In terms of target weight loss, NICE says practitioners should explain to the person that €losing 5-10 per cent of their weight in one year is a realistic initial target that would help reduce their risk of type 2 diabetes and also lead to other, significant health benefits.€7

NICE's public health guidelines on preventing type 2 diabetes includes dietary advice, while Diabetes UK's nutrition guidelines (March 2018) lists the following diets:7,8

·       Mediterranean diet;

·       DASH (Dietary Approaches to Stop Hypertension) diet which emphasises foods lower in sodium and rich in potassium, magnesium and calcium;

·       vegetarian or vegan diets;

·       Nordic healthy diet €“ similar to the Mediterranean diet, but using rapeseed(canola) oil rather than olive oil;

·       moderate carbohydrate restriction.

Low carb diets

Diabetes UK has said findings on the impact of reduced carbohydrate diets are inconsistent. This is in part due to studied diets ranging from promoting a 'modest reduction' of carbohydrates through to very low carbohydrate, ketogenic diets. High fibre diets will not have much impact on hyperglycaemia, and low glycaemic index diets appear to have a slight or no impact on hyperglycaemia.8

However, in updating its nutrition guidelines, Diabetes UK has for the first time outlined how people with type 2 diabetes could achieve remission. €This guidance has been added after the first-year results of the Diabetes UK funded study called DiRECT suggested that type 2 diabetes remission can occur with significant weight loss,€ it said.9

The DiRECT (DIabetes REmission Clinical Trial) study began after a Newcastle University pilot study in 2011 looked at the impact of a diet of 800 calories a day for eight weeks on people with type 2 diabetes. Liver and pancreas fat levels in 11 participants fell and insulin production returned. All participants in the trial were in remission after two months, and most still had normal blood glucose control after three months.10

For the current study, GPs have been recruiting overweight adults diagnosed with type 2 diabetes within the previous six years. Half the participants receive an intensive low-calorie, diet-based, weight management programme for eight to 20 weeks, while control group participants receive the best weight loss support currently available. The very low calorie diet comprises mainly soups, shakes and fluids, with normal food reintroduced gradually at the end of the diet period.

While the study is still running, initial results after a year were described as €hugely promising,€ having €found there was a close link between type 2 diabetes remission and total weight loss: 86 per cent of people who lost more than 15kg on the programme were in remission after a year, as were 57 per cent of people who lost 10€“15kg, and 34 per cent who lost 5€“10kg.€ Only 4 per cent of the control group were in remission.11

The researchers point out that the low-calorie, liquid diet is €incredibly challenging€ for some, and people may need to work hard to keep their weight healthy and remain in remission.

For people with type 2 diabetes using medication such as insulin or sulphonylureas, then the diet can put them at greater risk of experiencing hypoglycaemia. This will likely require changing the medication and monitoring blood glucose levels more frequently.