Can You Get Rid of Diabetes?  – Remission of Type 2 Diabetes 

From Prediabetes to Diabetes and vice versa 

Diabetes exists on a continuum. People can think of diabetes as controlled by a slider instead of an on-off switch. We have set a point along the slider that is diabetes and prediabetes happens when you’re sliding away from the starting point and closer to the point marking diabetes, often because of suboptimal eating or exercise habits. It’s a warning sign.  

However, the slider can move both ways. Just as negative behaviors can move the slider toward diabetes, positive lifestyle changes can move it away from diabetes and toward normal glycemic regulation. 

Can Diabetes Be Cured?  

There’s no cure for diabetes and no way to completely get rid of it. However, diabetes can be reversed in most people. To be in remission, your blood sugar levels must remain normal for at least three months without using glucose-lowering medications.   

Type 2 diabetes is a chronic disease, so we don’t say it’s ‘reversed’ or ‘cured.’ Instead, we say it’s in remission. Once your diabetes is in remission, you should see your doctor regularly to check for recurrence. 

According to recent research individuals can have glucose levels that return to non-diabetes range, (complete remission) or pre-diabetes glucose level (partial remission) The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight. 

We talk of remission and not a cure because it isn’t permanent. The beta cells have been damaged and the underlying genetic factors contributing to the person’s susceptibility to diabetes remain intact. Over time the disease process reasserts itself and continued destruction of the beta cells ensues. An environmental insult such as weight gain can bring back the symptomatic glucose intolerance. 

Patients may also go into remission when prior to treatment they were glucose toxic. Glucose toxicity can temporarily shut down insulin production from the beta cell. When glucose levels are lowered the beta cells begin to function again. This is often seen in people who have had untreated diabetes for a long time and whose A1c level is acutely elevated. They may require insulin for a short period of time and once the glucose level is lowered and the beta cells start to function again they then can often revert to pills or lifestyle management. 

Diabetes in remission means carefully managing blood sugars to a point where medications are no longer necessary, and staying at that manageable point through a healthy routine of diet and exercise. In medical terms, this means having a HbA1c below 48mmol/mol or 6.5%. This definition has been agreed by a team of international experts from Diabetes UK, the American Diabetes Association, and the European Association for the Study of Diabetes.

Returning to the slider analogy clarifies what it means to reverse diabetes. Healthy habits move the slider toward a more manageable state; they cannot switch the diabetes “off.” Furthermore, the slider can move back toward diabetes if someone fails to maintain healthy habits. 

Early diagnosis and intervention are critical in managing Type 2 diabetes. Remission of Type 2 diabetes is more likely if:

• you’ve been recently diagnosed with Type 2 diabetes
• have lower blood sugar levels and
• have achieved weight loss. 

Why we don’t call it ‘reversing’ type 2 diabetes 

Type 2 remission is called ‘reversal’ by some people, but the word remission is more accurate.  

The reason we call it remission is because ‘reversal’ can make it sound like your diabetes is cured or has gone away. However, you are more likely to feel better and see improvements in your health long-term.  And because of that people may stop going for their diabetes checks. 

When you’re in remission your diabetes has not gone away completely so you still need your checks. There are two main reasons for this:  

• Being in type 2 remission stops the diabetes from doing any new damage to you and your body.
• But you may have damage caused by high sugar levels from before you went into remission. Diabetes eye screening and checks for kidney disease are ways to check for signs of diabetes-related problems. 

The chances of going into type 2 diabetes remission 

We are still learning how to support everyone with type 2 diabetes to go into remission. Many people who have tried for remission have gone into it. Some people who have tried haven’t gone into remission. But we know that: 

• The chances of remission are better the sooner you try after your type 2 diagnosis. 
• If you are living with obesity, your type 2 diabetes is more likely to go into remission if you lose around 15kg of weight as quickly and safely as possible following diagnosis. 
• You can go in and out of remission. Some people stay in remission for years. Others find that their blood sugar levels rise again after a time if they regain weight, and they come out of remission. 

Staying in remission can be tough. You need to be supported to keep your weight at the level that is right for you, which prevents fat building up again in your liver and pancreas. 

Any time spent with your blood sugar levels below the diabetes range can have benefits. And, if you do come out of remission, it is possible to get your blood sugar levels back down to a non-diabetes range.. 

Whether you go into remission or not, working towards it and losing weight brings about many other health benefits. 

The rate of type 2 diabetes is increasing around the world. Type 2 diabetes is a major cause of vision loss and blindness, kidney failure requiring dialysis, heart attacks, strokes, amputations, infections, and even early death. Over 80% of people with prediabetes (that is, high blood sugar with the high risk for developing full-blown diabetes) don’t know it. And one in four people who have full-blown diabetes don’t know they have it. Research suggests that a healthy lifestyle can prevent diabetes from occurring in the first place — and even reverse its progress. 

You may not even know you have prediabetes or diabetes—you can be symptom-free for years. But once the complications of diabetes start to occur, nearly every aspect of your health can be affected. That’s because the excessive sugar in your blood damages blood vessels and nerves throughout your body

Benefits of type 2 diabetes remission 

Being in remission and having blood sugar levels below the diabetes range long-term can reduce your chances of developing diabetes-related complications, like heart attacks, strokes and diabetes-related sight loss. 

For some people, putting their type 2 diabetes into remission can help lower their blood pressure, cholesterol and body weight. All of which can have a huge impact on your everyday health and wellbeing, and your long-term health.  

The everyday benefits can include:  

• taking fewer medications  
• having more energy and sleeping better.  
• feeling like you have more control over your body.  
• The long-term benefits can include:  
• less risk of heart attack and stroke  
• less risk of avoidable sight loss   
• less risk of amputations    

How these long-term benefits work 

When your blood sugar levels and blood pressure are lower, this reduces the damage they can do to your blood vessels. 

Damaged blood vessels in the heart can cause heart attack and strokes. Damaged blood vessels in the eyes can cause diabetes-related sight loss. And damaged blood vessels in your hands and feet can affect the blood flow to these limbs. This can cause problems that can lead to amputations.  

Having lower blood sugar levels, blood pressure and cholesterol levels can help reduce your risk of getting these complications. In fact, any improvements in these levels can reduce your risk, whether you go into remission or not.  

We know that remission is a possibility for many people living with type 2 diabetes. And the strongest evidence we have suggests that type 2 diabetes is mainly put into remission by weight loss.  

We don’t know enough to say if weight loss will lead to remission for everyone though. There are people who haven’t been able to get their blood sugar levels below the diabetes range without the need for medication, no matter how hard they’ve tried. The causes of type 2 diabetes are multiple and complex. But we do know that in many cases it’s caused by a build-up of fat inside the liver and pancreas. 

Suggested action plan and lifestyle changes

Perhaps not surprisingly in one study done regarding diabetes remission, the diet and lifestyle intervention was incredibly effective. After three years, the diet and lifestyle group had a 58% lower risk of developing diabetes than the placebo group. Participants ages 60 and older had an even better response, with a whopping 71% lower risk of developing diabetes. The diet and lifestyle effect lasted: even after 10 years, those folks had a 34% lower risk of developing diabetes compared to placebo. 

Men, women, and all racial and ethnic groups had similar results (and almost half of participants represented racial and ethnic minorities). These results are not surprising because patients with prediabetes or diabetes do get their sugars down regularly with diet, exercise, and weight loss alone. 

Meanwhile, the medication group had a 31% lower risk of diabetes after three years, and an 18% lower risk after 10 years, which is also significant. It’s perfectly all right to use medications along with diet and lifestyle changes, because each boosts the effect of the other. Studies looking at the combination of medication (metformin) with diet and lifestyle changes have shown an even stronger result. 

Losing even a modest amount of weight may change the prognosis. 

Prediabetes can be seen as a warning sign—it’s the body’s way of saying that your insulin levels are rising. You can still prevent or delay type 2 diabetes by losing weight—even a modest amount—with the help of dietary changes, stress reduction, and physical activity. Taking medication can also help. 

And reversing the process is key because type 2 diabetes can be a devastating disease. The condition usually begins with insulin resistance, in which the fat, liver, and muscle cells do not use insulin properly. Eventually, the body needs more insulin than it can produce, causing blood glucose to rise. Those elevated levels can lead to serious health issues if they are not managed properly. 

Medications, like metformin, can prevent prediabetes from progressing into diabetes. However, these drugs aren’t as effective as making lifestyle changes. You can prevent and reverse insulin resistance and prediabetes by adopting healthy lifestyle habits. The key is to start making changes early on. 

In general, addressing the underlying weight issues that led to diabetes can help reverse it. 

A focus on eating less separates reversing diabetes from managing diabetes, which doesn’t necessarily involve weight loss. Managing diabetes involves stabilizing blood sugar levels through lifestyle modifications and medications such as Metformin. 

6 Lifestyle changes to put diabetes into remission 

• Exercise regularly. Work toward exercising 30 minutes a day, five days a week. Include a combination of light cardio and strength training. 
• Lose weight using medications, dietary changes, or bariatric (weight loss) surgery as prescribed by your doctor.  
• Eat healthily. There’s no one-size-fits-all diabetes diet. Start by reducing processed foods and foods high in sugar and carbohydrates. You can also try the Diabetes Plate Method. Or, meet with a  nutritionist or dietitian to develop an individual dietary plan. 
• Get enough sleep. Aim for at least seven to eight hours of sleep each night. 
• Quit smoking. Talk to your doctor if you need help breaking this habit. 
• Manage sleep apnea. If you suspect you have sleep apnea, get evaluated by your doctor and get treated. 

How can we reduce the number of people with prediabetes? 

Type 2 diabetes is more likely to occur in people who are over the age of 40, overweight, or have a family history in diabetes. Certain ethnic and racial groups also have higher risk for type 2 diabetes, including black, Hispanic/Latino, American Indian, Asian American and Pacific Islander. However, over the past decade the incidence of type2 diabetes has been increasing in adolescents and the young adult population. 

One of the challenges to bringing down prediabetes is identifying who has it, since many people aren’t automatically screened for the condition. In 2021, a U.S. Preventive Services Task Force recommended lowering the initial screening age for prediabetes (and type 2 diabetes) to age 35 for asymptomatic adults who have overweight or obesity. But that doesn’t cover people younger than 35—and a CDC study published in 2019 showed one in five adolescents and one in four young adults up to age 34 were already living with it.  

Parents may need to talk to a pediatrician when their children are in adolescence—or even before that—and adults should assess their lifestyles while they are still in their 20s or 30s. Glucose tolerance worsens with age, so problems that aren’t controlled early may be more difficult later on. 

Anyone who is concerned should understand their glucose numbers and check them routinely. You should know your weight, your blood pressure, and your A1C. Keep tabs on your health and take action if necessary. 

Read next: Dietary Changes and 6 Types of Diet for Diabetes Type 2 Remission 

References:

1. https://medschool.ucla.edu/news-article/can-diabetes-be-reversed#:~:text=There’s%20no%20cure%20for%20diabetes,routine%20of%20diet%20and%20exercise.
2. https://www.nebraskamed.com/diabetes/is-it-possible-to-reverse-diabetes
3. https://www.diabetes.org.uk/diabetes-the-basics/type-2-remission/type-2-reverse
4. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/reversing-diabetes
5. https://www.yalemedicine.org/news/prediabetes
6. https://www.joslin.org/patient-care/diabetes-education/diabetes-learning-center/can-type-2-diabetes-be-reversed