Is type 2 diabetes reversible?

We traditionally think of type 2 diabetes as a lifelong, progressive condition which is incurable. In other words, once you have diabetes, you have to live with it for the rest of your life. But is this true?

In most cases, type 2 diabetes is closely linked to obesity. If I was to oversimplify explaining the condition, I would describe it as the reduction in the body’s ability to process sugar and transfer it from the blood to the liver and muscle cells for storage. Insulin can be thought of as ‘the key that opens the door’ to our cells’ storage spaces. Being very overweight or obese leads to excess fat that ‘clogs the keyholes’, making our insulin inefficient and leading to a rise of sugar levels in our blood.

Type 2 diabetes can have serious health implications if not treated and managed well. And this can affect both lifespan and healthspan – or the period when you’re generally healthy. What researchers have uncovered in the last few years is mind blowing! It completely overhauls our thinking about the condition and could be life changing. 

Before I go any further, I’d like to clarify that I’m talking about type 2 diabetes and not type 1 diabetes and this is throughout the whole of this article.

Evidence suggests that losing around 15 kg (2.4 stones) within three to five months significantly increases the chances of successfully achieving remission

Could type 2 diabetes be beaten into remission?

There’s still a lot to learn about type 2 diabetes -and other health conditions for that matter – but the short answer is yes, in a large number of cases, it’s possible to reverse the condition and go into remission. This is when your blood sugar levels go back to normal and you no longer need to take diabetes medication. This is what a relatively recent study has uncovered and is so exciting to share, as this has the potential to transform the lives of people with a diagnosis of type 2 diabetes.

How do you reverse diabetes?

Losing weight -if overweight or obese- has a major role in reversing diabetes or more accurately going into remission (more on this later). And so is keeping that weight off! Although a number of factors -like epigenetics and aging- are involved in the development of type 2 diabetes, being overweight or obese are usually key determining factors. 

Evidence suggests that losing around 15 kg (2.4 stones) within three to five months significantly increases the chances of successfully achieving remission. If you’re overweight and you’re thinking of losing weight, it’s really important to speak to your healthcare professional before you start. They’ll make sure this is safe for you, especially if you have other medical conditions. They’ll also check if any medication you’re taking needs adjusting.

What does the science say?

Researchers at the university of Glasgow and Newcastle were the first to show that following a low-calorie diet can put diabetes into remission. Their initial two studies were small involving 11 and 30 people with type 2 diabetes. After eight weeks on a very low-calorie diet, people in the study had lower amounts of fat in their liver and pancreas. This is believed to have played a major role in putting their diabetes into remission. 

These results are promising but it’s probably worth noting that besides being small, the study followed people for a short period of time and only involved participants who had type 2 diabetes for a few years (less than four years).

To test the effectiveness of a weight management treatment involving a very low-calorie diet (around 850 calories a day) on a wider scale, the same group of researchers are currently doing a larger study called DiRECT. This stands for diabetes remission clinical trial. The trial involves 298 participants aged between 20 and 65, who have been diagnosed with type 2 diabetes within the last six years, who had a BMI (body mass index) of 27 to 45, and who weren’t on insulin. Although the study is still ongoing the initial results are very promising. After 12 months, around half of the people in the program lost an average of 10 kg and managed to put their diabetes into remission. And a staggering nine in 10 of those who lost 15 kg or more managed to revert to a non-diabetic state.

This approach will not work for everyone but it’s worth noting that even if you don’t manage to reverse your diabetes, losing excess weight (in a safe way and under medical supervision) has lots of benefits. You may see your blood sugar levels improve and may need fewer medicines to manage your diabetes. You’ll also lower your risk of complications. In all cases, always seek advice from your treating doctor. 

What’s a very low-calorie diet?

A very low-calorie diet involves having around 800 calories per day. This could be in the form of meal replacements, like shakes and soups, or small portions of normal food. The low-calorie meal replacements used in the DiRECT study were around 850 calories. If you have type 2 diabetes and you’re thinking of going on a very low-calorie diet, it’s really important to speak to your doctor first to make sure this is safe for you. 

Photo by Ella Olsson from Pexels

Why remission and not a cure?

This is often referred to as diabetes remission rather than a cure, because type 2 diabetes might come back, especially if the weight is put back on. So, if you’ve achieved remission, it’s so important to maintain a healthy lifestyle to make sure the pounds don’t creep back on.

Current limitations 

Current research on diabetes remission is only relevant to a large group of people with type 2 diabetes but not those with type 1 diabetes whose condition involves auto-immune elements. The remission is more likely to work nearer to your diagnosis (the earlier excess weight is lost the higher the chance of success), and this strategy doesn’t work (and isn’t recommended) if you’re already a healthy weight. Another point to consider is that a very low-calorie diet could be challenging to implement in real life.

While the results are very exciting, there are currently no guidelines for clinicians to implement this in practice, whilst awaiting the final results of the DiRECT study.

We know that remission is more likely the closer it is to your diagnosis, so don’t delay! Speak to your doctor to see if they can help you lose weight safely, whilst overseeing your progress and adjusting any medical treatment you’re on, along the way.

Sources

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext?elsca1=tlpr

https://link.springer.com/article/10.1007%2Fs00125-017-4503-0

https://link.springer.com/article/10.1007%2Fs00125-011-2204-7

https://care.diabetesjournals.org/content/39/5/808

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