Effective Weight Management in Diabetes

Effective diets to help manage and maintain healthy lifestyles in diabetic patients 

Upon receiving a diabetes diagnosis, patients go through many thoughts, one of the first being medication therapy. Besides medication therapy, the critical component for a healthy life with diabetes is maintaining a healthy lifestyle. The beneficial lifestyle modifications include exercise, management of comorbidities, and diet. No one likes the word diet as it tends to have a negative connotation. However, patients with diabetes must deal with this more often than those without diabetes. The problem is, there are so many diets out there. Which one works for what you need?

According to the International Diabetes Federation (IDF), at least 1 in 10 of the population has diabetes, and over 90% have type 2 diabetes. To be able to find the proper diet could be life-changing. By 2030, it is estimated by the IDF that over 600 million people will have diabetes worldwide and rise to over 750 million by 2045. These staggering numbers make it essential to find a diet to help all these patients. Because of the many diets that produce different results for patients, any study that has been previously done has conflicted with another. This conflicting data confuse providers as they are unsure what to recommend for their patients to provide the best benefit. Not only can diets be beneficial in the management of diabetes, but they can sometimes even help a patient receive remission from type 2 diabetes.

To approach this complex topic head-on, a team of worldwide researchers set out to reexamine previous research to find the most effective dietary approach. This team was led by Professor Michael Lean of the University of Glasgow in the United Kingdom. The researchers’ goals were to find a diet to help lose weight, maintain weight loss, and achieve remission from type 2 diabetes. This research was no small feat. Throughout their study, they found that very low-energy diets and meal supplements were the most effective for type 2 diabetic patients to lose weight. 

In a study completed by Professor Lean, DiRECT, patients achieved remission by maintaining a 10 kilogram or 22-pound weight loss. To conduct the previously mentioned research, Dr. Lean continued to build his research from the DiRECT trial. He and his team completed this by collating diet and weight loss meta-analyses in type 2 diabetic patients. They were also able to systematically review studies that included diets for type 2 diabetes remission. 

Their findings were somewhat unexpected but were shown to be effective. The analysis results showed that programs for weight loss that included very low energy and formula meal replacements were more effective and showed more significant weight loss than the conventional low energy diets. If the program had a total diet replacement at the beginning of the diet, they were more effective in providing a patient with type 2 diabetes remission. They found a median of 54% of patients had reported remission at the one-year mark. Surprisingly, the research found diets high in protein, Mediterranean, vegetarian, and diets with low glucose to have little to no weight loss. Professor Lean was surprised by the poor evidence surrounding the popular ketogenic (low-carb) diet. 

There were some limitations to the research. Most of the previous studies completed were focused on only short-term outcomes. These short-term outcomes are not beneficial in the grand scheme, as weight loss benefits would only come with long-term control. It is also challenging to determine the physical needs of individuals undergoing weight loss. As the weight begins to come down, changes may have to be made to continue the decrease. Per the researchers of this study, further and researchers should conduct more in-depth research to determine the long-term impacts on weight, glycemic control, clinical outcomes, and complications of diabetes. 

Practice Pearls

• There are many diets out that claim to be the one that works but have yet to be proven. The research studies that have previously been completed mostly conflict with one another. 
• Researchers reviewed many other worldwide studies to determine the best diet for type 2 diabetic patients. 
• The analysis results showed that programs for weight loss that included very low energy and formula meal replacements were more effective and showed more significant weight loss than the conventional low energy diets.

Churuangsuk, C., Hall, J., Reynolds, A. et al. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 65, 14–36 (2022). https://doi.org/10.1007/s00125-021-05577-2  

Lambert, Debbie. “Diabetes, Weight Loss, and Remission: Which Diets Are Best?” Medical News Today, Med Lexicon International, 19 Nov. 2021. 

Quinlynn Champ, PharmD Candidate 2022, South College School of Pharmacy