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Several studies have now shown that diabetes remission is possible in some individuals with type 2 diabetes (See Perspectives for more details). Significant weight loss is a key contributor to achieving remission, but the best type of diet to achieve and maintain weight loss and achieve diabetes remission is still unclear.

To try to answer these questions, earlier this year, a group of researchers published an umbrella review of published meta-analyses of diets for weight management and a systematic review of studies looking at diets for diabetes remission.

They first looked at 19 meta-analyses of weight-loss diets, published between 2013-2021. Only seven of these analyses were considered high quality. They found the greatest weight loss was seen with very low energy diets (1,700-2,100 kilojoules or 400-500 Calories per day) used for 8-12 weeks and the weight loss achieved with these was greater than with low energy diets (4,200-6,300 kilojoules or 1,000-1,500 Calories per day). In studies lasting between 12 and 52 weeks, formula meal replacements (e.g., meal replacement drinks or bars) achieved a 2.4 kg (5 Pounds) greater weight loss compared to low energy diets. The researchers found that low-carbohydrate diets were no better for weight loss than high-carbohydrate/low-fat diets. And compared with control diets, minimal or no differences in weight loss were seen with high-protein, Mediterranean, high monounsaturated fatty acid, vegetarian or low glycemic index diets.

The researchers then conducted a systematic review of 16 studies looking specifically at type 2 diabetes remission, defined as a HbA1c < 6.5% or fasting glucose <7 mmol/L without glucose lowering medication. In randomised controlled trials, where participants started by using low energy total diet replacements (i.e., all meals coming from meal replacements), 54% of participants achieved remission at one year. Smaller numbers achieved remission using 1-2 meal replacements per day (11%) and Mediterranean diets (15%). While studies of ketogenic/very low-carbohydrate diets and very low energy food-based diets showed around a 20% remission rate, these studies were found to be of low quality.

The authors of this paper concluded that very low energy diets and formula meal replacements are the most effective approaches for weight loss. Those which include an induction phase using meal replacement products for all meals appear to be the most effective for type 2 diabetes remission. They also point out that most of the evidence is restricted to 12 months or less and that further well conducted and longer-term studies are needed.

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Dr Kate Marsh is an is an Advanced Accredited Practising Dietitian, Credentialled Diabetes Educator and health and medical writer with a particular interest in plant-based eating and the dietary management of diabetes and polycystic ovary syndrome (PCOS).

Contact: Via her website