Diet curbs appetite, induces weight loss. New research has shown that if people achieve and maintain substantial weight loss to manage their type 2 diabetes, many can also effectively control their high blood pressure and stop or cut down on their anti-hypertensive medication.
A weight management program, developed by researchers at the Universities of Glasgow and Newcastle for the Diabetes UK-funded DIabetes REmission Clinical Trial (DIRECT), has proved effective at lowering blood pressure and reducing the need for antihypertensive medications, as well as bringing remission of type 2 diabetes. The study was published in the journal Diabetologia (Leslie, Ali, et al. 2021).
Diet induced weight loss program
The program involves an initial 12 weeks on a nutritionally complete formula diet (low-calorie soups and shakes) which will induce weight loss of over 15 kg (over 2 stones) if followed fully. Diabetes and blood pressure drugs were stopped at the start, and only re-started if blood sugar or blood pressure rose.
The weight loss phase is followed by support to choose foods and eat wisely for weight loss maintenance. Maintaining the 15 kg weight loss allowed 8 out of 10 people to become free from type 2 diabetes, without the need for diabetes medications for at least 2 years.
Findings of diet-induced weight-loss study
The study looked at 143 people who started the diet program, with more than half (78 people) on tablets for high blood pressure at the start (and 44 on two or more drugs). The researchers found that, overall, average blood pressure fell steadily as people lost weight. And blood pressure remained lower after the formula diet period finished, and then at 12 and at 24 months.
For those not previously treated for high blood pressure, blood pressures fell sharply from week one. For those who had stopped their blood pressure tablets, blood pressure still fell, although more slowly. Just over a quarter (28%) needed to reintroduce a blood pressure tablet during the formula diet period. However, researchers also found that the same proportion of participants (28%) were able to remain off their medications for at least two years.
Prof Mike Lean, from the University of Glasgow, said: “We wanted to evaluate the safety and efficacy of withdrawing blood pressure medication when beginning our specially-designed weight-loss program for type 2 diabetes, and we are really pleased with the results.
“Our study shows that, in addition to possible remission from type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks.
“Currently, over half of all the 4.5 million people with type 2 diabetes in the UK also require tablets for hypertension, to reduce serious vascular complications. Being overweight is the main cause, and losing weight can bring a remission from hypertension for many, as well as a remission of diabetes. Withdrawing blood pressure medications is safe, provided people lost weight and blood pressure was checked regularly, in case tablets needed to be reintroduced.
“The DiRECT trial was done entirely in primary care. The evidence shows that GPs can safely offer an evidence-based intensive weight management intervention, aiming for substantial weight loss and remission of type 2 diabetes. The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain the weight loss is vital.”
Professor Roy Taylor, from Newcastle University, said: “Guidelines encourage doctors to start tablets but there have been few demonstrations of how tablets can be stopped.”
Dr Wilma Leslie, University of Glasgow, said: “The potential to no longer need medications for blood pressure and diabetes is a big incentive for people. We hope our results will reassure health professionals that this is possible, and encourage the wider provision of diabetes remission services.”
Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “These important results show that the Diabetes UK-funded DiRECT low-calorie, weight management program not only helps some people put their type 2 diabetes into remission but can also lower blood pressure, allowing some people to safely stop taking their blood pressure medication.
“We’re delighted to see more evidence of the life-changing impact of the DiRECT program on people’s health. This makes us even more determined to make sure as many people as possible have access to type 2 diabetes remission services.”