Is Diabetes Reversible?
New studies have shown that it may be possible to reverse type 2 diabetes without the need for pharmaceutical drugs or invasive procedures.
Clinical research has definitively taught us that diabetes is preventable for the majority of those at risk for it. To clarify, there are two types of diabetes, broadly speaking. The first, termed type 1 diabetes, is due to an immunological problem that destroys the ability of the pancreas to make insulin. Type 1 diabetes accounts for less than 10% of all diabetes, and it cannot currently be prevented. On the other hand, type 2 diabetes, which results from the multifactorial contribution of genetics, lifestyle, and one’s environment, accounts for over 90% of all diabetes. It is this type of diabetes that studies have shown can be prevented by dedicated, stepwise lifestyle modification.
The big question really is: can diabetes be reversed once you get it? For type 1 diabetes, the current answer is: no, although research is proceeding furiously to change this reality. On the other hand, there is ongoing work that strongly suggests the possibility that type 2 diabetes might be reversible. We all may have heard of someone with type 2 diabetes who had to manage their blood sugar with pills or insulin shots, but now doesn’t need these medications any longer. But how applicable are these stories to the average person, and most importantly, how did they do it?
The medical and research community typically views type 2 diabetes as a continuum, beginning at an early stage with prediabetes, progressing to full-blown type 2 diabetes (if no healthy life style changes are made), and ultimately leading to a requirement for insulin for those in whom the pancreas begins to fail slowly over time. We know that taking immediate steps, including adopting a healthier diet and increasing daily activity, can prevent the disease, but what happens once type 2 diabetes is diagnosed? Is it possible to shift this continuum and revisit ourselves when we were healthier?
Until recently, the best evidence that type 2 diabetes might be reversible comes from bariatric surgery patients who were both obese and diabetic. In such people, gastric bypass and related procedures can rapidly and robustly normalize blood sugar levels. Ever since doctors made this striking finding, the goal has been to discover exactly how this works, and whether it can be reproduced without surgery.
A few new studies have encouragingly shown that it may be possible to reverse diabetes without the need for pharmaceutical drugs or invasive procedures. Researchers at Newcastle University in the United Kingdom discovered that deep reductions in calorie consumption, and subsequent weight loss, can reverse diabetes. They also found that these effects are quite durable, lasting for periods of up to six months.
However, the study does have a few caveats. For one, the study participants could only eat up to 700 calories per day. That goal was met by limiting their consumption to specifically designed shakes and vegetables. It might be difficult to get a large population of people to commit to such a strict diet for months at a time. The effects were also only seen in small groups of about a dozen people. To be reliable, many more people must be included in such a study, including both men and women from multiple ethnicities. Also, since the study only lasted for six months, many who had seen a reversal based on the strict diet saw the diabetes return after a year or more. This suggests that such an extreme diet might not remain as promising an approach for long-term management.
By comparison, milder dietary changes, including for example, the adoption of a “Mediterranean diet”, have been shown to help prevent diabetes in those at risk, but have not been definitively studied in people who already have diabetes. Such studies are in the works. Indeed, the CDC’s Diabetes Prevention Program (DPP), which includes a formalized approach to lifestyle modification involving diet, physical activity, and stress reduction, was shown to improve glucose control even in people who already had diabetes. Thus, the stage is set to test whether a program such as the DPP, or any of a variety of other approaches, can stably put type 2 diabetes into remission, at least when it is still in its early stages.
As we continue to search for ways to reverse diabetes — for example, exploring the relationships between what bariatric surgery and profound calorie restriction do to glucose control — it is highly likely that we’ll start to see increasingly innovative and scalable strategies emerge to address the ongoing worldwide diabetes epidemic. As mentioned, these are likely to focus not only on preventing diabetes, but also on reversing it for good.
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