Weight loss can reduce need for diabetes and hypertension medication

A restricted-calorie diet and significant weight loss allowed people with diabetes and hypertension to reduce their medication for both conditions in a small international study.
 
Adding to the body of evidence on the effectiveness of lifestyle factors in managing diabetes and other chronic conditions, the UK DiRECT study found the 12-week low-calorie soup and shake program could bring about remission of type 2 diabetes and lower blood pressure.
 
Dr Gary Deed, Chair of RACGP Diabetes Specific Interest Network, told newsGP the study reinforces current guidelines to consider weight loss, education and healthy eating approaches.
 
‘Even if patients have been on medications for a long time, such as in this study with blood-pressure medication, lifestyle [changes] have shown significant benefits in some patients,’ he said.
 
‘This study reinforces that focusing on significant weight loss, if achievable, can change people’s need for blood pressure medications.
 
‘It really just again reinforces that … GPs are able to support patients through different lifestyle processes, one of which one is a very low-calorie weight loss dietary program, but it should be individualised.’
 
Dr Deed notes the study was only a short pilot of early-stage diabetes and not all of the 143 participants achieved significant weight loss that affected their blood pressure medication.
 
Published in Diabetologia, the study involved undertaking an 830-calorie, nutritionally complete diet that would induce weight loss of more than 15 kg in 12 weeks.
 
Participants stopped their medications at the start of the trial, but started taking them again if their diabetes or hypertension control was reduced. This occurred in 28 per cent of the trial cohort.
 
It found the average blood pressure fell as people lost weight, and continued to fall after the diet ended.
 
Dr Deed said while the calorie-restricted diet ‘is not impossible’ in general practice, support services are needed.
 
‘It’s a model that we can try to work towards, with an accredited practicing dietitian, appropriate psychological support services for patients,’ he said.
 
He said obesity and weight management are embedded in the RACGP’s diabetes management guidelines, including to eat according to the Australian dietary guidelines, advising weight loss for people with overweight or obesity and type 2 diabetes, and physical activity.
 
‘It’s worthwhile individually assessing all patients and giving them a chance,’ Dr Deed said. ‘This can put their diabetes in remission and support other management such as reduction of medication and improvement of cardiovascular fitness.
 
‘People who are at risk and those newly diagnosed really should be offered lifestyle support at the get go.
 
‘It’s not just the responsibility of general practitioners. It’s a whole-of-health approach.
 
‘It really is a call to policy-makers to help align policy and economic support to preventative activity.’
 
These supports are publicly available in some states, Dr Deed said, pointing to the Get Healthy Information and Coaching Service in Queensland and in New South Wales that offers personalised healthy eating assistance.
 
‘Guidelines encourage doctors to start tablets, but there have been few demonstrations of how tablets can be stopped,’ Newcastle University’s Professor Roy Taylor said in a statement.
 
‘My patients, like so many, do not like swallowing multiple tablets, and this study is important as we can now reassure them that stopping blood pressure tablets is not only safe but also good for their health.
 
‘We’ve shown that when substantial weight loss is achieved and maintained, patients can effectively manage both their blood pressure and type 2 diabetes without drugs.’
 
One of the study’s authors, the University of Gladgow’s Professor Mike Lean, said researchers are pleased with the results of the study, which aimed to evaluate the safety and efficacy of removing blood pressure medication at the start of the weight-loss program.
 
‘The DiRECT trial was done entirely in primary care,’ he said.
 
‘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 weight loss is vital.’
 
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diabetes hypertension overweight and obesity