Losing weight is hard but not any harder if you have type 2 diabetes

OPINION: A study has found weight loss could reverse type 2 diabetes. The UK clinical trial showed that 46% of people who followed a low-calorie diet, among other measures, for 12 months were able to stop their type 2 diabetes medications.

This confirms a position outlined in a previous paper that people can beat diabetes into remission if they lost about 15 kilograms. Another study showed that prediabetes (a blood sugar level that is high, but lower than necessary for diabetes diagnosis) can be prevented by losing as little as 2kg.

If weight loss isn’t already hard enough, many people think it’s more difficult if you have diabetes. One small study perhaps sowed the seed for this defeatist idea. A dozen overweight diabetic subjects and their overweight non-diabetic spouses were treated together in a behavioural weight-control program. After 20 weeks, the diabetic group lost 7.4kg on average while their non-diabetic spouses lost 13.4kg.

But there’s more to this story than meets the eye. In fact, losing weight with type 2 diabetes is no harder than it is without it.

Where does this idea come from?

Type 2 diabetes triples the risk of heart attack and stroke, and is the leading cause of blindness, amputations and kidney failure. Treatment with modern drugs improves the outlook, but complications still develop and life expectancy is substantially reduced, especially for younger people. So beating it into remission is the ultimate goal of management.

If weight loss helps reach that goal, people need to know if it’s harder to achieve than without diabetes. From all the information out there you might think it is. In diabetes, the fat-burning mitochondria (the powerhouse of our cells) may be more sluggish and hunger hormones may be out of whack.

Then there’s the insulin angle. In response to high levels of blood sugar (glucose), the pancreas pumps out insulin and packs glucose away into tissues like muscle to store or use for energy. Type 2 diabetes is characterised by insulin resistance, because the muscle cells are not sensitive to insulin. So glucose accumulates in the blood or is taken up into fat cells where it can be made into more fat.

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