Is Type 2 Diabetes Reversible?

Type 2 diabetes is often described as a progressive disease.

If left unchecked, and without the right healthcare and lifestyle changes, it can gradually deteriorate one’s health over time with more medications needed just to manage the disease.

But with the right lifestyle changes can this disease be put into remission?

Reversal implies a permanent cure but unfortunately for Type 2 diabetes, there is no known cure.

However, it is proven that the disease can be controlled and in some cases, it has gone into remission.

What remission means in Type 2 diabetes is that your blood sugar levels are healthy once more without the need to take any medication to control it.

More specifically, your A1C (your estimated average blood sugar level or glucose level) has been reduced to the level of someone without diabetes (less than 6.5 per cent) and therefore you are able to either limit the medication you are taking or eliminate it altogether for over six months or longer.

Knowing this can mean hope for a lot of Type 2 diabetes patients but how does one do it?

This was the focus of a webinar co-organised by the Center of Transformative Nutrition & Health (CTNH) at International Medical University (IMU) with the Malaysian Endocrine and Metabolic Society (MEMS), and the Malaysian Dietitians’ Association (MDA), titled “Diabetes in Malaysia and Southeast Asia: Is Remission Possible?”

Moderated by Prof Winnie Chee, professor of nutrition and dietetics at IMU, a recent webinar featuring speakers such as Datuk Dr Zanariah Hussein, Head of Endocrinology Services from the Ministry of Health, Malaysia, past president of MEMS, Dr Anthony Leeds, Prof Dr Susan Jebb, Professor of Diet and Population Health, and Prof Dr Paul Aveyard, Professor of Behavioural Medicine, both from Oxford university.

The webinar garnered over 500 participants who were physicians, dietitian, diabetes educators, nurses and other healthcare professionals from Malaysia, Singapore, Middle East and the UK.

It needs to be stated that diabetes remission is quite a new idea and a lot more research is required before it can be fully understood.

However, the strongest evidence suggests diabetes remission can be done by weight loss and maintenance in which te webinar had discussed some proven dietary approaches for remission.

The fact remains that Type 2 diabetes is a lifestyle disease that is also on the rise.

Datuk Dr Zanariah Hussein said there there has been an upsurge in Type 2 diabetes and its related risk factors, which include rising levels of obesity, unhealthy diets, and widespread sedentary lifestyle in this part of the world.

“Growing urbanisation and changing lifestyle habits are contributory factors as well.

“However, with the right management for your diet and lifestyle, the risk of the disease is significantly reduced.

“For those living with diabetes, being on top of both factors can improve your quality life.

Dr Zanariah added that lifestyle modification is the primary step once diabetes is diagnosed.

She cites the latest version of Management of Type 2 Diabetes Mellitus that recommends patients with Type 2 diabetes with aims of achieving diabetes remission to consider meal replacement therapy (MRT) and very low-calorie diet (VLCD).

But how exactly does losing weight encourage diabetes remission? First, you need to understand what extra weight does to your body.

Fat can build up around important organs like the liver and pancreas, making it difficult for these organs to work.

This can lead to how Type 2 diabetes develops, though other factors come into play as well such as age, ethnicity, and family history. And the vice versa is true as well: Losing fat affects diabetes remission.

Dr Anthony Leeds backs up this fact by sharing how studies in the UK and the Middle East showed that dietitian-led weight loss programmes using Total Diet Replacement (TDR – a formula diet providing all food) achieved more than 15kg of weight loss in a year, leading to diabetes remission.

“The key message is that with more than 10kg in weight loss maintained at two years will help two out of three people achieve diabetes remission,” said Dr Leeds.

Further encouraging weight loss as a way to remission, Prof Susan Jebb said: “Even people who lose up to only 5kg, a small proportion of them will be successful.”

Together with Prof Paul Aveyard, Prof Jebb has been studying the impact of weight loss in a primary care setting for Type 2 diabetes patients.

She added that there is a linear relationship between weight loss and the likelihood of achieving remission.

She also emphasises that while the recommendation is Total Diet Replacement (TDR), it is not suitable for everyone.

“For the last 10 years or more, we’ve been working hard on the effectiveness of weight loss for remission. It is important to realise that there are a range of different ways to lose weight.

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“Encouraging people to manage their weight themselves is modestly effective though the weight loss is limited. But if the whole population did that, you can imagine the benefits accrued from that,” said Prof Jebb.

It is important to know that remission is not a one-off event as it needs to be maintained because there is always a chance that your diabetes might return, said Prof Aveyard.

“This is where healthcare practitioners come in to provide support for their patients.

“With the right ‘script’, patients responded much better,” said Prof Aveyard.

He also highlights that aside from diabetes remission, weight loss also has other long-term benefits in terms of cardiometabolic effects.

As such efforts to lose weight in diabetes are all worthwhile due to this legacy effect.

Whether it is the accelerated approach to weight loss or a gradual approach, the idea is simply to get started and find one diet plan that works.

In fact, dieting is not the only way for Type 2 diabetes to enter into remission, some patients have had bariatric or weight-loss surgery.

“It is important to speak to your healthcare provider for help because support plays an important role too, from the person helping you manage your diabetes to your loved ones,” he added.