Achieving remission in type 2 Diabetes

Type 2 diabetes remission refers to a state where blood sugar levels return to normal or prediabetic levels without the need for diabetes medications, especially insulin or oral hypoglycemic agents. It is important to note that remission does not mean a cure; rather, it indicates effective management of the condition to the point where glucose levels remain in a healthy range for an extended period.
The American Diabetes Association (ADA) defines remission as:
Partial remission: Blood glucose levels are lower than the diabetes range but still above the normal range for at least one year without the use of medications.
Complete remission: Blood glucose levels are within the normal range for at least one year without medications.
Prolonged remission: Normal glucose levels maintained for at least five years.
Key parameters for remission:
• HbA1C (Glycated Hemoglobin): Below 6.5% without medication.
• Fasting blood glucose: Less than 6.1 mmol/L.
• Post-meal blood glucose: Less than 7.8 mmol/L (two hours after eating).
How can type 2 diabetes remission be achieved?
Remission is most often achieved through significant lifestyle changes, weight management, and, in some cases, medical interventions. Here are some of the primary strategies:
• Weight Loss and calorie restriction:
Achieving and maintaining significant weight loss, particularly in the early stages of type 2 diabetes, can dramatically improve insulin sensitivity and lower blood glucose levels.
Methods:
• Very Low-Calorie Diets (VLCD): These involve consuming around 800 calories per day for a short period (usually 8-12 weeks), often followed by a structured plan for reintroducing normal foods.
• Weight loss of 10-15%: Studies show that losing 10-15% of body weight can lead to diabetes remission in many individuals, especially those who are overweight or obese.
• Bariatric surgery
Who it is for: Bariatric surgery is a viable option for individuals with type 2 diabetes and obesity, especially if other weight-loss methods have failed.
Types of surgery: Procedures like gastric bypass and sleeve gastrectomy can lead to significant weight loss and hormonal changes that improve blood glucose control.
Success rate: Many patients experience remission of diabetes after bariatric surgery, with some studies showing remission rates of 50-80%.
• Dietary changes
Low-carbohydrate diets: Reducing carbohydrate intake can lower blood sugar levels and improve insulin sensitivity.
Mediterranean diet: Emphasises whole foods, healthy fats, lean proteins, and plenty of fruits and vegetables.
Plant-based diets: Diets rich in fiber, vegetables, legumes, and whole grains can help improve insulin sensitivity and reduce blood sugar levels.
• Increased physical activity
Exercise types: Incorporating aerobic exercises (like walking, jogging, and swimming) and strength training can enhance insulin sensitivity and promote weight loss.
Frequency: At least 150 minutes of moderate exercise per week, plus strength training exercises twice a week, is recommended for optimal results.
• Intermittent fasting
Concept: Intermittent fasting (e.g., the 16/8 method, where you eat during an 8-hour window and fast for 16 hours) has shown promise in improving insulin sensitivity and reducing blood sugar levels.
Impact: Some studies suggest intermittent fasting may help achieve diabetes remission by improving insulin sensitivity and reducing insulin resistance.
• Factors influencing type 2 diabetes remission
Duration of diabetes: The shorter the time someone has had type 2 diabetes, the higher the chances of achieving remission, particularly if it’s within the first few years of diagnosis.
Age: Younger individuals tend to have better outcomes due to increased insulin sensitivity and the ability to make lifestyle changes.
Initial blood sugar levels: Those with lower A1C levels at diagnosis may find it easier to go into remission.
Lifestyle commitment: Consistent adherence to a healthy lifestyle, including diet and exercise, plays a crucial role.
Achieving remission of type 2 diabetes is possible, especially with early intervention, significant lifestyle changes, and, in some cases, medical procedures. However, it requires dedication and a long-term commitment to healthy habits to sustain it.
The writer is the Associate Professor of Department of Endocrinology at Bangabandhu Sheikh Mujib Medical University.
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