The possibility of achieving lasting remission of type 2 diabetes, off all hypoglycaemic medications, seemed far-fetched – until the last decade. The Counterpoint study established in 2011 that the type 2 diabetes could be reversed to normal glucose control merely by 15kg weight loss. A feasible and well-accepted method of achieving this was developed to test the previously published Twin Cycle Hypothesis of the aetiology of the condition. In 2016, the Counterbalance study demonstrated that reversal to normal depended largely upon duration of type 2 diabetes, and that remission would last at least 6 months provided weight regain was avoided. Then The Diabetes Remission Clinical Study (DiRECT) showed that this could be delivered in routine family practice by regular NHS staff given 8 hours of structured training. This RCT demonstrated that 36% of people with type 2 diabetes remained free of diabetes over 2 years. Further insights into the aetiology and pathophysiology of type 2 diabetes have since been gained. One critically important message for this Lifestyle conference is that substantial weight loss can be achieved by dietary means, but starting new exercise programs must be delayed until after the weight loss has been achieved. This temporal separation of food restriction and new physical activity programs deserves to be widely recognized.

Learning Objectives:

  • Describe the simple etiology of type 2 diabetes now understood.
  • Discuss how to achieve substantial weight loss using a low calorie diet, temporally separated from increase in physical activity.
  • Explain the criteria for remission of type 2 diabetes.



The date


Sat, 24 Oct 2020