November 14 marks World Diabetes Day, a day dedicated to raising awareness about the major impact of diabetes mellitus (particularly type 2 diabetes) on individual health, healthcare systems, and society as a whole. It reminds us that this chronic disease is no longer just a “metabolic disorder,” but a social and economic phenomenon with profound consequences.
Both nutritional intervention and prevention or remission are extremely important in managing these diseases and are based on scientific data meant to inform, support, and motivate both patients and healthcare professionals. Along with the other benefits nutritional intervention offers in type 2 diabetes management, improved glycemic control, reduced risk of complications, and overall better health are among the most significant outcomes.
According to the most recent data (2024–2025), around 552m adults (ages 20–79) worldwide live with diabetes; 1 in 2 adults with diabetes are undiagnosed (257m people); 1 in 8 adults have impaired glucose tolerance (567m people); 1 in 17 adults have pre-diabetes (328 million people); 1 in 6 live births (22 million) are affected by hyperglycemia in pregnancy (approximately 80% due to gestational diabetes mellitus – GDM); 1.3m children and adolescents under 20 have type 1 diabetes; 3 out of 4 people with diabetes live in low- or middle-income countries; 11.8% of global health expenditures go toward diabetes (USD 1.03 trillion); and 6.9m deaths are caused annually by diabetes.
Globally, it is estimated that by 2050 the number of people with diabetes will exceed 850 million. Thus, diabetes represents a major public health challenge requiring preventive, early diagnostic, and effective management interventions.
The major impact of diabetes
Diabetes is a condition in which the body does not produce enough insulin or uses it inefficiently, leading to elevated blood glucose levels. Over time, persistent hyperglycemia can damage blood vessels, nerves, kidneys, eyes, and the cardiovascular system.
Major implications include: Increased risk of heart attack, stroke, kidney failure, amputations, and vision loss; Reduced quality of life (patients must be constantly monitored); Long-term treatment and high risk of complications; Substantial healthcare costs (diagnosis, treatment, chronic complications).
Risk factors
Several factors increase the likelihood of developing type 2 diabetes, including: Overweight/obesity: Excess fat, especially visceral fat, promotes insulin resistance; Sedentary lifestyle: Physical inactivity contributes to weight gain and reduced insulin sensitivity; Smoking: Linked to a higher risk of diabetes and more severe complications; Hypertension: Often associated with obesity, dyslipidemia, and insulin resistance; Age: As we age, metabolism slows, and insulin sensitivity typically decreases; Depression/chronic stress: Mental health and psychological stress affect lifestyle (diet, activity) and hormonal balance (e.g., cortisol); Other factors: Genetic predisposition, family history, prior gestational diabetes, dyslipidemia, metabolic syndrome.
Overweight and obesity are among the most visible and modifiable risk factors, highlighting the importance of lifestyle changes. Excess weight, sedentary habits, smoking, and high blood pressure increase vulnerability. Diabetes can develop “silently” for years without major symptoms but with progressive internal damage. Early intervention through lifestyle changes—healthy eating, regular physical activity, quitting smoking, controlling blood pressure and cholesterol—can prevent or delay diabetes progression.
Data show that diabetes prevalence is rising, meaning individual risk grows if no action is taken. Prevention, health education, and regular screening (glucose, HbA1c, blood pressure, cholesterol) can make a crucial difference.
The situation in Romania
According to the latest data, approximately 1.32 million adults (ages 20–79) in Romania live with diabetes—about 1 in 11 adults. Over 10,000 deaths annually are attributed to diabetes. Another report shows that 11.6% of the adult population suffers from diabetes mellitus. The number of diagnosed diabetes cases in Romania has increased by around 30% in the last five years, while direct healthcare expenditures for diabetic patients have reached 2.6 billion RON.
These figures highlight a concerning trend: rising prevalence, mortality, and costs all emphasize the urgent need for prevention, health education, and support for at-risk individuals.
Benefits of VLCD/TDR diet interventions and relevant studies
Type 2 diabetes is no longer seen as “irreversible.” Increasing evidence shows that remission (normal blood glucose levels without antidiabetic medication) can be achieved through intensive weight loss and lifestyle interventions.
The DiRECT study was the first randomized trial to demonstrate that type 2 diabetes can enter remission through specific dietary and lifestyle changes. Initially launched in 2020, this groundbreaking NHS (UK National Health Service) program was inspired by findings from two major studies—DiRECT and DROPLET. These studies conclusively showed that significant weight loss is crucial not only for managing type 2 diabetes but also for its potential complete remission.
Every year, the NHS spends over £10 billion treating type 2 diabetes and related complications, underscoring the critical need for effective therapeutic options. The diabetes remission program is now implemented in countries such as the United Kingdom and Northern Ireland.
The NHS Type 2 Diabetes Path to Remission Program was designed to address this public health challenge, providing clinically supported weight-loss solutions proven to lead to diabetes remission. Participants underwent a 12-month treatment beginning with 12 weeks of total diet replacement (about 850 kcal/day), followed by gradual food reintroduction and weight maintenance support.
Results showed that significant weight loss in primary care settings can normalize blood sugar levels—without medication.
The effect of Total Diet Replacement (TDR) on Diabetes Remission
In the landmark DiRECT study, researchers analyzed the effects of a total diet replacement (TDR) regimen—around 800 kcal/day—on type 2 diabetes remission. Participants followed this plan for 12 weeks, replacing regular meals with low-calorie shakes and soups. The results were remarkable.
The NHS Type 2 Diabetes Path to Remission program, developed in collaboration with NHS England and Diabetes UK, is based on this research. It provides a similar approach to individuals with type 2 diabetes and excess weight.
After one year, nearly half of the participants achieved diabetes remission. A quarter lost 15 kg or more, and 86% of those reached full remission.
