Can Diabetes Be Reversed?

I get asked this question all the time by my patients with type 2 diabetes. In the past, I would have said that it was highly unlikely that type 2 diabetes could be reversed. However, newer research has made me think twice!

Here’s an example

I recently provided nutritional counseling to a patient with newly diagnosed type 2 diabetes. His initial HbA1c (12 week blood sugar average) was 6.7. He was very diligent with the reduced calorie, lower carb diet and exercise plan we set up and was able to lose 20 pounds. After 3 months, his HbA1c dropped to 6.1. He asked me the big question “Do I still have diabetes?” Many experts would say yes you do, but now it’s called “diet controlled” diabetes. But is this accurate?

Type 2 Diabetes and Insulin Resistance

First, a little background info. Most people with type 2 diabetes are insulin resistant. Insulin in a hormone that is produced by the pancreas in order to get sugar out of the blood and into the cells to be used for energy. Insulin resistance means the body is not sensitive to insulin so the pancreas has to pump out more and more insulin in order to get the sugar into the cells. Eventually the pancreas can’t make enough insulin, blood sugar levels rise and type 2 diabetes occurs.

There are many factors that can contribute towards insulin resistance including aging, genetics, inadequate exercise, and medical conditions like PCOS to name a few. But the biggest impact is being overweight. Almost 90% of people living with type 2 diabetes are overweight or have obesity. Excess fat in the body, especially around the midsection and internal organs worsen insulin resistance.

So can type 2 diabetes be reversed?

Reversal (or remission as many experts like to call it) ) of diabetes is when a patient no longer no longer has diabetes – at least for a period of time. This is definitely possible for some people to achieve. Weight loss is the answer to reversal of diabetes. When you lose weight, including the fat around the internal organs, insulin resistance is improved and beta cell function in the pancreas is restored. But the key is that the weight needs to stay off … and we know that is NOT easy.

How much weight loss is needed to reverse diabetes?

An analysis published in the BMJ September 2017 showed that losing 33 pounds often helps put diabetes into remission. This specific number was taken from a previously published study that found that 40 percent of people who lost about 33 lbs and kept it off for six months through a low-calorie diet were able to send the diabetes into remission by restoring beta cell
function. In that study, the authors concluded that type 2 diabetes “is a potentially reversible condition.”

Does this mean every overweight person with type 2 diabetes needs to lose exactly 33 pounds in order to potentially reverse diabetes?  The study coauthor Louise McCombie RD, research associate at the University of Glasgow in Scotland, says that “Further work on this is ongoing, regarding the actual weight loss needed”. So the answer is – we don’t know yet!

Here is another study – somewhat controversial  – that showed that even if you have diabetes for as long as 6 years, it’s still possible to put it into remission. However the method was pretty hard core … 250 patients with type 2 diabetes had to stick to a very low-calorie liquid diet, of around 850 kcal per day for 3 to 5 months, and then gradually reintroduce food, with ongoing support for maintenance of weight loss that includes strategies to increase physical activity and cognitive behavioral therapy.

How do you know if it’s in remission?

While there is no consensus on the criteria for remission of diabetes, most major diabetes organizations agree that measurement of either HbA1c or blood glucose is sufficient to identify remission. It’s recommend that patients should have two tests results (usually HbA1c) at least two months apart to confirm remission. (reference)
HbA1c results:

–Normal HbA1c: < 5.7
-Prediabetes (or glucose intolerance): 5.7-6.4
-Diabetes: 6.5 and higher

Patients in remission should continue to get annual blood tests. Partial remission of diabetes would be HbA1c test results in the area of  5.7-6.4 and remission of “pre-diabetes” would be HbA1c under  < 5.7.

Moving forward

I think this is encouraging news that it’s possible to put diabetes into remission. I’d like to see more focus on getting to the root of type 2 diabetes – insulin resistance  – and helping overweight patients understand how significant weight loss may improve insulin sensitivity. Often times, a patient is handed a prescription for a medication to lower blood sugar and maybe some vague advice to lose weight, eat less sugar and white carbs and walk more. I’m certainly not denying the need for medications. After all, the goal of diabetes management is to keep blood sugar in a healthy range to prevent compilations and medications do this. But what about letting the patient know that it MAY BE POSSIBLE to reverse diabetes if significant weight loss occurs?  This may be a strong motivator for the patient to make – and keep – the necessary behavior changes.

But the trick here is that the weight needs to be kept off.   More studies are needed to determine the amount of weight loss needed to cause this reversal. And since diabetes tends to be a progressive disease, this reversal is not guaranteed in every overweight patient who has diabetes and loses weight. And obviously someone who is already on the lean side can’t reverse diabetes by turning into a skeleton!

Stay tuned for an upcoming blog post on nutrition tips to help you potentially reverse diabetes. 

References:

Reversing Diabetes Through Weight Loss: How Much Should You Lose? 

BMJ 2017;358:j4030 doi: 10.1136/bmj.j4030 

https://www.ncbi.nlm.nih.gov/pubmed/27002059

https://www.medscape.com/viewarticle/889618#vp_1