SINGAPORE - Diabetes can be reversed, even in people who have had it for several years.

A study in Britain has proven that, and now, Singapore's National Healthcare Group (NHG) hopes to show that it can also work for Asians.

It is doing so through the Diabetes Reversal Programme, which is aimed at enabling at least some diabetics here to become free of a disease that can lead to severe consequences such as blindness, kidney failure and even death.

The trigger to reversing diabetes is to significantly reduce the weight of people who are overweight or obese, the target being a 10 per cent cut or a 15kg reduction over a period of six months.

Associate Professor Lim Su Chi, a senior consultant at Khoo Teck Puat Hospital (KTPH) and a principal investigator of the NHG programme, said: "Weight loss is the strongest link to remission. More than half of diabetics here are overweight or obese."

The British study, called Direct, or Diabetes Remission Clinical Trial, had found that the majority who were able to achieve the target weight loss were no longer diabetic.

Those who remained diabetic after losing more than 15kg had achieved better control of their sugar levels.

The study, conducted between 2017 and 2018, involved putting 149 participants on a low-calorie diet. Its findings were published in The Lancet in 2018 and 2019.

At the end of the first year of the study, 46 per cent were no longer diabetic. However, not all were able to maintain this, with only 36 per cent staying free of diabetes at the end of the second year.

Associate Professor Tang Wern Ee, senior consultant at NHG Polyclinics (NHGP) and the programme's lead investigator, said that is still a very good outcome, as it means that more than one in three were free of the disease.

Diabetes is a major problem in Singapore, with more than 400,000 people living with the disease. If nothing is done, the number of diabetics here is projected to surpass one million by 2050 and cost the country US$1.8 billion (S$2.5 billion).

In 2016, the Ministry of Health (MOH) declared a war on diabetes to try to slow the increase in numbers.

People with diabetes are unable to use up the sugar in their blood. This can damage blood vessels as well as reduce oxygen to the heart and brain. Two major contributory factors are obesity and insufficient exercise.

Prof Tang said her team would like to see Singapore moving away from just treating the disease to getting more people reverting to a non-diabetic state.

The programme will recruit 100 participants aged 21 to 60 with a body mass index (BMI) of between 27 and 45 who have had diabetes for less than six years and do not have complications caused by the disease.

A normal BMI for Asians is 18.5 to 22.9.

Half of the participants will be with the control group who will continue to be cared for by their doctor.

The other half will stop their medication and be put on a very low-calorie liquid diet for three months, or less, should they achieve the target weight loss earlier.

"The first five days on the liquid diet can be very difficult. They will feel hungry and very tired," said Ms Pauline Xie, NHGP's principal dietitian who is part of the study team.

By day six though, the body starts to burn the stored fat in the body, which will energise them, she added.

After three months, even if they have yet to meet the weight loss target, they would move to phase two, where they will be reintroduced to food, starting with just one meal a day, while still maintaining a low-calorie intake.

The study is funded by a $2.6 million grant from the Tanoto Foundation and $1 million from the NHG Fund.

The money will be used to pay for the Optifast liquid diet, which retails at $5 per portion, wearables that will track how participants are doing, as well as manpower for the trial.

Prof Tang said the study also aims to discover how to change behaviour so that it becomes something diabetics enjoy doing in the long term.

The team will interact with participants throughout the programme, to find out what works for them, and what does not.

Mr Hafiz Abdul Aziz, 36, is keen to be on the programme. The data engineer, who has a BMI of 32, found out he had diabetes in February this year. 

“It was quite scary,” he said. He is now eating a lot less, having a banana and one slice of bread for breakfast instead of the large plate of nasi rawon - rice with black beef soup - he used to eat.

He is keen to join the programme because he finds it difficult to lose weight on his own. He added: “Thinking long term, I don’t want to have my legs cut off or have my kidneys fail.”

The study will take three years in all, and recruitment is in progress. Diabetics who fit the profile and wish to volunteer can find details at this website.