Sara Garretson RD, LD, CDCES
‘‘Is Type 2 diabetes reversible?” As a Dietitian who specializes in diabetes care and education, this is one of the most frequently asked questions I get from clients. The good news is emerging forms of therapy are making type 2 diabetes (T2DM) easier to manage, and remission is possible for some. Let’s delve into the details and discuss what diabetes remission entails.
Defining Diabetes Remission
- In 2021 an international group of experts in diabetes was put together and published a Consensus Report defining the diagnostic criteria for remission of type 2 diabetes. Remission is currently defined by:
- A1c <6.5% measured at least 3 months after ceasing glucose-lowering medications.
Remission vs Cure, Resolution or Reversal
- In the Consensus Report, it was determined that remission is the most appropriate term, ‘It strikes an appropriate balance, noting that diabetes may not always be active and progressive yet implying that a notable improvement may not be permanent.’
Is Remission Possible for everyone? What the Current Research Says:
- T2DM is often considered a progressive disease, characterized by insulin resistance. However, recent studies indicate that remission is attainable, especially for those diagnosed more recently. Individuals with shorter diabetes duration and significant weight loss are more likely to achieve remission.
Weight Loss and Remission: The Link
- Weight loss plays a crucial role in T2DM remission. Excess weight, particularly fat accumulation in the liver and pancreas, is closely associated with the development of T2DM. Studies such as the U.K. Diabetes Remission Clinical Trial (DiRECT) have shown that greater weight loss leads to higher rates of remission.
The Impact of Weight Loss on Remission
Recent studies have emphasized intensive lifestyle interventions (ILI) for achieving weight loss and Type 2 diabetes remission. Here’s a summary of key findings:
- Look AHEAD Study:
- Intervention resulted in 7.9% weight loss at 1 year and −3.9% weight loss at 4 years
- Remission rates: 2% in the control group, 11.5% at 1 year, and 7.3% at 4 years in ILI group.
- Mean diabetes duration of 5 years.
- U.K. Diabetes Remission Clinical Trial (DiRECT):
- Intervention led to approximately 10% weight loss.
- Remission rate: 46% at 1 year, compared to 4% in the control group.
- Diabetes duration of around 3 years.
- Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I):
- Intervention resulted in approximately 12% weight loss.
- Remission rate: 61% at 1 year, compared to 12% in the control group.
- Diabetes duration of ≤3 years.
- DiRECT-Aus Study:
- Participants achieved an average weight loss of 11.2%.
- Remission rate: 55% at 1 year.
- Mean diabetes duration of 2.8 years
Promising New Medications for Diabetes/Weight Loss (Ozempic, Mounjaro, Victoza)
Weight loss, particularly long-term weight loss can be challenging. In recent years, there’s been exciting progress in the development of glucagon-like peptide-1 (GLP-1) medications for T2DM and weight loss. These medications not only lower blood sugar, but help people to lose weight through several mechanisms:
- Appetite Control: GLP-1 medications help regulate appetite by increasing feelings of fullness (satiety) and reducing cravings for food, leading to decreased calorie intake.
- Slowing Gastric Emptying: These medications slow down the emptying of food from the stomach into the small intestine, which prolongs the feeling of fullness and reduces the urge to eat.
When used in conjunction with a healthy lifestyle (healthy eating, exercise, stress management, getting adequate sleep) these medications show promise in not only helping individuals achieve significant weight loss but also in lowering HbA1c levels within the range associated with T2DM remission.
Is Remission Permanent?
Maintaining remission (and weight loss) can pose challenges. While some individuals sustain remission for extended periods, others may experience a resurgence of elevated blood sugar levels, leading them out of remission. Your healthcare provider will closely monitor your blood sugar levels to promptly address any rise, guiding you through necessary actions to maintain your health and manage diabetes effectively.
Conclusion: Embracing Hope
T2DM remission is a realistic goal, particularly with lifestyle changes focused on weight loss. While it’s not a cure, achieving remission offers significant improvements in managing the condition and reducing its impact on health and quality of life.
Final Thoughts
It’s essential to remember that the use of medication to control glucose levels does not indicate inferior health. In fact, such medications can reduce the risk of diabetes-related complications. Building a supportive healthcare team that listens to your goals and explains all available options is crucial for successful diabetes management.
To learn more about how I may be able to help you achieve your health goals, visit https://positiveshiftnutrition.com/
Wishing you health and happiness,
~Sara