Diabetes remission or reversal?

These days you hear about diabetes remission right and left through social media. There is so much misunderstanding around what it means to achieve diabetes remission- from healthcare professionals to the general public. Many people use catchy words such as diabetes reversal, and diabetes cure to sell their products.

People in general like words such as ‘cure’, even if these claims are misleading. I write this article to explain what diabetes remission is, what is the science behind it, what is hype about it and how is this misused by some people. Experts knew from a long time that in several conditions, diabetes do remit. For instance, when a person is given a course of steroid medicines for a particular ailment such as asthma, diabetes may appear.

This steroid-induced diabetes usually remits once the steroids are withdrawn. Similarly, many women develop diabetes during pregnancy, which usually resolves following delivery. Sometimes, stress causes diabetes, especially during a severe episode of an illness such as pneumonia, which later resolves once the ailment is over. When a person with obesity undergoes weight-loss surgery, in which a portion of stomach is removed or the intestinal connections are modified, he/she shows immediate improvement in diabetes. Three-quarters of people undergoing these weight-loss surgeries undergo diabetes remission for a long period. This proves that remission of diabetes is possible with sufficient weight loss.

There are newer medicines that may cause enough weight loss for the diabetes to remit. What is the science behind diabetes remission? It should be noted that here we are taking about type 2 diabetes, in which both glucose and insulin levels are increased in the blood. In this type of diabetes, due to overweight or obesity, fat builds up in the liver and muscle also. Insulin does not work normally when there is fat in the liver and muscle. Since there is no problem with insulin production, more and more insulin is in fact produced as a compensation. This means a person with type 2 diabetes has higher levels of insulin in the blood, but this insulin does not work, leading to diabetes.

The good news is that if you lose weight, fat in the liver and muscle comes out first, and insulin starts working again. It indicates that the problem with insulin-not-working type 2 diabetes is reversible. However, for the remission of diabetes to happen, a person should fulfil certain conditions. Firstly, he should have new onset or short duration diabetes, usually less than five years of duration. In long duration diabetes, there are also problems with insulin production, which makes it difficult to remit.

Secondly, the individual should be overweight or obese at the diagnosis of diabetes, which makes it possible to lose enough weight to enter remission of diabetes. Thirdly, initial blood glucose should not be very high. However, the third condition is not a strict rule, as we have seen people undergo remission even if initial glucose levels were very high.

You have seen a huge hype about diabetes remission on the social media. Diabetes remission is our technical word for return of blood glucose to normal levels, following the diagnosis of diabetes, and maintenance of these normal glucose levels without diabetes medicines for at least three months.

You can prolong this remission for many months and years, provided you continue following lifestyle changes and do not regain weight. Some people, especially those who are selling products for weight loss or who are not trained experts, use alternative terms for diabetes remission, such as diabetes reversal, diabetes cure, and others. One message from this article should be clear that diabetes remission conveys the message that it is ‘temporary’, though you can prolong this remission to months and years. But if you regain weight, diabetes will recur. ‘Reversal’ or ‘cure’ on the other hand sounds that the disappearance of diabetes is a ‘permanent’ thing, which is not a fact.

They claim that once you lose weight, taking a 3-months or 6-months diet or drug course, then you can go back to your previous lifestyle. We have seen people coming with recurrence of diabetes within 6-months of diabetes remission, as they have been told to do diet changes for 3-months only. They are not informed about the full picture, that what happens after the diet course or drug course is over.

Diabetes is a lifelong disease, a 3-months or 6-months solution is of little use. You have to find a lifelong solution. You have to make lifelong changes in your diet and physical activity. Whatever term your expert uses for diabetes remission, may it be reversal or cure, you should understand that it is a temporary thing. However, you can prolong that temporary diabetes remission for months and years by maintaining lifestyle changes that induced the remission.

Dr M Shafi Kuchay, Senior Endocrinologist, Medanta The Medicity, Gurugram