A team of UK scientists have found that it is possible to send patients with type 2 diabetes into remission through lifestyle changes. The researchers from Glasgow University and the University of Newcastle, published their research in the British Medical Journal (BMJ), which is a peer-reviewed publication. The abstract can be read online.
Between 5-10% of the UK population is affected with type 2 diabetes, caused when the body no longer produces enough insulin to maintain healthy blood sugar levels. When a patient's average blood sugar level rises to harmful levels, then diabetes is diagnosed. Patients are prescribed anti-diabetic medication to help manage their blood sugar and prevent complications developing which could cause disability or death. These include leg ulcers, eye damage and heart disease. Obesity is linked to the disease, and along the prescription, patients are recommended to try and achieve weight loss and take part in more activity.
It has been recorded by doctors that if patients manage to achieve weight loss, then their blood sugar levels can drop back to normal and stabilise, without the use of diabetes medicines. If the patient were to regain the weight, then the disease might well return, so doctors talk about it being in remission rather than cured.
The study reviewed type 2 diabetes management and remission, but found that there was no systemised way to assess and record remission from the disease. The scientists found that only 0.14% of 120,000 people achieved remission in a US study while less than 0.1% of Scots diagnosed with the condition had been logged as being in remission. The scientists acknowledge that the reason for the low figures is likely that not many patients are currently achieving remission, but they argue that part of the reason for that is that doctors and patients are not aware that remission could be achieved with significant weight loss.
The scientists suggest that without gathering official information on remission of type 2 diabetes, then it is hard to compile accurate figures. They suggest that there is a lack of agreed criteria and guidance over recoding the disease, but that it is important that when remission is achieved that it is noted and that people are reclassified as non-diabetic. Patients who achieve remission should still be monitored annually and be aware that if the weight is gained again, that the disease may return. The scientists suggested new criteria to define remission from diabetes: that when two blood sugar measurements of less than 6.5% glycated haemoglobin, which is measured for diabetes, are taken at least 2 months apart in patients that have not been taking their medication, then the patient should be coded as being in remission.
The scientists pointed out that achieving remission offers great health benefits, produces a strong sense of personal achievement, removes stigma and empowers patients.
Studies have shown that the best way to achieve weight loss is to follow a calorie-controlled diet. Overweight patients who have type 2 diabetes will need to lose at least 15 kg. 75% of patients who achieve this weight loss will go into diabetes remission. The patient will also gain other health benefits.
Patients who are diagnosed with type 2 diabetes are recommended to make lifestyle changes such as eating a healthy, balanced diet, taking regular exercise, following current guidelines (at least 150 minutes of moderate-intensity exercise a week), giving up smoking and limiting alcohol to recommended daily amounts (currently no more than 14 units a week). They are also recommended to have annual eye tests for diabetic retinopathy and twice yearly for other conditions, keep a careful eye on the health of their feet and take care of their health, including having an annual flu jab.
McCombie L., et al., Beating type 2 diabetes into remission, BMJ, 2017; 358:j4030