Dr. Elizabeth Robertson, chimed in, declaring, “These important results show that the Diabetes UK-funded DiRECT low-calorie, weight management program not only helps some people put their type 2 diabetes into remission but can also lower blood pressure, allowing some people to safely stop taking their blood pressure medication.
We’re delighted to see more evidence of the life-changing impact of the DiRECT program on people’s health. This makes us even more determined to make sure as many people as possible have access to type 2 diabetes remission services.”
Mike Lean, MA, MB, BChir, MD (Cambridge), FRCP (Edinb), FRCPS (Glasgow), FRSE, Professor, University of Glasgow
Roy Taylor, BSc, MB ChB, MD, FRCP, FRCPE, Professor, Newcastle University
Dr. Wilma Leslie, University of Glasgow
Call to Action: Check out the study titled “Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT),” now available in Diabetologia.