Being diagnosed with type 2 diabetes can be difficult, especially since the disease is perceived as incurable.
But experts say diabetes can be reversed early on.
“If you follow the advice of your doctors and nutritionist and make an effort to lose weight, diabetes can be reversed by normalizing your blood sugar levels without medication early in the course of the disease, that is the first three to five years,” Dr. Sangeeta Kashyap, endocrinologist at Cleveland Clinic, told Healthline.
Researchers at the University of Glasgow in Scotland agree and want to promote this message.
In a recent study published in The BMJ, Scottish researchers report that patients and doctors may not be aware that type 2 diabetes can be reversed.
They said that weight loss of around 33 pounds often produces total remission of the disease, yet remission is often not coded in medical records.
They point to a U.S. study that found remissions in less than 1 percent of 120,000 patients who were tracked for seven years.
Similarly, a database that includes all patients in Scotland shows less than 1 percent of type 2 diabetes coded as being in remission.
The researchers argue that greater awareness, documentation, and surveillance of remissions would improve health outcomes and reduce healthcare costs.
Just a honeymoon period?
Researchers say that the reasons why remission isn’t coded may be due to medical professionals’ disagreement on criteria and guidance as well as the fact that few patients are trying to gain remission or actually achieving remission.
Dr. Ashwin Patel, the chief medical officer of InquisitHealth who also sits on the Community Leadership Board of the American Diabetes Association, agrees.
“There’s a ‘fixed’ criteria for the diagnosis of diabetes, so it makes diabetes seem like it’s a very clear, binary diagnosis. In that, either you have it or you don’t,” Patel told Healthline. “Importantly, not only is there ongoing debate on what the right criteria should be, there is a growing realization that diabetes, especially type 2, isn’t binary physiologically. It’s much more of a continuum.”
Another reason, Kashyap points out, is that even if blood sugars reach normal levels due to weight loss achieved by dieting, exercising, or surgery, they may not stay normal for a long period of time.
“Blood sugars can come back into the diabetes range, and so some people feel like this isn’t reversing diabetes, [but rather] silencing the disease,” said Kashyap. “I call this a ‘honeymoon period,’ meaning the blood sugars normalize, there’s no meds needed, and things look great, but we don’t know how long that will last.”
She notes that in up to 60 percent of people who have bariatric surgery, their diabetes comes back within 15 years.
“I tell people it’s a nice vacation from their disease and we hope it does slow down developing complications from diabetes, such as heart, eye, kidney, and nerve disease,” said Kashyap.
Why does diabetes come back?
The reasons aren’t known, but it may be due to weight gain or genetics.
“Part of the reason that the pancreases fails to produce insulin over time is genetic. Also, as you age, your pancreatic function declines. That’s why it’s common to see diabetes in people in their 60s and 70s,” Kashyap explained.
Worth the psychological boost
Whether or not a person stays in remission from diabetes long term, researchers say that noting their remission is still worth it.
“When someone works really hard to lose 15 percent of their body weight, they’ve put a lot of work in. If blood sugar is normalized and they’re not on medications, it can be a big psychological boost to put in their chart that they are in remission,” said Kashyap. “It reinforces the message that if you work hard to lose weight you can see results.”
Think of someone with breast cancer who undergoes treatment and then goes into remission. When this occurs, remission is almost always documented in their records.
“This gives the person hope. They may even forget about cancer for a while,” said Kashyap.
When it comes to diabetes, recognizing remission may also give a person a sense of control since weight and diabetes are strongly tied.
“Weight is the root cause of people developing diabetes at a young age. More than 82 percent of people with type 2 diabetes are overweight,” said Kashyap. “Now we have a lot of tools to help people to lose weight, such as nutritionists, exercise physiologists, medications, and surgery. You can’t control your age or who your parents are, but you can modify your weight.”
From the physician’s perspective, documenting remission is a way to back the importance of lifestyle changes.
“Like The BMJ article said, we physicians often push drugs, but give lip service to lifestyle modification. This is a way to not do lip service. By putting it in the chart, we’re recognizing patients’ efforts and keeping them motivated to keep it up,” Kashyap said.
If lifestyle changes are implemented successfully during the early stages of being officially diagnosed with diabetes, and if medications are no longer required, Patel says documenting diabetes “remission,” diabetes “being reversed,” or simply that someone’s diabetes is now “diet-controlled” can have impact beyond the patients themselves.
“These might seem like semantics, but they have real downstream implications for research, budget/cost analyses, and most importantly, for the individuals having, or not, the potentially stigmatizing label of diabetes,” noted Patel.