Can I reverse my Type 2 diabetes?

While there is no cure for Type 2 diabetes, through weight loss and a calorie controlled diet, it is possible to put it into remission.

December, 2020

Tags

There is no cure for Type 2 diabetes, which is a life-long condition. People cannot reverse it altogether, but, if they are overweight, there is a chance that they can put it into remission through weight loss.

People who achieve remission have normal blood sugar levels, no longer need their diabetes medication, and are less likely to develop long-term complications. If someone is overweight, achieving remission involves losing a substantial amount of weight, usually over a short period of time. And staying in remission means keeping the weight off.

But while scientists are discovering more all the time, there are still lots of uncertainties. We do not know if remission is possible for everyone, and we do not know how long it lasts. That is why people should always keep up to date with appointments in order to help manage their condition.

What is diabetes remission?

People develop Type 2 diabetes when they stop producing insulin properly. Insulin is a hormone that regulates levels of sugar, or glucose, in the blood. It turns the sugar in the carbohydrates we eat into energy. Without it, blood glucose levels can soar. Over time, this damages the blood vessels and organs.

No one knows exactly why some people develop Type 2 diabetes and others do not, there are several factors that could contribute such as age, ethnicity and being overweight.

Scientists believe that a build-up of fat inside the liver and the pancreas can stop the body making the right amount of insulin at the right time. Doctors call this insulin resistance. As such, losing weight can increase insulin sensitivity, or the body’s ability to use insulin properly.

Referring to Diabetes UK [i], losing around 15kg can significantly increase someone’s chances of achieving remission – which they describe as having a HbA1c of below 48mmol/mol or 6.5% for at least six months.

This only applies to Type 2 diabetes. People with Type 1 diabetes do not produce any of their own insulin and cannot achieve remission through weight loss.

Losing weight

Losing weight usually focuses on diet and exercise. People might choose to up their fruit and vegetable intake, cut out fatty snacks, and swap white pasta and rice for wholemeal versions. They also might take up dancing, swimming, or gardening to get – or stay – active.

Many people with Type 2 diabetes have reversed their condition by using this gradual approach to weight loss.

However, the current evidence shows remission is more likely in people who lose a substantial amount of weight as quickly as possible after diagnosis, and sustain the weight loss alongside the support of their healthcare team.

Safe and sustainable weight loss

Anyone who wants to achieve remission of their Type 2 diabetes should first speak to their healthcare team to make a safe, sustainable weight loss plan.

Doctors might recommend rapid weight loss by following a low-calorie diet [ii] for just a short period. That might include replacing meals with diet replacement products, such as shakes and soups, for three months. After the three months, healthcare teams will support people to reintroduce normal meals, without putting the weight back on.

The Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT) [iii]. found that more than a third of people with Type 2 diabetes who followed a similar programme with their GP were in remission two years later.

Of course, it does not work for everyone. Bariatric surgery may be a good option for some who meet specific criteria, especially those with a BMI of more than 40 who struggle to lose weight through diet and exercise. Research has shown that weight-loss surgery can change how the digestive system works. It can affect how the pancreas makes insulin and improve the way the body uses it. All this contributes to achieving remission. In fact, a study found that almost 30.4% of people who had weight-loss surgery were still in remission 15 years later[iv].

There are three main types of bariatric surgery. A gastric band operation, whereby surgeons place a band around the upper part of the stomach. A gastric bypass re-routes the digestive system to bypass most of the stomach except for a small pouch at the top, and a sleeve gastrectomy during which, part of the stomach is removed. They all have the same affect: they make people feel fuller sooner, meaning they eat less.

Keeping it up

Whether people follow a low-calorie diet or are suitable for bariatric surgery route, the impact is the same. They lose fat from around their liver and pancreas, allowing the body to “reboot” its insulin production processes.

Remission does not mean cured, though. The DiRECT study found that once people regained weight, their insulin resistance also came back. That is why everyone diagnosed with Type 2 diabetes should keep up to date with their appointments – even if they are in remission.

It is also important to remember that not everyone who loses weight will be able to put their Type 2 diabetes into remission. However anyone who is overweight and loses as little as 5% of their body weight stands to reap the benefits [v]. As well as feeling fitter and healthier, they will usually need to take fewer medications and have better blood glucose levels. What’s more, they will be at a lower risk of developing common long-term complications, such as cardiovascular issues or stroke.

References

[i] Diabetes UK – can you reverse Type 2. Available at : https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse Last accessed 5th November 2020
[ii] Diabetes UK low calorie diet programme. Available at : https://www.diabetes.org.uk/about_us/news/nhs-low-calorie-diet-remission Last accessed 5th November 2020
[iii] Diabetes remission clinical trial. Available at: https://www.directclinicaltrial.org.uk/ Last accessed 5th November 2020
[iv] Sjöström L, et al. JAMA. 2014 Jun 11;311(22):2297-304
[v] Diabetes UK – can you reverse Type 2. Available at: https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse Last accessed 5th November 2020