New Study Shows Weight Loss Can Reduce The Need For Blood Pressure Medications

Weight Loss Can Reduce The Need For Blood Pressure Medications

Type 2 diabetes is a chronic disease that has become more prevalent, with the number of people suffering from the condition estimated to be 422 million as of 2014 (1).

Diabetes is significantly linked to obesity and high blood pressure. This relationship is of great interest to researchers, and a recent study was carried out to see the effect of weight loss on blood sugar and blood pressure levels (2).

The study, dubbed the DiRECT trial, was funded by Diabetes UK, whom the researchers claimed had no role in the study’s design.

Overview of the DiRECT Trial

The DiRECT trial investigates the potential benefits of intensive weight loss and weight loss maintenance programs for people with Type 2 diabetes. This involves understanding the relationship between diabetes and weight loss and how weight loss can lead to diabetes remission.

A total of 298 people were recruited for the trial. Participants were required to be aged 20 – 65 years, diagnosed with type 2 diabetes within the last six years, and had a body mass index of 27 – 45 kg/m2 which is within the overweight and obesity range (3).

The participants were divided into two groups, with one group (referred to as the control group) receiving standard diabetes care from their general practitioners (GP).

In contrast, the other group (referred to as the intervention group) received a structured weight management program, the Counterweight Plus Programme, to help them lose weight and maintain the weight loss.

The program included a change in diet as low-calorie and nutrient-complete diets (about 800 calories per day) were introduced for between 12 and 20 weeks. A structured food introduction took place over 2 – 8 weeks with ongoing support for weight loss maintenance with dietitians or nurses.

The intervention group participants were required to stop diabetes, and weight loss medications at the start of the trial, with these medications, introduced only when necessary.

Follow-up then commenced, and the results obtained after two years will be discussed below. It’s worth mentioning that all study appointments took place at the participants’ own GP practices.

Results of the Trial

Results of the Trial

A weight loss of 15 kg (33 lbs) or more was recorded in 36 (24%) participants in the intervention group and 0 participants in the control group.

Also, 68 (46%) participants in the intervention group experienced diabetes remission, while only 6 (4%) participants in the control group entered remission.

68% (101) of the participants in the intervention group stayed off antihypertensive drugs after a year as their blood pressure remained under control since the start of the trial.

Another follow-up was carried out after two years to determine the durability of the positive results recorded after the first year. The second follow-up revealed that 28% of the participants that stopped taking antihypertensive drugs after the first year did not need to retake them.

Furthermore, diabetes remission persisted (53 people after two years compared to 74 after the first year) throughout the second year as most participants maintained the weight loss.

The side effects observed during the trial were generally mild, especially for the intervention group. Mild to moderate dizziness and constipation were the main adverse effects.

Conclusions That Can Be Drawn From The Study

The DiRECT study confirms what other studies have shown – that diabetes isn’t necessarily a permanent condition. Reversal is more likely for type 2 diabetes of up to 6 years.

The trial also shows that diabetes can be reversed through weight loss with the degree of remission corresponding to the amount of weight lost. To see significant results, individuals may lose up to 15 kg bodyweight.

Weight loss can reduce blood pressure as it is estimated that every kilogram of weight loss can lower blood pressure by 1 millimeter of mercury (mmHg) (4). This is reflected in the 68% of the intervention group participants that didn’t have to take antihypertensive medications after a year.

The DiRECT trials show that a structured weight loss program can reduce medical costs by reducing the need for diabetes and blood pressure drugs.

In Scotland, the practical and cost-effective Counter Weight Programme is already a part of the health system. It is available in every NHS Scotland Health Board (5).

The Challenges of Losing Weight

Losing weight is not an easy task (6). Fitness influencers simplify the weight loss process to a matter of calories in and out, an easy equation to quickly shed off unwanted body weight.

But in reality, losing weight is difficult as individuals have to deal with stress, cravings, emotional eating, and their relationships with friends, family, and other loved ones.

The more significant challenge is long-term weight loss, as many will regain most of the weight initially lost (5). However, face-to-face support from medical professionals can help lose weight long-term, as the DiRECT trial demonstrated.

While this is bound to increase demands on healthcare professionals, telemedicine, the method of providing healthcare remotely, can allow a health professional to offer their services to more people conveniently (7).

References

1. World Health Organization. Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes

2. MEJ Lean, W.S Leslie, A.C Barnes, N. Brosnahan, G. Thom, & L. McCombie. (2019). Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. DOI: https://doi.org/10.1016/S2213-8587(19)30068-3. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext

3. NHS UK. What is the body mass index (BMI)? https://www.nhs.uk/common-health-questions/lifestyle/what-is-the-body-mass-index-bmi/

4. Mayo Clinic. 10 ways to control high blood pressure without medication. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974#:~:text=If%20you’re%20overweight%20or,2.2%20pounds)%20of%20weight%20lost.

5. NHS Lanarkshire. Type 2 Diabetes Remission Programme (using Counterweight Plus®). https://www.nhslanarkshire.scot.nhs.uk/services/diabetes/type-2-diabetes-remission-programme-using-counterweight-plus/

6. University of Utah. Why Is It So Hard To Lose Weight? https://healthcare.utah.edu/weight-management/why-hard-to-lose-weight.php

7. John Hopkins Medicine. Benefits of Telemedicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/benefits-of-telemedicine

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