A diagnosis of type 2 diabetes frequently necessitates lifelong treatment, surveillance, and apprehension over complications. But a new study from the University of Glasgow shows that it may be able to reset the disease to a non-diabetic state in some circumstances.
What "Reversal" Or "Remission" Means
In medical words, remission of type 2 diabetes means that blood sugar levels drop below the diabetic threshold for a set amount of time without any active drug or surgical treatment. This result is not the same as a cure because in many cases the underlying propensity and pathophysiology stay the same. Because the word "reversal" is occasionally used in the same way, it's important to be clear. In real life, this means a big and long-lasting improvement in blood sugar management, which generally means stopping using diabetes drugs.
Mechanisms and biology
Two problems lie at the heart of type 2 diabetes: insulin resistance (particularly in the liver and muscle) and the pancreatic beta-cells not being able to release insulin properly. Studies show that fat buildup in the liver and pancreas is very important. When too much fat gets into these organs, insulin release goes down and glucose control is worse. The University of Glasgow's Diabetes Remission Clinical (DiRECT) study and other studies have shown that when people lose weight quickly, the amount of fat in their liver and pancreas goes down. This helps the pancreas make insulin again and makes the body use it better, which can often lead to diabetes going away.
The "Twin Cycle Hypothesis" proposed by Roy Taylor describes this process of fat-related dysfunction and reversal.
Methods That Have Shown Remission
People with type 2 diabetes can often bring their blood sugar back to normal by losing extra weight and improving how their body handles insulin. Weight-loss surgery, very low-calorie diets, or reducing carbs and calories have shown clear benefits. In some cases, these changes have even helped people stop needing diabetes medication.
1. Surgery for obesity
For people living with severe obesity or conditions like diabetes, high blood pressure, or sleep apnea, bariatric surgery offers a medical way to regain health. It is usually advised for those with a BMI above 32 when other conditions exist, or above 35 in cases of extreme obesity. With robotic-assisted surgery, doctors can work with more accuracy, cause less bleeding, and help patients recover faster. Procedures like sleeve gastrectomy and gastric bypass make the stomach smaller and change hunger-related hormones, which helps people lose weight and manage blood sugar better. Research from the STAMPEDE and ARMMS-T2D trials indicated that surgery leads to lasting weight loss, better control of blood sugar, and less dependence on medication. The STAMPEDE study from the Cleveland Clinic found that those who had surgery achieved far better diabetes control than those on medical therapy alone.
Another study by Buchwald and colleagues also pointed out that 76% to 92% of patients were able to achieve remission after surgery, thus indicating the positive effect of bariatric surgery. This, it can help many people turn back the effects of type 2 diabetes.
2. Diets with Few Calories
Studies using very low-calorie diets (VLCDs) show that losing around 15 kg or more can help type 2 diabetes go into remission, especially when the weight loss happens soon after diagnosis. For instance, almost half of the people in the DiRECT trial who lost 33 lb (about 15 kg) or more in the first year went into remission. This method requires strong support, close monitoring, and good plans to keep the weight off.
3. Diets that limit carbohydrates or have low energy
Some studies have also shown that dietary therapy that focuses on cutting back on carbs or calories can lead to remission. These diets lower the amount of sugar in the blood, lower the need for insulin, and help people lose weight. In one study of intermittent fasting, more than half of the people who took part were free of their illness for at least a year.
Who Is Most Likely to Get Better?
The chances of diabetes going into remission are highest when treatment begins early, before the pancreas is too damaged and insulin-producing cells still work well. Losing and maintaining a significant amount of weight plays a big role too. Even a 10% drop in body weight can make the body respond better to insulin, but shedding 10 to 15 kilos or more greatly increases the likelihood of full remission.
People who have had diabetes for a shorter time, had less exposure to glucose at first, kept their beta-cell reserve, and had less complications do better. For a lot of people, remission is still something they hope for instead than something that happens all the time.
Making Plans
Getting into remission doesn't mean that diabetes is permanently gone. The underlying susceptibility stays the same, and if you gain weight, stop exercising, or have other metabolic stressors, you could relapse. Currently, remission rates in regular community settings are quite low. For instance, in a major Scottish database, less than 0.1% of patients were categorized as being in remission.
Also, the longer someone has diabetes, the less probable it is that they will go into reverse remission. The guidelines still stress controlling hyperglycemia and cardiovascular risk instead of making sure that reversal happens.
What this means for real-world clinical practice
If someone has type 2 diabetes and is motivated and medically eligible, they may be able to go into remission. Some important things to do are:
- Start losing weight early and aggressively to get rid of visceral fat
- Provide structured support for very low-calorie or carbohydrate-restricted diets when it is safe to do so
- Regular exercise and strength training to make the body more sensitive to insulin - Close monitoring of glucose, insulin demands, and problems throughout and after the intervention
- Long-term follow-up with measures to keep the weight off and avoid relapse
Clinicians should also make it apparent that remission is not guaranteed, stress the necessity for continued attention, and make sure that regular preventative treatment is being done.
It is scientifically possible for type 2 diabetes to go away or get better, and more and more clinical trials are backing this up, especially when people lose a lot of weight and reset their metabolism early in the disease. Bariatric surgery, very-low-calorie diets, and meal plans that reduce carbohydrates have all shown strong results in bringing type 2 diabetes into remission. However, remission does not happen for everyone. It needs effort, regular medical follow-ups, and long-term commitment to healthier living.
It's better to think of remission as an optional objective than of the default one. Future work has to focus on making weight-loss programs more widely available, making them last longer, and including remission in standard diabetes management plans.
(By Dr. Ashish Gautam, Senior Bariatric, Robotic and Gastrointestinal Surgeon | Medical Director, Dr. Gautam Health Care Center and Clinic | Senior Director, Robotic and Laparoscopic Surgery, Max Super Speciality Hospital, Patparganj, New Delhi)
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