Author: Dr. Sean Wheatley, PhD – Science and Research Lead/20 February 2018
Traditionally Type 2 diabetes (T2DM) was considered a progressive condition. Treatment was aimed at slowing the rate at which health declined to try and stave off the consequences for as long as possible. It was considered almost inevitable that individuals would eventually need insulin to keep their blood glucose levels in check.
But now the story has changed. It is becoming more and more common to hear or read about T2DM being reversed! This an exciting possibility that provides hope and reassurance for millions of people worldwide. If it is true that is…
So, can it be reversed?
The short answer is… YES!
Although there is some debate around whether T2DM is truly “reversed” or whether terms such as “remission” would be more appropriate, there is now clear evidence that individuals who have been diagnosed with T2DM can make changes to their lifestyle that can enable their blood glucose to return to what would be considered normal. Practically speaking, this means they no longer have diabetes.
What’s the problem with saying “reversed”?
Any discussion around whether the term “reversed” should be used could be considered a bit pedantic.
It is important to recognise that someone who has “reversed” their T2DM can easily become diabetic again if they revert to an unhealthy lifestyle. There is also a worthwhile debate to be had about whether any damage an individual has done to their body is truly undone. But these are issues to be discussed in medical and scientific circles, and need not detract from the messages we can give to the patients involved.
The positive feelings someone gets from no longer being labelled as having T2DM should not be downplayed. Avoiding terms like “reversal” seems unnecessary (at least to me) and could even be considered to remove a powerful psychological tool from our public health arsenal; a tool that can give a much needed boost to the people we are working with.
So how can Type 2 Diabetes be reversed?
The main methods that have recently been shown to be effective are a VERY LOW CALORIE diet and a VERY LOW CARBOHYDRATE diet.
A very low calorie diet has been shown to work by the DiRECT study, which is funded by Diabetes UK. In a nutshell:
* Participants followed a total diet replacement plan (a nutrient-dense liquid diet) for between 3 and 5 months, before having a 2 to 8 week food reintroduction phase followed by structured support for maintenance of weight loss
* The 12 month results of this studyshowed that about half of the 149 people who started this plan had achieved diabetes “remission”, compared to just 4% of those who received their usual care
* The more weight people lost, the more likely they were to have achieved diabetes “remission”
* Only one person following this intervention experienced any adverse events that were potentially related to the low calorie diet
Amongst other sources, a very low carbohydrate diet has been shown to work by a company called Virta (who are based in the USA). Most of the participants in this trial were required to have less than 30 grams of carbohydrate each day. To help them stick to this they received education either using a web-based app or via group classes (weekly for the first 12 weeks, bi-weekly for the next 12 weeks, and monthly for 6 months afterwards). All individuals could schedule visits with a medical provider if required and received remote care from health coaches. The one year results were very encouraging:
* 83% of the 262 individuals who started the intervention were still taking part after a year
* Medication usage dropped significantly (nearly everyone who was taking insulin reduced their dose and everyone on sulphonylureas no longer required them)
* HbA1c (a measure of blood glucose control over time) and weight reduced significantly
* 25% of participants met the criteria for diabetes “remission”
* An additional 35% reduced their HbA1c to below the cut-point for diabetes, but were not classed as being in “remission” because they were still taking metformin. It is worth noting that individuals were only taken off metformin in this study if they asked or if there were problems with them taking it. This therefore restricted the number who could be classed as being in “remission”
* There were no adverse events that could be attributed to the intervention
So can this work for me?
The studies mentioned above provide clear evidence that these approaches can be safe, that they can be effective and that (at least some) people can stick to them. Both of these studies recruited volunteers from general populations; normal people who wanted to take control of their own health. So with appropriate support it is absolutely possible for many people, possibly even most people, to achieve the same.
That doesn’t mean it is easy though. Parts of these interventions require a lot of commitment and discipline. But with the right motivation these approaches have been shown to be effective
Do lifestyle changes need to be this dramatic?
The evidence from these studies, and others, suggests that the amount of weight lost is the best predictor of whether an intervention can help you to reverse T2DM. There is also evidence suggesting that losing even a small amount of fat from your liver and pancreas can help improve their function, and so help reverse T2DM. Therefore, any lifestyle change that helps your body to lose fat can probably help you reach your goals.
A less extreme version of the Virta intervention might be to try a less dramatic form of carbohydrate restriction. A summary of what a low-carb diet is can be found here, and Diabetes.co.uk have an online low carb programme which has helped a lot of people achieve success in managing their health by adopting this dietary approach.
As we’ve said many times before though, one size doesn’t fit all. The approach that will help you make sustainable changes may well be different to what works for someone else. To help you decide what might work for you, you can find summaries of the other dietary approaches included in the X-PERT Diabetes Programmes here.
Is there anything else I need to consider?
One VERY IMPORTANT thing to consider is how any medications you are taking might be affected by some of these approaches. You should never make any dramatic lifestyle changes without discussing them with appropriately qualified healthcare professionals, but when you are on certain medications this is even more important to make sure there are no major risks.
Insulin and sulphonylureas are two examples of medication classes that can cause problems if you reduce the amount of carbs you consume. These meds will continue to remove glucose from your blood even if there isn’t that much already in there, which can cause blood glucose levels to go too low (i.e. can cause a “hypo”). If you are taking any medication you may need a medication review before you can try any form of carb restriction, but it is important that you DO NOT MAKE ANY MAJOR CHANGES TO YOUR DIET AND LIFESTYLE WITHOUT DISCUSSING IT WITH YOUR HEALTHCARE TEAM FIRST.
So what’s the bottom line?
The most important message for people to take home here is that IT IS POSSIBLE TO REVERSE TYPE 2 DIABETES. We can put the technicalities to one side for now, and focus on this important, positive and uplifting message. Rather than an inevitable decline in health, we now know that there are changes we can make which can lead to meaningful improvements to reduce the risk of long-term complications.
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