In short – yes, Type 2 diabetes can be reversed. However, it is neither easy nor possible for all patients. It is possible to have remission of diabetes if certain criteria are met.
Dr Angela Murphy continues.
According to the American Diabetes Association these criteria are:
Full diabetes remission – fasting blood glucose (FBG) < 5.56mmol/l and HbA1c < 6.0% on no diabetes treatment.
Partial diabetes remission – FBG is 5.56-6.9mmol/L and HbA1c 6.0-6.5% on no diabetes treatment.
There are two ways diabetes remission can be achieved:
- Weight loss – extreme calorie restriction has been shown to normalize blood sugars in patients with Type 2 diabetes. Studies were done giving subjects 600kCal daily which produced this result. The challenge is being able to live on such a low energy diet. The DiRECT Trial, conducted in a general practice setting in the United Kingdom, showed diabetes remission in 46% of patients after a year and 36% of patients were still in remission after 2 years. This showed that a calorie-controlled diet could induce diabetes remission. The use of weight loss medications may make this approach more sustainable, but cost and tolerance must be considered. The average weight lost to achieve remission in studies has been 15kg.
- Bariatric surgery – We now talk about Metabolic Surgery which is defined as gastrointestinal surgery with the intent of treating diabetes and obesity. The improvement in glucose control post bariatric surgery occurs within days so it is not entirely dependent on actual weight loss. Procedures which cause more malabsorption, such as the SADI, have shown higher rates of remission. However, even with the more traditional gastric bypass remission rates were over 70% two years post-surgery. Many medical and scientific societies now endorse bariatric surgery as an effective treatment for Type 2 diabetes and a means to achieve diabetes remission.
Factors such as longer diabetes duration, poor glucose control and low endogenous insulin production are less likely to allow diabetes remission despite the above suggested interventions. It is important that people with Type 2 diabetes are aware of these interventions but for many they might not be appropriate. Surgery is expensive, the calorie restriction can be punitive and genetic factors may make remission difficult. It is vital to remember that good diabetes control decreases the risk of diabetes complications. It is much more beneficial to have good control with diabetic medications than fail at attempts to reverse diabetes and end up with poor control. To achieve diabetes remission is possible but not easy. To achieve diabetes control is possible and usually easier.