Is type 2 diabetes reversible? Understanding remission and management

Approximately 1 in 20 Australians have type 2 diabetes. It is often seen as a lifelong condition, but recent research has brought new hope. Find out about whether type 2 diabetes can be reversed, and how.

What is type 2 diabetes?

Type 2 diabetes is a condition where the body becomes resistant to insulin, a hormone that helps convert glucose into energy. Over time the pancreas can lose its ability to produce enough insulin. This leads to higher blood glucose levels.

Type 2 diabetes is often diagnosed through a HbA1c test, which measures the average blood glucose levels over the past three months. A HbA1c level of 6.5% or higher indicates type 2 diabetes.

Causes and risk factors

A combination of genetic and lifestyle factors can increase your risk of developing type 2 diabetes. Factors that can put you at risk include obesity, physical inactivity, poor diet, and advancing age. Some risk factors are unavoidable, like genetics and age. But other factors, such as weight, diet, and physical activity, can be managed to reduce the risk.

Understanding type 2 diabetes remission

What is type 2 diabetes remission?

Remission from type 2 diabetes doesn’t mean the diabetes is cured. Diabetes remission is a sustained improvement in blood glucose levels. This means that HbA1c levels remain below 6.5% for at least three months without the need for glucose-lowering medications.

Achieving remission often requires significant lifestyle changes, including weight loss and dietary modifications.

Remission vs. reversal vs. cure

Remission, reversal, and cure are three different things:

• Remission: blood glucose levels are within the normal range without medication, but the underlying tendency towards diabetes remains.
• Reversal: a more permanent state where normal glucose levels are maintained, although the possibility of the condition coming back remains.
• Cure: the condition is completely eradicated. This isn’t currently possible for type 2 diabetes.
  
  

How can you achieve remission?

How weight loss and diet can help

For many people, achieving remission from type 2 diabetes will involve significant weight loss and dietary changes.

According to one trial which offered an intensive weight-loss program for people with type 2 diabetes, 46% of those who participated had their type 2 diabetes in remission after one year, and 36% remained in remission after two years.

Research indicates that losing around 10-15% of body weight can substantially improve your blood glucose levels. You can achieve this weight loss in various ways, including very low energy diets. These diets focus on reducing calorie intake to promote weight loss and improve insulin sensitivity. Regular physical activity also plays a crucial role in managing weight and enhancing overall health.

Very low energy diets

Very low energy diets (VLEDs) involve consuming a nutritionally adequate but highly restricted calorie intake. This is often through meal replacement products like shakes, soups, or bars. These diets typically provide around 3,300 kJ (800 cal) per day or less, and may be suitable for adults with type 2 diabetes and a BMI greater than 27kg/m2.

VLEDs have been shown to be effective in achieving rapid weight loss and improving blood glucose levels. Studies, like the DiRECT trial, demonstrated that VLEDs can lead to remission in a significant proportion of participants.

When on a VLED, it’s important to get the right support. An appropriate health professional, like an accredited practising dietitian, can provide advice both during the VLED and afterwards for ongoing weight maintenance.

Weight loss surgery

Weight loss (bariatric) surgery is an effective option for some: usually younger people and those newly diagnosed with type 2 diabetes. These procedures reduce the size or capacity of the stomach, which limits the amount of food you can eat. This leads to significant weight loss. Studies have shown that weight loss surgery can lead to type 2 diabetes remission in a substantial number of patients, with some maintaining remission for several years.

While effective, however, weight loss surgery is a significant commitment. It also requires ongoing lifestyle changes and the support of a multidisciplinary healthcare team (including surgeons, accredited practicing dietitians, psychologists and physicians) to sustain the benefits.

The role of your healthcare team

If you would like to aim for a remission from type 2 diabetes, consulting healthcare professionals will be vital. Your diabetes healthcare team can provide tailored advice, monitor your progress, and adjust your treatment plans and medications as needed. They can also identify any potential risks that may come from a significant change in your diet or other interventions.

If you do achieve remission, it will be important to keep having regular diabetes check-ups. You will also need to continue with your annual cycle of care to monitor your diabetes and address any health problems as they arise. Regular visits with your health care team (including GP, diabetes educator, podiatrist and dietitian) are essential.

Can type 2 diabetes be reversed permanently?

The answer remains complex. While remission is achievable, it isn’t a cure. The underlying tendency towards diabetes is still there, and people still need ongoing management to sustain remission. For many people, the goal is not necessarily permanent reversal but rather achieving and maintaining better health. With the right approach, people with type 2 diabetes can lead healthier, more fulfilling lives.

It's important to keep in mind that remission from type 2 diabetes may not be possible for everyone. Some people will still need to continue taking glucose lowering medications because they can help with other health conditions like high blood pressure or cholesterol.

Things to keep in mind

While type 2 diabetes remission is possible for some people, it’s not possible for everyone. There are factors that can influence whether someone can achieve it, like how long it’s been since the onset of diabetes, their initial HbA1c levels, and whether they have other health conditions. Studies indicate that less than half of those who attempt remission through intensive dietary changes will achieve it within a year, and only about a third will sustain it over two years. So, it’s important to have realistic expectations and a personalised treatment plan before you attempt it.

If you attempt remission but don’t achieve it, you have still done something great for your health! There’s a whole range of health benefits that come from reducing both weight and HbA1c, including decreasing the risk of developing diabetes-related complications.