Basics: can T2DM be reversed?

A discussion that comes back a lot in diabetes forums is whether T2 diabetes can be “reversed”. Heated debates concentrate on deciding if it is a possibility or simply a mirage that leads to disappointment.

A lot of it is a matter of definitions. Many people use “remission” to avoid saying that you can get rid of diabetes completely. Some people use “reversal”, which implies a permanent fix.

Some studies have shown that “remission” is possible. The key here is weight loss to eliminate the fatty deposits in the liver and pancreas that create the conditions for diabetes to develop. Once these inappropriate deposits disappear, the pancreas and the liver can go back to their normal balanced interacting mechanism, and diabetes symptoms disappear (insulin resistance diminishes, glycaemia goes back to non-diabetic levels, and sugar intake reaction is normal), provided that enough pancreas beta cells remain (about 20% is generally accepted as the minimum).

Some of these studies have shown that it’s possible to go back to a normal diet under some conditions: diagnosis less than 8 years ago, ethnicity has an impact, etc. Within these restrictions, it’s sometimes called “reversal” because of the return to a normal diet. However, we don’t have enough data to know if it’s forever (or what “forever” means). The longest studies have only been on a couple of years1, which isn’t enough to judge long term stability of “reversal”.

What’s important to note though is that a return to normal diet doesn’t mean going back to the diet that created the diabetes conditions. And that is the main argument used by those who hate the term “reversal”: according to them, if you are in remission but go back to your pre-diagnosis diet, diabetes will come back. Which is very probably true and has been observed.

But that’s a nonsensical argument. Going back to a normal diet means switching to a diet that contains normal food, in a normal mix, and in normal quantities. Not the excessive or inappropriate diet that caused the diabetes in the first place. The obvious illustration would be cancer remission: if you had cancer generated by smoking, going back to normal behaviour after remission doesn’t mean going back to smoking! That would obviously bring back the cancer. This is the same with diet and diabetes. So that argument doesn’t hold.

Whether we call it “remission” or “reversal”, what is definitively possible with T2, when it’s diagnosed early enough, is to control it well enough to stop all medication, and control glycaemia to within the non diabetic range using a good diet. Nothing more. That is an important message for all those who were recently diagnosed.

1 Update on DiRECT study: it has been announced that next week, an update showing that remission continued for 3 more years will be presented at the DUKPC conference.

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