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Newcastle U’s second take on type 2 diabetes research still comes up short

Type 2 diabetes is not for life

Our Review Summary

The news release focuses on a Lancet article describing the first-year results of an ongoing two-year study aimed at determining how effective diet-based weight loss can be at achieving remission of type 2 diabetes in adults. The release notes that 45.6 percent of patients who took part in the weight loss program achieved remission of their type 2 diabetes, and that remission was closely correlated with weight loss; the more weight study participants lost, the more likely they were to achieve remission.

While the release does a good job of describing the study, it does not mention previous studies related to weight loss and type 2 diabetes. That’s a significant oversight that makes it difficult for readers to place the new findings in context. It’s worth noting that HealthNewsReview.org reviewed a previous release from the same university on earlier findings from the same research group. While the more recent release does a better job of addressing benefits and the quality of the evidence, some problems — such as the failure to address novelty and place the work in context — were not addressed.  Further, there is no mention in the release about the conflicts of interest on the part of several authors in their relationships with Counterweight and Cambridge Weight Plans.

And like the TIME story on the Newcastle University research, the release doesn’t inform readers about cost and harms of the diet.

 

Why This Matters

Type 2 diabetes is a common medical problem. According to the CDC, an estimated 30.3 million Americans have diabetes — and approximately 95 percent of them have type 2 diabetes. And the incidence of type 2 diabetes appears to be on the rise. That means research findings about new treatment options for type 2 diabetes have a large audience. It’s important for related news releases to place these new research findings into context. How do they build on or differ from previous studies? What could that mean for treatment options? These are important considerations for those living with type 2 diabetes, and the release falls short on these points.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

This is a tough one. Presumably, any patient with type 2 diabetes could adopt a healthier diet to help themselves lose weight — in which case, costs would not be applicable here. However, this particular study involved a carefully crafted diet that changed over time in order to facilitate early weight loss and then help patients keep that weight off. Did the investigators provide or pay for the food? If so, that would be important to mention.

And, as the release notes: “Importantly, long-term support by routine General Practice staff was given to help the participants maintain their weight loss.” That sort of weight-loss regime and patient support is not without expense. Ergo, some discussion of cost should have been included. While the cost of the weight-loss efforts may be lower than the cost of pharmaceutical treatment for type 2 diabetes, that is also something that could have been discussed (even briefly) in the release.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The release does a good job here, stating that 45.6 percent of those who adopted the low-calorie diet achieved remission from type 2 diabetes. The release also clearly defines what it means by “remission,” including the fact that patients no longer required diabetes medications and had blood glucose levels of less than 6.5 percent. In addition, the release broke the results down according to the amount of weight lost. For example, noting that 86 percent those who lost more than 15 kilograms (kg) achieved remission, as compared to 34 percent of those who lost 5-10 kg. We also think it’s important that the release noted the limitations of the study in regard to assessing benefits. For example, the release states that “Whether putting Type 2 diabetes into remission can protect against diabetes-related complications later in life is not yet known, which is why it is important that those who achieve remission continue to receive health checks.”

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The release doesn’t discuss potential harms. Even if the risk of potential harms is low, it’s important to articulate the risks to readers. And significant weight loss does carry some risks. In this case, the relevant journal article notes that “Nine serious adverse events were reported by seven (4%) of 157 participants in the intervention group ….Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention.”

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The release does a good job of describing the study. However, since the release notes that different levels of weight loss corresponded to a higher likelihood of remission, it would have been good to tell readers how many study participants achieved those levels of weight loss. For example, while the release tells readers that 86 percent of patients who lost at least 15 kg achieved remission, it doesn’t mention that only 36 people achieved that level of weight loss.

It would have been useful to note whether the investigators provided or paid for the food. It’s well known that people do well on packaged meal plans when someone provides the food. When people have to pay themselves, the results aren’t as great.

One other omission that we’d have liked to have seen is a mention that some study participants took part in an exercise program and were given step counters. This was mentioned in the published report but not the release. It would be important to include since it’s a potential source of bias in the results.

Does the news release commit disease-mongering?

Satisfactory

There’s no disease mongering here, but there is a point to be made. The release refers (repeatedly) to the “millions of people” affected by type 2 diabetes. If a release is going to use that kind of language (which is accurate), why not simply include information about the incidence of type 2 diabetes? That would be just as simple, and significantly more useful for readers.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release clearly notes that funding came from Diabetes UK, as well as the amounts of funding. However, it doesn’t mention that four of the researchers are paid by or otherwise associated with Counterweight and another four with Cambridge Weight Plan, according to the study. Those are conflicts of interest that needed to be made transparent in the release.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The release doesn’t address other approaches that could be used to address type 2 diabetes through weight loss — such as bariatric surgery. This will come up again under the “Establish Novelty” criterion.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Applicable

Lifestyle-based weight loss programs are well known and widespread. It can be assumed that readers are familiar with the concept.

Does the news release establish the true novelty of the approach?

Not Satisfactory

The idea of using weight loss to treat type 2 diabetes is not new. Much of the previous work has focused on the use of bariatric surgeries to treat the condition — such as this 2008 JAMA paper that compared outcomes between type 2 diabetes patients who received gastric bands versus those who attempted weight loss through lifestyle change. But there has been previous work focused solely on how effective lifestyle change can be at treating type 2 diabetes, such as this 2012 JAMA paper. In order to place the new study’s findings in context, it’s important to understand how those findings support (or differ from) previous studies. The release fails to do this.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Not Satisfactory

As is often the case, the culprit here is the headline. The headline states that “Type 2 diabetes is not for life.” That’s not quite right. At best, study participants have put their type 2 diabetes into remission — in the first year of a study. How long will the remission last? We don’t know. And some patients — even patients who lost more than 15 kg of weight — were not able to put their type 2 diabetes into remission. For those patients, barring a change in their status, type 2 diabetes does appear to be for life. At its most optimistic, the headline should read: “Type 2 diabetes is not necessarily for life.” The maintenance of weight loss requires continued attention to the patient’s diet and presumably the ongoing use of an additional exercise regimen.

Total Score: 3 of 9 Satisfactory

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