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Is it possible to reverse type 2 diabetes?

Living with type 2 diabetes usually means having to take medication, dealing with symptoms and side effects, and running the risk of serious complications. But what if you could put an end to all that and actually reverse the condition? It’s a hot topic and one that scientists and doctors are learning more about all the time. Here’s an overview of what you need to know about reversing type 2 diabetes and going into remission.
Allie Anderson
9/13/2022
11
min read
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Quick summary

  • It’s possible to reverse type 2 diabetes and put the disease into remission – meaning below-target HbA1c levels for 3 months or more without medication.
  • The link between type 2 diabetes and obesity has driven research into the role of significant weight loss in reversing the condition.
  • Evidence suggests that short-term total diet replacement (TDR) followed by phased food reintroduction and commitment to lifestyle change shows the most promise.
  • There is no quick fix and it’s important to be aware of any supposed remedies that promise one.
  • Always get advice from your doctor or healthcare professional before attempting any programme aimed at reversing type 2 diabetes.

The idea of reversing type 2 diabetes isn’t new; scientists have been looking for ways to do it for decades. Various studies from around the world—as well as powerful real-life anecdotes from patients who have lived with type 2 diabetes—have shown that people with the condition can reverse it and go into remission. But what does that mean, and how does it work?

What is remission?

There are different ways of talking about reversing diabetes, and you’ll probably see the terms ‘remission’ and ‘reversal’ used interchangeably. 

In real terms, reversing type 2 diabetes—or achieving remission—means your blood glucose remains consistently below the recommended target over time, as indicated by what’s called glycated haemoglobin, or HbA1c. This is a measure of your average blood glucose over 3 months, which is checked by periodical blood tests. Most people with type 2 diabetes aim for 48mmol/mol (6.5%) or lower. 

Medically, someone is said to be in remission if their HbA1c levels return to 48mmol/mol (6.5%) or below for at least 3 months after stopping medication to lower their glucose.[1] 

Remission, reversal, or cure? 

It’s worth noting a difference, albeit just a semantic one, between diabetes reversal and remission. Where remission describes the state of having consistent, sustained, normalised blood glucose levels over the long term, reversal is the process of getting to that point. 

Remission is when HbA1c levels are sustained at 48mmol/mol (6.5%) or below for 3 months without medication

Diabetes UK

So, reversing type 2 diabetes doesn’t necessarily mean you’re in remission. But if you’ve achieved remission, you can be said to have reversed the condition. 

Some people might even talk about ‘curing’ type 2. However, experts avoid using the word ‘cure’ because it implies a permanent state; that you’re healed forever. But even if someone with type 2 diabetes reverses their condition and stays in remission for many years, it’s possible they can get type 2 diabetes again in the future. 

The reasons will become clear as we learn more about how reversal and remission happen in the first place.

Can you reverse type 2 diabetes?

To put it simply, yes – it’s possible. There is a swathe of compelling evidence to that effect, which researchers are adding to all the time. All that evidence points to one common factor among participants who lowered their blood glucose in the longer term – significant weight loss. 

The link between type 2 diabetes and being overweight is well established. Obesity—having a body mass index (BMI) of 30 or higher—is the main risk factor for type 2 diabetes and accounts for up to 85% of an individual’s risk of developing the condition.[2] Figures suggest that around 90% of people with type 2 diabetes are obese or overweight (a BMI of 25 or higher).[3]

So, it stands to reason that losing excess weight could contribute to better-controlled blood glucose levels. The effect has been seen as far back as the 1980s, when a study showed patients who underwent successful bariatric surgery were able to lower their blood glucose.[4] In a more recent study, patients who lost 15kg or more following gastric band surgery achieved type 2 diabetes remission.[5] Researchers have been investigating whether similar effects can be achieved through diet alone—and the results are positive. 

One of the most significant studies to date, known as the DiRECT trial, found that 86% of patients who lost 15kg or more by following a very low-calorie diet were in diabetes remission after a year, and 70% of those remained in remission after 2 years.[6]

How is type 2 diabetes reversed?

When you lose a lot of weight, you lose fat. You see the results in the mirror as your body becomes smaller and your clothes get looser. What you’re seeing is the loss of subcutaneous fat—the fat that sits just below the skin and makes up around 90% of the fat in the body. What you don’t see, is that you’re also losing hidden or ‘visceral’ fat that’s stored deep inside and clings to your internal organs. 

Reducing the amount of fat in the liver and pancreas—the organs involved in regulating glucose and insulin—appears to be particularly important in reversing type 2 diabetes. 

In a study examining this link, participants who’d followed a low-calorie diet for 8 weeks lowered their pancreatic fat by more 22% and reduced the fat in their liver by a whopping 77%. As a result, they were able to normalise their blood sugar levels, without taking any medication, within just 1 week![7] 

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What’s the best way to go about it?

Obviously, there are different ways to lose weight, and some are more sustainable in the long-term than others—regardless of whether you have type 2 diabetes. And sustainable weight loss, it seems, is the crux of the matter when it comes to reversing type 2 diabetes and achieving long-term remission.

Going back to the DiRECT trial mentioned above, which saw impressive rates of remission 1 and 2 years after significant weight loss, the intervention involved total diet replacement (TDR) for 12 to 20 weeks, followed by phased reintroduction of food and structured, long-term support to maintain weight loss.[6] 

86% of people who lost over 15kg by following a low-calorie diet were in remission after a year

Lean et al., Lancet

While other diets or programmes have demonstrated some success in reaching type 2 remission—we discuss some of them here—the medical literature suggests that very low-calorie diets, such as TDR, offer the best chances for obese people to sustain weight loss and for those with type 2 diabetes to reverse their disease [8,9]. 

At this point, it’s worth noting that most of the research into diabetes reversal has looked at people who are obese. Currently, the ReTUNE trial is building on the findings from the DiRECT study by examining whether weight loss in people who aren’t obese can lead to remission.[10]

A magic pill for diabetes reversal? Things not to try

As the saying goes—no pain, no gain. And unfortunately, there’s no silver bullet that will suddenly and effortlessly put diabetes into remission. If something seems too good to be true, it probably is. 

For instance, The Telegraph reported back in 2015 that “a chemical which caused munitions factory workers to lose weight inexplicably in the First World War could cure diabetes”.[11] 

The chemical in question is known as DNP, and in the 1920s it was mixed with other agents to make explosives. On exposure to DNP, the workers’ metabolisms drastically sped up leading them to shed huge amounts of weight. 

Weight-loss drugs made from DNP in the aftermath of its metabolic effects being discovered were very quickly banned, because the chemical is dangerously toxic even in minuscule quantities. But a century later, preparations of DNP are still available—illegally—on the internet, putting lives at risk.

The 2015 newspaper article was in fact reporting on a research study, which found that a much less potent dose of DNP—100 times weaker than previously used—was effective in reversing type 2 diabetes and reducing liver fat in mice.[12] The study’s authors believe that similar results could be replicated in humans, by harnessing the positive metabolic effects of the chemical while removing the toxicity. 

Although this is encouraging, it’s important to recognise that this research will take many years to progress to human trials, if it’s even given the go-ahead. 

Meanwhile, the advice is very simple: do not take DNP or any derivatives under any circumstances, and steer clear of any type of ‘diabetes supplement’, ‘natural diabetes treatment’ or another remedy that markets itself as an easy fix. 

Despite appealing-sounding claims, many are illegal and unsafe,[13,14] Avoid any treatments that are not part of your management plan overseen by your specialist healthcare professional. 

The takeaway—reversing type 2 diabetes

The key to unlocking diabetes reversal and putting your disease into remission is sustained, long-term weight loss, and is best achieved through a structured programme of total diet replacement followed by gradual reintroduction of food. 

However, it’s not a one-size-fits-all approach, and it might not be suitable or work for everyone. 

And if it works, it’s not easy to get there: TDR typically means consuming around 800 calories in the form of nutritionally complete, powdered soups and shakes for around 12 weeks—and that requires a huge amount of willpower. Even when food is phased back into a healthy, balanced diet, continued success relies on hard work, commitment, and dedication to make the necessary lifestyle changes and stick to those healthy habits.

The payoff is well worth the effort, however. People in type 2 diabetes remission no longer need to take glucose-lowering medication, enjoy all-round healthier lives, and could potentially reduce their risk of cardiovascular complications associated with carrying extra weight. 

And remember—before embarking on any lifestyle change or weight-loss programme, consult your GP or diabetes healthcare professional. 

References

1. Riddle, M., Cefalu, W.T., Evans, P.H., et al. (2021). Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care 44 (10): 2438–2444. Accessible here.

2. Number of people with obesity almost doubles in 20 years. Diabetes UK. Retrieved 15 August 2022. Accessible here.

3. Type 2 Diabetes and Metabolic Surgery. American Society for Metabolic and Bariatric Surgery. Retrieved 15 August 2022. Accessible here

4. Pories W.J., Caro, J.F., Flickinger, E.G., et al. (1987). The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. Ann Surg 206(3):316-323. Accessible here.

5. Dixon J.B., O'Brien, P.E., Playfair, J., et al. (2008). Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes: A Randomized Controlled Trial. JAMA 299(3):316–323. Accessible here

6. Lean M.E.J., Leslie, W.S., Barnes, A.C., et al. (2019). Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 7(5):344-355. Accessible here.

7. Lim E.L., Hollingsworth, K.G., Aribisala, B.S., et al. (2011). Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 54:2506–2514. Accessible here.

8. Anderson J.W., Konz, E.C., Frederich R.C., Wood, C.L., et al. (2001). Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 74(5):579-84. Accessible here.

9. Churuangsuk C., Hall, J., Reynolds, R., et al. (2022). Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 65:14–36 . Accessible here

10. ReTUNEing Type 2 Diabetes Remission. Diabetes UK. Retrieved 22 June 2022. Accessible here

11. Knapton S. First World War explosive could reverse diabetes, says Yale University. The Telegraph, 26 February 2015. Retrieved 15 August 2022. Accessible here.

12. Perry R.J., Zhang, D., Zhang, X-M., et al. (2015). Controlled-release mitochondrial protonophore reverses diabetes and steatohepatitis in rats. Science 347(6227):1253-1256. Accessible here.

13. Beware of Illegally Marketed Diabetes Treatments. US Food and Drug Administration. Retrieved 15 August 2022. Accessible here.

14. Herbal and food supplements. Diabetes UK. Retrieved 15 August 2022. Accessible here

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