Is it possible to reverse type 2 diabetes?

Type 2 diabetes nearly killed Anthony Wilson before he was diagnosed.

One morning in 2012, his wife, Sheila, woke up to work to find that her husband had dark circles under his eyes and his skin looked gray. She knew something was seriously wrong and she had to take him to the hospital immediately. He resisted, but she persisted and prevailed, he recalls.

Wilson, now 54, who lives in Virginia Beach, said: “She led me downstairs at home, and the next thing I remember is when I wake up in the ICU. Tests showed Wilson’s blood sugar was many times the threshold needed for diagnosis Type 2 diabetesa chronic condition in which the body does not use insulin properly, causing blood sugar to rise unchecked.

Wilson’s body was so tense that his organs collapsed. Wilson said that doctors talked about putting him on dialysis for kidney failure, and that they had to go into cardiogenic shock twice to get his heart working again because his diabetes had exacerbated his condition. the heart lies still.

Once he was stable, a doctor told Wilson he had type 2 diabetes and would need to take insulin for the rest of his life. But not only was he able to stop taking insulin within months of being diagnosed, he was also able to keep his blood sugar at a healthy, normal range without needing diabetes medication.

After losing 60 lb. in 2020 — thanks to dietary changes and exercise regularly—Wilson, EMS operations manager and American Diabetes Association (ADA) volunteer, achieved what is considered the holy grail in Managing type 2 diabetes by putting it in “remission”.

“I’m the type of person who wants to be in control of my health,” says Wilson. “I share my story with anyone who will listen, in the hope that it can make a difference.”

Diabetes ‘reversed’ by a different name

The concept of type 2 diabetes remission, which is increasingly being noticed by researchers and doctors, goes by other names, including “reversal,” “resolved,” and even “cured” diabetes. from”. But a consensus of experts led by the ADA last year agreed on the term remission is the most accurate.

“The reason we use the word remission is because if someone thinks they’ve been cured or cured, the challenge is they may not feel like they need to get anything checked out,” said Dr. Robert Gabbay, chief scientific and medical officer of the ADA said.

In the simplest terms, the panel of experts has defined type 2 diabetes in remission as having blood glucose levels below the established threshold for a diagnosis of diabetes for at least three months without medication. diabetes. That would be below, say, 6.5% A1c, for a blood test used to take three-month average blood sugar levels.

But there’s still a lot that’s still unclear – how long remission usually lasts, for example, because it varies. And experts stress that continuing to monitor health care providers – not only to monitor blood sugar levels but also to check for complications of diabetes – is important because The impact of diabetes remission (transient or long-term) on things like heart health and mortality is still poorly understood.

Something to strive for, or a rare phenomenon?

Advances in the treatment of Type 2 diabetes could put more people in remission, especially those newly diagnosed. “The most popular place we saw [diabetes remission] Gabbay said.

In addition to the weight loss, he added that there may be hormone secretions due to surgical reconfiguration of the gastrointestinal tract that results in more remission. Some studies suggest that after stomach surgery When taken, several intestinal hormones stimulate insulin production in the body, including glucagon-like peptide-1 (GLP-1) and peptide tyrosine-tyrosine (PYY), which lowers blood sugar.

But although remission is strongly associated with curative surgery, striking research suggests that only significant weight loss – without surgery – may be enough to put Type 2 diabetes into remission. A closer look will find that losing weight can cut the amount of fat inside the liver and pancreas, keeping those organs functioning properly and allowing them to better regulate blood sugar levels.

And remission is not accessible only to a select few.

DiRECT test published in Lancet in 2018 found that almost half (46%) of the 149 participants studied – those who had been diagnosed with Type 2 diabetes within six years and who did not use insulin – were able to go into remission. through an evidence-based weight loss program. The study was done in primary care settings — not specialized weight loss centers — over a one-year period. People who lost 33 lb or more were most likely to achieve remission.

Follow-up study, published in Diabetes & Endocrinology Lancet in 2019, found that one-third of the participants remained in remission at the two-year mark. Consistent remission has been linked to weight loss.

According to Dr. Roy Taylor, professor of medicine and metabolism at the Institute of Clinical and Translational Research, the biggest factor in a person’s ability to drop blood sugar below diabetic levels and stay there without no need for medication. The University of Newcastle at Tyne in the United Kingdom Taylor is the principal investigator and senior co-author of the DiRECT trial.

Taylor says there is growing acceptance that remission is possible for a broader group of patients than previously thought, and that is supported by research. But he expressed disappointment that many doctors still don’t approach patients this way – at least give them the option to pursue this goal, if they choose to do so.

Despite the same study results as those from the DiRECT trial, many physicians consider such weight loss difficult for patients to achieve and then maintain. They emphasize that diabetes control – not in remission – remains the primary goal.

Jill Crandall, professor of medicine and chief of endocrinology at the Albert Einstein College of Medicine and the Montefiore Health System in the Bronx, says it’s very difficult for people to lose the weight they need. “It is possible that we are passing up an opportunity to really motivate patients to lose weight by introducing the concept of remission. But I think it’s not first in the minds of most diabetes doctors. ”

Others say it should be.

“I used to feel like I was serving a life sentence when I diagnosed a patient with diabetes. I now work with my patients to reverse their disease,” said Dr. Stephenie Lucas, an endocrinologist at Beaumont Health, based in the Detroit area. “Many patients with Type 2 diabetes are in remission and do not need medication to maintain normal blood glucose levels.”

It is more widely accepted: regardless of whether the patient is in remission or not, continued vigilance is key.

“There is no permanent cure for diabetes, because the insulin-producing cells have been damaged and the underlying genetic factors remain,” says Lucas. “Patients maintain an increased likelihood of diabetes recurrence, so lifestyle interventions must be continued.”

Give the patient a choice

Doctors stress that patients should be supported in prioritizing diabetes management — however they choose to do so — regardless of whether the goal is remission.

Gwendolyne Jack, endocrinologist and clinical educator at Weill Cornell Medicine in New York City, says the majority of patients don’t go into remission, but the goal is to keep their blood sugar under control. good. To achieve this, she says, some patients will continue to need lifelong medication, including insulin. “That’s okay. It’s not a failure on their part,” said Jack.

But the impact of the diagnosis on the patient — and the desire of many patients to control blood sugar without medication or insulin — should not be overlooked, Taylor and others emphasize. The survey results are published in Medicines for diabetes in February 2018 found this to be the #1 question patients want researchers to answer about the disease: “Is type 2 diabetes curable or reversible, what is the best way to achieve it? What is this, and is there a point beyond which the condition can” not be reversed? “

Taylor admits that many people with a chronic illness see it as something a doctor would deal with; Patients often get help with blood sugar control, but their goals are not in remission. “However, at least 40% of people with type 2 diabetes hate their condition and will do their best to get rid of it,” he says. “They describe the moment of diagnosis as a hammer blow. Many doctors don’t understand that.”

For those who want to work towards remission, Taylor recommends building on that motivation:

  • Write down your reasons so you can come back to them later.
  • Discuss your plans with the people you live, work and communicate with for support and understanding.
  • When you’re ready, decide when to start — and prepare meticulously. “This is not a weight loss diet,” says Taylor.
  • Understand that your chances of remission are best as you get closer to your diagnosis, but it can still happen up to 10 years after diagnosis. It’s less common than that; Waiting makes the goal harder to achieve.
  • Losing and maintaining weight, sticking to a diet and being active are key to improving your chances of remission.

Whether your goal is to go into remission or to improve blood sugar control through lifestyle changes beyond taking diabetes medication or using insulin, you’ll want to be clear with your endocrinologist. And together, carefully analyze your dietary approach before making changes to what you eat to make sure it’s safe and you’re getting all the nutrients you need.

Wilson said it’s important for him to see a doctor as dedicated to his diabetes goals as he is.

He has other conditions that his Type 2 diabetes could make worse, including high blood pressure and supraventricular tachycardia, for which he needs a pacemaker. He also has risk factors – like a family history of kidney disease – that make his diabetes possibly worse. So Wilson wants to make sure his A1c stays below 6.5% and has worked hard to make sure the A1c is easily within the healthy, normal range.

The longtime doctor was undeterred when he decided to try to reverse his type 2 diabetes in 2020. So he went to see an endocrinologist, who put him on a strict diet. Strictly 1,200 calories per day, Wilson adhered to. He eats lean protein, drinks plenty of water, limits carbs, cuts sugar, reduces portion sizes, and stays active. These steps helped him lose 60 lb. While no single diet is recommended to reduce the disease, a low-calorie and low-carb plan has been found to help with weight loss and significant weight loss can increase a person’s chances of remission.

Wilson credits his wife Sheila for supporting him throughout his journey with type 2 diabetes. She exercises with him and helps him maintain a healthy weight. healthy diet. “We still have to be accountable to each other,” Wilson said, adding that he uses ADA as a resource and volunteers with the organization to support others. “I feel pretty good knowing that with just hard work you can accomplish your goals and I did it with the help of my family.”

He’s also careful not to become complacent. It’s something experts say is crucial to not only achieving but — more importantly — maintaining remission of Type 2 diabetes.

Wilson was prepared to continue his hard work. “I didn’t work hard to lose the weight back to the way it was,” he said.

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