Is Type 2 diabetes reversible?

Currently almost over 60% -80% of Type 2 diabetes patients are obese or over weight .In these subset of patients Type 2 diabetes can be reversed to a great extent if treated the right way. Through diet changes and weight loss, you may be able to get your blood sugar levels to normal levels without medication. This doesn’t mean you’re completely cured. 

When you’re in remission, which means you aren’t taking medication and your blood sugar levels stay in a healthy range. However, there’s always a chance that symptoms can return if you start increasing your weight.

Before we understand how reversal/remission happens, let’s understand how our body metabolises sugar.

Insulin is secreted from the beta cells of the pancreas. Its main function is to drive glucose in cells besides others.

So you can imagine it to be a key which controls the door to a lock on all the cells.

Remember glucose is the primary fuel of all cells to generate energy.

So insulin (the key) and lock mechanism are extremely important for survival.

The pathology of Type 2 diabetes is 2 fold: one is insulin resistance and second Beta cell failure…

Insulin resistance is basically a problem with the lock of the door and hence your pancreas needs to work extra to open it, i.e. more keys to open the same door. Over a period of time the beta cells can no longer match up to the extra effort required and cannot produce so much insulin leading to beta cell dysfunction and precipitating diabetes.

Insulin resistance is the crux of the problem and healthy lifestyle with targeting the weight and exercises is the key to improve it. Drugs like metformin and SGLT2 inhibitors improve this insulin resistance.

Insulin and insulin secreting drugs are required to get the sugars down faster and increase Beta cell secretion. However it has its limitations i.e. failure over a period of time due to the inherent pathology of the disease. But it is a trade-off, as longer your sugars remains higher more complications will develop. Hence these drugs are useful to get sugars down quickly.

So how do we achieve remission/reversal?

Working on insulin resistance is the key, once that’s achieved these drugs can definitely be stopped .However patients commitment in continuing diet and exercise regimes for long is extremely important.

Is there enough evidence to support this?

Yes, there are multiple research studies, however one of the landmark trials was the DiRECT study (Diabetes Remission Clinical Trial). DiRECT enrolled a sample of 306 relatively healthy participants with T2D (people on insulin or with a diabetes duration longer than six years were excluded).

 They were cluster randomized to either standard diabetes care or an intervention using low-calorie meal replacement diet (825–853 kcal/day) for three to five months, followed by stepwise food re-introduction and a long-term weight maintenance program. 

At one-year follow-up, 46% of patients met the study criteria of diabetes remission (HbA1c <6.5% without antiglycemic medications) and at two years the remission rate was 36%.

Reference: Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019; 7(5):344-355. Doi: 10.1016/S2213-8587(19)30068-3

ROLE OF BARIATRIC SURGERY:

Bariatric surgery has been recognized as a potential evidence based treatment for both morbid obesity and the metabolic processes that accompany it, specifically Type 2 diabetes. 

While the efficacy of diabetes reversal depends on the choice of procedure, there is improvement in glycemia following any form of bariatric procedure. Bariatric surgery has been found to be superior to intensive T2D medical management in a number of trials.

Which form of therapy would be beneficial for you to reverse diabetes depends on your doctor who makes this decision after considering multiple factors. Currently many newer drugs have been evolving for weight loss changing the paradigm of treatment in type 2 diabetes.