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Is type 2 diabetes reversal permanent?

We now know that reversing type 2 diabetes is possible through weight loss and other healthy practices. But the question remains, can type 2 diabetes be reversed permanently?
Simon Lovick
8/3/2022
10
min read
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Quick summary

  • Type 2 diabetes reversal tends to happen as a result of weight loss and implementing much stricter diets
  • It’s best not to think of reversal as a cure though, given that it isn’t permanent 
  • Keeping your type 2 diabetes in remission requires long-term, sustained effort
  • Dieting and exercise are just some of the good practices to maintain your reversal

It’s official. Decades of research, including extensive patient trials, have concluded that type 2 diabetes is reversible. 

Through a number of courses of action, mostly through changing lifestyle or eating habits, people living with type 2 diabetes are able to put symptoms into remission. At Habitual, we shine a light on the number of things you can do to move towards type 2 diabetes reversal.

It would be a mistake, however, to think of reversal as the end of the journey. So can type 2 diabetes be reversed permanently? In short, no: there is no permanent cure yet for type 2 diabetes. 

In this article, we’ll explain how type 2 diabetes reversal works, and what you need to do in order to achieve and sustain your remission. The aim is to provide type 2 diabetes patients with a long-term view of how to keep the risk of their diagnosis as low as possible.

How does type 2 diabetes reversal work?

Type 2 diabetes reversal is not something that happens overnight. It requires your sustained effort and commitment to change your lifestyle, in particular your bad habits, enough to put your diabetes into remission. 

Weight loss is central to this. There have been a series of groundbreaking studies that have found a strong correlation between weight loss (usually through a diet upheaval) and remission. These include:

  • 2011 studies at Newcastle University took MRI scans of diabetes patients across an 8-week low-calorie diet, observing fat reduction on the liver and the pancreas, and blood sugar levels falling to within a normal range [1,2]
  • DiRECT trials - hundreds of patients undertook total diet replacement and behaviour change over 12 months. After 1 year, 46% had lost enough weight to see their diabetes go into remission; in those that had lost over 15kg, 86% went into remission. After 2 years, 70% who had gone into remission were still in remission [3]

So what is actually causing this? It’s certainly worth understanding the science to see what is actually happening inside your body. When you lose weight, you’re not only shedding subcutaneous fat (below the skin), but also the fat which builds up inside your organs. 

There’s a strong correlation between weight loss and type 2 diabetes reversal

Lean et al, Lancet

This happens particularly around the liver and pancreas—which is relevant for type 2 diabetes patients as these are the organs responsible for glucose and insulin balance. As they see a reduction in fat, their ability to control blood sugar resumes: in some studies, this can happen as quickly as 1 week. 

Weight loss must be significant—hence the benchmark of 15kg used in many trials looking into type 2 diabetes reversal. This isn’t exact—people have been known to enter remission having lost less than 15kg—so it’s best thought of as a goal for weight loss.    

Can type 2 diabetes be reversed permanently?

While weight loss and a healthy diet can see longer-term benefits, you shouldn’t think of type 2 diabetes reversal as permanent. 

Why is this? Well, just as the process of weight loss removes the internal fat from your organs, putting the weight back on can restore this fat on your organs. As soon as the fat comes back, then these organs can lose their formally-restored ability to regulate blood sugar levels. 

It is also worth acknowledging that, with regards to research around type 2 diabetes reversal, we’re still in the very early stages. Most trials only really have data for 2-3 years after remission: beyond that is somewhat of an uncertainty. 

In that sense, it's better to think of it as a treatment rather than a cure. So no—it’s not permanent.

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How can you keep type 2 diabetes in remission?

Understanding how you can put your type 2 diabetes in remission is only half the battle: knowing how to sustain it is just as important. This requires you to keep the good habits in place that helped you lose the weight in the first instance. 

Implementing and maintaining a healthy diet is certainly an effective way of losing weight, or at the very least keeping you at a healthy weight. One such technique is total diet replacement, or TDR. This involves a very low intake of calories (around 800kcal a day), usually through nutritionally complete shakes, smoothies, or soups. This technique was used in the DiRECT trials, so you can trust its efficacy with a high degree of confidence.

There are other dieting techniques that may help you with weight loss. This includes nutritional ketosis, a very low-carb, high-fat diet. Without carbohydrates, your body burns fat in order to release ketones, which act as fuel. There is strong evidence that a ketogenic diet can help people with a type 2 diabetes diagnosis, helping control blood sugar and thus reducing your reliance on medication (although patients studied still took metformin).[4] Word of warning: many people find keto diets very hard to maintain in the long term.

Dieting is of course only part of the picture. There are many things that contribute to weight loss, to a healthier lifestyle, and ultimately, to keeping your type 2 diabetes in remission. 

Exercise, for one, is a great way to stay trim and keep off that weight that you’ve lost. There’s also a close link between type 2 diabetes reversal and exercise that goes beyond weight loss: exercise releases proteins that help with glucose uptake, while also increasing blood flow around the body, which can also help regulate sugar levels. General guidance is to aim for around 30 minutes a day, or 2.5 hours a week.[5]

You should also be conscious of other risk factors for type 2 diabetes. Excessive drinking, smoking, and a sedentary lifestyle (when you spend most of your day sitting) all contribute to your risk of type 2 diabetes: avoiding these can help you stay in remission. 

Type 2 diabetes reversal is not permanent, so can’t be viewed with a short-term mindset. Take our plans—we’ve designed them with the view of putting type 2 diabetes into remission, but more importantly, it can help you implement healthier living practices holistically that will make you feel better physically and mentally. So don’t just view it as a simple weight loss exercise: view it with the long-term goal of living and feeling healthier.

References

[1] 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(10):2506-14. Accessible here.

[2] Taylor, R., Al-Mrabeh, A., Sattar, N. (2019). Understanding the mechanisms of reversal of type 2 diabetes.. Lancet Diabetes Endocrinol 7(9):726-736. Accessible here.

[3] 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.

[4] Halberg, S, McKenzie, A, Williams, P, et al. (2018). Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther 9(2):583-612. Accessible here.

[5] Exercise. NHS. Retrieved 12 May 2022. Accessible here.

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