# Type 2 diabetes remission is possible for people with lower BMIs



## Eddy Edson (Apr 3, 2022)

Roy Taylor presenting further results from the normal/slightly-overweight ReTUNE trial at the DUK Professional Conference: https://medicalxpress.com/news/2022-04-diabetes-remission-people-bmis.html

(Following prelim results in Sep last year.) Not peer reviewed or journal-published as yet.  

As with the big obese DiRECT study, about 70% of participants got to remission via weight loss, via the same mechanisms. Another data point suggesting that about 70% of T2D's have this kind of visceral fat-related diabetes, regardless of total bodyweight.

_Results from the Diabetes UK-funded Reversal of Type 2 Diabetes upon Normalisation of Energy Intake in the Non-obese (ReTUNE) trial show a staggering 70% of participants with lower bodyweights went into type 2 remission through diet-induced weight loss, despite not living with obesity or overweight.

While obesity increases the risk of developing type 2 diabetes, 10% of people with type 2 diabetes have a BMI that is not in the obesity or overweight category.

Professor Roy Taylor, principal investigator on the ReTUNE trial, Newcastle University said: "This is very good news for everyone with type 2 diabetes, not only pointing the way forward for effective return to health but also challenging the misconceptions clinging to the condition."

Previously, Professor Taylor's landmark Diabetes Remission Clinical Trial (DiRECT) gave hope to millions of people with type 2 diabetes and obesity or overweight by showing it was possible for some people to put their condition into remission through weight loss.

The Counterpoint study, also funded by Diabetes UK, first showed that shedding fat from inside the pancreas and liver—the two key organs involved in blood sugar control—was key to remission from type 2 in people living with obesity or overweight.

To find out if losing excess fat from these organs could also help people with BMIs in the healthy range to go into remission from type 2 diabetes, Professor Roy Taylor and his ReTUNE team put 20 people with the condition and a BMI at or just above the healthy range (BMI below 27) on a similar low-calorie diet program to that followed in Counterpoint.

Participants were supported by a medical team to stop all glucose lowering tablets and follow a strict low-calorie diet (800 kcal per day), consisting of formula meal replacements and non-starchy vegetables for 2–4 weeks, followed by a 4–6 week weight loss maintenance period which involved the gradual reintroduction of normal foods. All participants had received a diagnosis of type 2 diabetes within the last 5 years. This cycle of weight loss and maintenance was repeated up to three times, until participants lost between 10 and 15% of their bodyweight.

After each cycle, the research team measured the amount of fat in the participants' pancreas and liver and looked to see who how remission was produced.

Following on from last year's promising preliminary results, the study's complete data confirms for the first time that people with type 2 diabetes and lower BMIs can be supported to put their type 2 into remission through a structured low-calorie diet program, and that the key to this is losing harmful fat from the liver and pancreas.

After 12 months, the findings showed that:

Participants' BMI averaged 22.4 kg/m2 at the end of the study (reduced from an average of 24.8 kg/m2).
About three quarters (70%, or 14/20) of participants went into remission from type 2 diabetes during the study, with 50% (10/20) of these going into remission after the first weight loss cycle.
Average weight loss of around 8% of bodyweight was required for remission.
In the 14 people who went into remission, average HbA1c fell from 53 mmol/mol at the start of the study to 45 mmol/mol off all diabetes medication, and blood pressure dropped despite taking less anti-BP drugs.
The participants' liver and pancreas fat levels were higher than expected at the start of the trial but then decreased to normal levels following weight loss.
Participants reported feeling satisfied with their weight loss and health improvements and didn't report difficulties with keeping the weight off that they'd lost.

Chris Askew, Chief Executive of Diabetes UK, said: "Building on the pioneering DiRECT trial, this game-changing study from Professor Taylor and his team advances our understanding of why type 2 diabetes develops, and what can be done to treat it.

"Our ambition is for as many people as possible to have the chance to put their type 2 diabetes into remission and live well for longer. The findings of ReTUNE potentially take us a significant step closer to achieving this goal by showing that remission isn't only possible for people of certain body weights.

"It is our hope that ReTUNE—as DiRECT did before it—will inform the development of services and support so that many more people with type 2 diabetes will have the possibility of remission open to them."_


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## Eddy Edson (Apr 3, 2022)

DUK thread with some brief words from Taylor: 



__ https://twitter.com/i/web/status/1509842544187826179


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## travellor (Apr 3, 2022)

Sounds great news.
And weight loss is good for many other health issues as well as diabetes.


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## Kreator (Apr 3, 2022)

Great news indeed! - These continuous studies seem to be revolutionising the NHS treatment for T2D for sure - Roy Taylor and his team deserve a lot of credit!


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## Gwynn (Apr 3, 2022)

This is excellent news.


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## harbottle (Apr 3, 2022)

Interesting work. I got my BMI down from over 28 to 22 in three months and feel so much better.


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## Eddy Edson (Apr 3, 2022)

Just looking at the ReTUNE trial details: https://www.dtu.ox.ac.uk/OurTrials/ReTune.php

.It includes these secondary aims:
.
_To find out which blood tests (biomarkers) might indicate an individual’s Personal Fat Threshold

To find out why diabetes develops in non-obese people by gaining more information about the pancreas and liver

To develop a Diet Decision Aid to help people decide which eating pattern to follow for long-term maintenance of the weight loss._

The first one is obviously really interesting - for screening, prevention etc - but I would guess it'd take a lot more work to actually develop a tool.

Not sure why this work would lead to a "Diet Decision Aid" superior to all the others out there but will be interesting to see what they come up with. My guess is that the best "aid" for many people will be: take semaglutide/Wegovy/Ozempic or one of the new weight-loss meds in the development pipeline. Behavioural approaches are pretty ineffective.


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## Drummer (Apr 3, 2022)

They do make a fuss - and I am not really sure that they are coming at the problem from the tight 'facts'.
I just went low carb, reduced down to a normal blood glucose level and stuck to those foods.
Job done.

Sure, other things happened - my waist shrank, my weight reduced, my metabolism took off like a sprinter chasing Usain Bolt and my usual cheerfulness returned - all after I cut out the high carb foods I could not cope with. The changes began from diagnosis because I dealt with the problem - the carbs - went low carb from that moment. 
It seems that they are looking for problems which are not the problem.

I am often challenged to eat the high carb foods again to 'prove' I am cured - which is crazy - I know I can't cope with them long term - I could never cope with them - few in my family can - so having proven that by eventually becoming diabetic, having beaten it, having been eating my own, safe, delicious way of eating and taking no medication for it, now I am seeing my 'dead' thyroid resurrect itself - what could be better?


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## Windy (Apr 3, 2022)

Drummer said:


> They do make a fuss - and I am not really sure that they are coming at the problem from the tight 'facts'.
> I just went low carb, reduced down to a normal blood glucose level and stuck to those foods.
> Job done.
> 
> ...


I disagree, they should make a fuss - I don't know if it's typical or not, but my experience of diabetes education is that the DESMOND course doesn't even cover remission, nor low carb diets for that matter, so neither are offered for people to try out to see if they work for them.
The lady running the course said "and don't even get me started about Michael Mosley"... which didn't encourage me to ask questions about remission. I definitely didn't raise low carb either, but knew the benefits from others on the forum, including you @Drummer, and I'm grateful, as it's got my BG down.
Roy Taylor and his colleagues should be singing from the rooftops that there's a different way to tackle T2 diabetes, as T2s should be given the chance to try for remission if they want, whether they are obese, overweight or thin.
It shouldn't be just people who have time to sign up for the forum who have access to this sort of information or happen across it, or get to read scientific papers about it, it should be for everyone, otherwise it embeds health inequalities further.
Sarah
PS, good news about your thyroid


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## travellor (Apr 3, 2022)

Drummer said:


> They do make a fuss - and I am not really sure that they are coming at the problem from the tight 'facts'.
> I just went low carb, reduced down to a normal blood glucose level and stuck to those foods.
> Job done.
> 
> ...



That's the thing though.
My problem was I was type 2 diabetic, my problem wasn't carbs.
Personally, I preferred to remove diabetes from my life.

Professor Taylor is interested in "remission" that does enable coping with carbs long term, and addressing all diabetic complication and other health benefits given by lower BMI.
Not simply focussing on manipulating blood glucose to an acceptable reading on a meter, by artificially limiting what diabetics can eat, and limiting personal choices and social occasions.
It's definitely worth making a fuss over.


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## nonethewiser (Apr 4, 2022)

Guy is doing great work, would recommend route to anyone newly diagnosed or pre type 2 diabetes.


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## trophywench (Apr 4, 2022)

I agree with the low carb ethos for T2 generally, whether people need to low carb forever or not depends on them - not merely 'as a matter of personal choice' but also for the simple fact that although as humans we obviously have certain things in common - as my brother in law is fond of saying - two of some things down our sides and one of other things down the middle of our bodies - every single one of us is actually different!  

Therefore with diabetes, as with every other aspect of life - we need to do what suits us, to get whatever results we happen to want!  Not Do As I Do for anything.


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## travellor (Apr 4, 2022)

trophywench said:


> I agree with the low carb ethos for T2 generally, whether people need to low carb forever or not depends on them - not merely 'as a matter of personal choice' but also for the simple fact that although as humans we obviously have certain things in common - as my brother in law is fond of saying - two of some things down our sides and one of other things down the middle of our bodies - every single one of us is actually different!
> 
> Therefore with diabetes, as with every other aspect of life - we need to do what suits us, to get whatever results we happen to want!  Not Do As I Do for anything.


Nah.
Just reverse it, and crack on with a normal life.
No need for the low carb nonsense for type 2.
Type  1 is different, if that's your preference, it's all good for you.


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## Drummer (Apr 4, 2022)

Unfortunately that low carb nonsense is what me and my family all require for normal living - otherwise we end up piling on weight even with calorie counting and low fat options.


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## MikeyBikey (Apr 4, 2022)

It's been known for years that some peoe retain a fatty liver when they drop down from obese to say a BMI of 24 - 25 and that they need to get to 19 - 21 to clear it (although it is not always possible). People need to remain aware that weight gain/ageing will/may cause an increase in HbAc1 and symptoms as it is never cured. Between 30% - 50% of people in care homes are diabetic. Interesting bit not really new. 

The real problem is that rubbish food, like Greggs and MacDonald's is so much cheaper not helped by the widening gap between rich and poor. If II look at photographs from our local market in the sixties only a few people were overweight. Now it seems at least half are seriously overweight or obese.


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## travellor (Apr 5, 2022)

MikeyBikey said:


> It's been known for years that some peoe retain a fatty liver when they drop down from obese to say a BMI of 24 - 25 and that they need to get to 19 - 21 to clear it (although it is not always possible). People need to remain aware that weight gain/ageing will/may cause an increase in HbAc1 and symptoms as it is never cured. Between 30% - 50% of people in care homes are diabetic. Interesting bit not really new.
> 
> The real problem is that rubbish food, like Greggs and MacDonald's is so much cheaper not helped by the widening gap between rich and poor. If II look at photographs from our local market in the sixties only a few people were overweight. Now it seems at least half are seriously overweight or obese.


I suspect a correction may be coming as inflation bites.


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## Drummer (Apr 5, 2022)

I have never eaten anything from a Greggs and only ate in a MacDonalds if I took the kids into town shopping - so the last time was well over 20 years ago - but the low fat high carb 'healthy' diet pushed by my GP was putting weight on me every month - but that was my fault for doing it wrong, apparently.
As long as it is advised to eat high carb low fat foods, there will be people struggling to control their weight - be it porridge or a pie.


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## travellor (Apr 5, 2022)

Drummer said:


> I have never eaten anything from a Greggs and only ate in a MacDonalds if I took the kids into town shopping - so the last time was well over 20 years ago - but the low fat high carb 'healthy' diet pushed by my GP was putting weight on me every month - but that was my fault for doing it wrong, apparently.
> As long as it is advised to eat high carb low fat foods, there will be people struggling to control their weight - be it porridge or a pie.



Now, if we are talking pies.









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## Drummer (Apr 5, 2022)

travellor said:


> Now, if we are talking pies.
> 
> 
> 
> ...


Buy a pie? My grandmothers would come back and haunt me.
I used to make pies for the family, and Yorkshire puddings. Suet, or flaky pastry, short crust or rough puff - I used to work for Allied Lyons and kept a copy of Mrs Beeton in my locker, so I could show them what proper cooking was all about - but I used to eat about 1/8th of the pastry and divide the rest into thirds.
I bought a stand mixer recently and plan to make some low carb versions of various baked goods, but I need to accumulate ingredients first.


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## travellor (Apr 5, 2022)

Drummer said:


> Buy a pie? My grandmothers would come back and haunt me.
> I used to make pies for the family, and Yorkshire puddings. Suet, or flaky pastry, short crust or rough puff - I used to work for Allied Lyons and kept a copy of Mrs Beeton in my locker, so I could show them what proper cooking was all about - but I used to eat about 1/8th of the pastry and divide the rest into thirds.
> I bought a stand mixer recently and plan to make some low carb versions of various baked goods, but I need to accumulate ingredients first.



That's like saying you couldn't eat a steak out if you had to buy it in a restaurant.
I like a meal out, so I'm fine with it.

However hot water crust pastry is the true mark of a proper pie for me.
A chorizo macaroni cheese pie was my last homemade one 

Then cauliflower and broccoli cheese layered in filo pastry.
Chicken tikka in short crust pastry next time.


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## Drummer (Apr 5, 2022)

travellor said:


> That's like saying you couldn't eat a steak out if you had to buy it in a restaurant.
> I like a meal out, so I'm fine with it.
> 
> However hot water crust pastry is the true mark of a proper pie for me.
> ...


Sorry - I don't follow the argument.
I don't eat out very often - never have, but perhaps I have had some bad luck and been served up some absolutely dreadful food - and the milkshake made with sour milk I was brought when very young was decidedly off putting.
My own home made food is far better than anything I have eaten in a restaurant.


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## Eddy Edson (Apr 7, 2022)

Medscape piece has snippets of interview with Taylor: https://www.medscape.com/viewarticle/971599

_This information should make a profound difference in what doctors advise their patients, Taylor added.

"One of the dramatic things about dealing with people in this group," he said, "is they feel very resentful that healthcare professionals tell them not to lose weight."

Based on the current results, Taylor believes this is "inappropriate advice, and it's that personal advice that I think that this study points a way towards."_

That resonates with me. At DX my GP said "try not to lose too much weight", and the practice nurse referred to me as "slim".  Which amazed me - I would have said "podgy" - but I guess I was kind of "slim" relatively to my 57 year old peer group. 

Anyway, with a BMI of 25 point something I suppose nobody would have recommended weight loss as a first line therapy for me, up until this work by Taylor et al. 

But now, people should ditch that standard "think about losing weight if you're carrying some extra pounds" advice & replace it with just "think about losing weight".


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## Eddy Edson (Jun 6, 2022)

Interview with Roy Taylor going thru ReTune stuff, at the ADA conference happening in New Orleans at the moment: https://www.hcplive.com/view/roy-taylor-personal-fat-thresholds-type-2-diabetes-remission


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