Prevention and reversal of Type 2 diabetes: highlights from a symposium at the 2019 Diabetes UK Annual Professional Conference

Abstract

Aim This symposium covers the gamut of Type 2 diabetes prevention, reversing established Type 2 diabetes, population‐level delivery of weight loss programmes and personal insights into achieving and retaining substantial weight loss. Results The NHS Diabetes Prevention Programme was launched in 2016 and rates of referral and attendance have both exceeded expectations. By March 2018, mean weight loss for completers (those attending more than 60% of sessions) was 3.2 kg reflecting considerable health benefits. Established Type 2 diabetes is now known to be a reversible condition in the early years, and the underlying mechanism is the removal of the excess fat from within liver and pancreas in these susceptible individuals. The Diabetes Remission Clinical Trial has shown that around half of a primary care population of people with Type 2 diabetes of less than 6 years’ duration can be returned to non‐diabetic blood glucose control which lasts at least 12 months. This raises the question of population‐level intervention to achieve weight loss. The success of some mass weight loss programmes requires to be recognized. Reframing mass provision of weight loss support should be a vital part of our clinical strategy to prevent and treat Type 2 diabetes. However, the current obesogenic environment is a reality in which individuals must live. A personal account of achieving substantial and maintaining substantial weight loss provides an invaluable insight into practical problems encountered. All health professionals dealing with weight control should assimilate and reflect upon this understanding. Conclusions Effective prevention and long term reversal of Type 2 diabetes is feasible. The impact upon the individual must be considered during delivery of advice and support.

The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

“…Since the weight change in our control group was close to zero and trial eligibility criteria and sample characteristics were almost identical to those of the NHS DPP, our data provide some confidence that the clinically meaningful weight loss (3.2 kg) observed for participants with high levels of attendance at NHS DPP sessions [14] is an accurate estimate. This estimate is also broadly consistent with our CACE analysis, which estimated a 3 kg weight loss for people attending all four core programme sessions.…”

“…Without intervention, 30–50% of people with one or more markers of non-diabetic hyperglycaemia [11], a state of chronically raised blood glucose indicated by impaired fasting glucose, impaired glucose tolerance, or raised HbA1c (glycated haemoglobin of 42–47 mmol/mol) [3], will develop type 2 diabetes within 5 years [12]. Announced in March 2015, the “Healthier You: NHS Diabetes Prevention Programme” (NHS DPP) launched in 2016 to target the estimated 11% of people across England with non-diabetic hyperglycaemia [13], with more than 280,000 people referred as of September 2018 [14].…”

“…A systematic review [15] reported that “real-world” diabetes prevention interventions demonstrating greater adherence to recommendations on intervention content [3] generated higher levels of weight loss (up to 4 kg at 12 months for the most guideline-adherent). Preliminary data from the NHS DPP [14] indicate a mean weight loss of 3.2 kg amongst the half of participants who attended at least 60% of the sessions, which is sufficient to affect diabetes risk [3, 5]. Cautious interpretation is warranted, however, because this finding was based on a selective sub-group of participants, without reference to a comparison group.…”

The importance of facts and figures in diabetes care

“…Over the last three years, Diabetic Medicine has held successful symposia at the Diabetes UK annual professional conference. These well attended meetings have each been accompanied by a review article written by the conference presenters . We decided to expand this initiative beyond the UK and held a productive meeting at the Hong Kong 21 st Diabetes and Cardiovascular Risk Factors East meets West symposium in September 2019, coordinated by Professor Ronald Ma and his colleagues at the Hong Kong Institute of Diabetes and Obesity, Chinese University Hong Kong.…”

Corrigendum

“…The article by Taylor et al. was published without the funding information and disclaimer text. The missing funding information and disclaimer text are given below:…”