Patients and doctors may not realise a condition which costs the NHS £22m a day can be reversed, a new report says.

Diabetes UK said type 2 diabetes is generally considered incurable, but evidence was growing to refute that.

The Glasgow University study called for greater awareness that the condition is not incurable.

Type 2 diabetes could be beaten into remission if patients shed around 15kg, the report published in the British Medical Journal (BMJ) said.

The report suggested there is poor awareness of the benefits of weight loss leading to remission from the condition, with the authors arguing that is because it is rarely recorded officially.

"Not only is type 2 diabetes preventable by not getting fat in the first place, but as long as you get in early after the disease is established - in the first five years or so - you have a better than even chance of becoming non-diabetic."

"They are not treating the disease process, and are missing the point," he said.

Professor Mike Lean, from Glasgow University's Human Nutrition Section, said 488 different drugs are currently licensed worldwide to treat type 2 diabetes by lowering blood glucose levels.

About 10% of total UK NHS expenditure goes on treating the condition, with international figures suggesting medical costs for people with diabetes are two or three times greater than the average for non-sufferers of similar age and sex.

Type 2 diabetes now affects 5-10% of the UK population - with 254,000 people living with the illness in Scotland.

The Glasgow University research argued that achieving remission not only has health benefits, it produces a strong sense of personal achievement and empowerment, removes stigma, and may even reduce insurance premiums.

"In the meantime, we need to ensure that those who do achieve remission are recognised in the right way and receive the right care."

Emily Burns, head of research communications at Diabetes UK, said: "The ability to put type 2 diabetes into remission could be transformative for millions of people around the world, and evidence is building to suggest that it's possible.

"It is in everybody's interest to reclassify people with type 2 diabetes when they become non-diabetic. Official guidelines and international consensus for recording diabetes in remission are needed."

"Patients and doctors may be unaware that type 2 diabetes can be reversed, despite recent publicity.

The BMJ report said: "Lack of agreed criteria and guidance over recoding may have led to hesitation in coding remission, but the main reason for the low recording is probably that few patients are attempting or achieving remission.

A US study they quoted found remissions in only 0.14% of 120,000 patients followed for seven years, while the Scottish Care Information Diabetes database, which includes every patient in Scotland, shows less than 0.1% of those with type 2 diabetes were coded as being in remission.

A body of research putting people with Type 2 diabetes on a low calorie diet has confirmed the underlying causes of the condition and established that it is reversible.





Professor Roy Taylor at Newcastle University, UK has spent almost four decades studying the condition and will present an overview of his findings at the European Association For The Study Of Diabetes (EASD 2017) in Lisbon.





In the talk he will be highlighting how his research has revealed that for people with Type 2 diabetes:

Excess calories leads to excess fat in the liver

As a result, the liver responds poorly to insulin and produces too much glucose

Excess fat in the liver is passed on to the pancreas, causing the insulin producing cells to fail

Losing less than 1 gram of fat from the pancreas through diet can re-start the normal production of insulin, reversing Type 2 diabetes

This reversal of diabetes remains possible for at least 10 years after the onset of the condition

"I think the real importance of this work is for the patients themselves," Professor Taylor says. "Many have described to me how embarking on the low calorie diet has been the only option to prevent what they thought -- or had been told -- was an inevitable decline into further medication and further ill health because of their diabetes. By studying the underlying mechanisms we have been able to demonstrate the simplicity of type 2 diabetes."





Get rid of the fat and reverse Type 2 diabetes





The body of research by Professor Roy Taylor now confirms his Twin Cycle Hypothesis -- that Type 2 diabetes is caused by excess fat actually within both liver and pancreas.





This causes the liver to respond poorly to insulin. As insulin controls the normal process of making glucose, the liver then produces too much glucose. Simultaneously, excess fat in the liver increases the normal process of export of fat to all tissues. In the pancreas, this excess fat causes the insulin producing cells to fail.





The Counterpoint study which was published in 2011, confirmed that if excess food intake was sharply decreased through a very low calorie diet, all these abnormal factors would be reversed.





The study showed a profound fall in liver fat content resulting in normalisation of hepatic insulin sensitivity within 7 days of starting a very low calorie diet in people with type 2 diabetes. Fasting plasma glucose became normal in 7 days. Over 8 weeks, the raised pancreas fat content fell and normal first phase insulin secretion became re-established, with normal plasma glucose control.





Keep the weight off and keep the diabetes at bay





"The good news for people with Type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you are likely to be able to reverse it by moving that all important tiny amount of fat out of the pancreas. At present, this can only be done through substantial weight loss," Professor Taylor adds.





The Counterbalance study published in 2016, demonstrated that Type 2 diabetes remains reversible for up to 10 years in most people, and also that the normal metabolism persists long term, as long as the person doesn't regain the weight.





Professor Taylor explained the science behind the mechanisms: "Work in the lab has shown that the excess fat in the insulin producing cell causes loss of specialised function. The cells go into a survival mode, merely existing and not contributing to whole body wellbeing. Removal of the excess fat allows resumption of the specialised function of producing insulin. The observations of the clinical studies can now be fully explained."





He added: "Surprisingly, it was observed that the diet devised as an experimental tool was actually liked by research participants. It was associated with no hunger and no tiredness in most people, but with rapidly increased wellbeing. The 'One, Two' approach used in the Counterbalance study was a defined two phase programme. The Phase 1 is the period of weight loss -- calorie restriction without additional exercise. A carefully planned transition period leads to Phase 2 -- long term supported weight maintenance by modest calorie restriction with increased daily physical activity."





This approach consistently brings about 15kg of weight loss on average.





After the details were posted on the Newcastle University, UK website, this has been applied clinically and people who were highly motivated have reported that they have reversed their type 2 diabetes and continued to have normal glucose levels (normoglycaemic) over years.





A further study in general practice, the Diabetes Remission Clinical Trial (DiRECT) funded by Diabetes UK is now underway to determine the applicability of this general approach to routine Primary Care practice with findings due before the end of the year.





Patients or GPs who would like more information about the diet that reverses Type 2 diabetes see the Magnetic Resonance Centre website.