If the diagnosis of type 2 diabetes was not too long ago, it is possible to turn back the clock, as was shown in the DiRECT study (Diabetes Remission Clinical Trial). This obviously applies not only to glucose metabolism but also to hypertension, which is often also present.
The study, which was conducted in GP practices, involved 298 obese patients with type 2 diabetes who had been diagnosed on average three years (maximum six years) previously. The intervention group followed "counterweight-plus" weight management, which was guided by trained dietitians or medical assistants and consisted of a 12-week formula diet with a daily intake of 830 kilocalories and exercise. The diet was very successful with an average weight loss of 10 kg and also led to a significant improvement in blood glucose levels. Of the patients who managed to maintain their reduced weight for two years, almost half managed without further antidiabetic medication, so that the diabetes could be considered "cured".
Hypertension is a very common comorbidity in type 2 diabetes. Also in the intervention group, 78 of the 143 participants (55%) were affected and received antihypertensive medication before the start of the study, more than half of them two or more different substances. For fear of orthostatic hypotension under the strict diet, these medications were completely discontinued in most patients at the start of the intervention and were then to be gradually restarted according to predefined rules. Within the first two weeks, this was the case for systolic blood pressure > 165 mmHg, and thereafter for values > 140 mmHg.
In the entire intervention group, there was a relatively rapid reduction in blood pressure below baseline, which was associated with mild dizziness due to orthostatic hypotension in some. Already in the first week of the diet, blood pressure was significantly lower than before the intervention - likewise at the end of the diet and after 12 and 24 months.
In the 69 patients in whom the antihypertensives had been completely discontinued, the blood pressure did not change in the first week, but then also decreased from week 9 onwards. Excessive increases in blood pressure were not observed - but in 19 patients (27.5%) the medication had to be restarted during the diet phase (mostly in the first 3-7 weeks and despite weight loss). This mainly affected patients who had previously taken two or more different antihypertensives. In contrast, as many as 28% of the 69 patients no longer needed antihypertensive medication even after 24 months.
The data show that a strict reduction diet in obese patients with type 2 diabetes leads to a significant reduction in blood pressure. It seems to be safe to discontinue the hypertensive medication first under such a diet. However, regular blood pressure checks must be carried out, as more than two-thirds of patients then need medication to treat hypertension again after some time.
Reference:
Wilma S. Leslie et al; Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT); Diabetologia (2021)