However, there is always the risk of symptoms returning. For this reason, experts are wary of suggesting that type 2 diabetes is curable. Instead, when a person reaches normal blood sugar levels without medication, they are said to be in remission.
Recent research explores three strategies for achieving remission: very low-calorie diet, intensive lifestyle therapy, and weight-loss surgery.
Very low-calorie diet
Studies suggest that a low-calorie diet may enable a person to reach normal blood sugar levels without medication.
A review published in the journal Clinical Science suggests that every individual has their own "personal fat threshold." If the amount of fat that builds up in key organs exceeds this threshold, cells are blocked from responding to insulin.
The goal of a short-term very low-calorie diet is to burn fat from key organs quickly. This does two things:
- Kickstarts the response of cells to insulin.
- Gives the pancreas a rest. Though the pancreas initially works hard to secrete extra insulin, it will eventually burn out.
With the body's insulin production and sensitivity reset, people can move toward a long-term low-calorie diet and healthful lifestyle plan.
A recent study in the journal Diabetes Care tested the very low-calorie approach in 30 people. The study used a three-step program:
- an 8-week diet of nutrition shakes and nonstarchy vegetables
- gradual replacement of shakes with normal solid food diet over 2 weeks
- a personal weight maintenance and exercise program for 6 months
The nutrition shakes were 43 percent carbohydrate, 34 percent protein, and 19.5 percent fat. Around 624-700 kilocalories (kcal) were consumed per day during the first 8 weeks.
After the first 8 weeks, 40 percent of participants achieved remission. After the 6-month maintenance period, the statistic increased to 43 percent.
Those who could not sustain remission after the first stage were referred to as "non-responders." Non-responders followed the program, lost weight, and showed improved sensitivity to insulin. However, diet and exercise alone could not recover their pancreases' full abilities to produce insulin or improve their bodies sensitivity to insulin.
The non-responders in the study had diabetes for longer than 8 years. The people who sustained remission had diabetes for less than 4 years. This finding supports the idea that type 2 diabetes is a progressive disease.
Intensive lifestyle therapy
A similar option to the very low-calorie diet approach was explored in a recent study in the Journal of Natural Science, Biology, and Medicine study. Intensive lifestyle therapy also relies on major changes to diet and exercise. However, there are a few differences:
- participants are allowed 1,500 kcal a day, and food is solid
- the same diet is followed in the long term
- diabetes medication is initially taken
The diet is 60 percent carbs, 15 percent proteins, and 25 percent fat. Diabetes medication is stopped after normal fasting blood sugar levels are achieved.
Reversal took a bit longer to achieve using this approach, but the results were still strong. A total of 75 percent of participants achieved remission at 3 months and sustained remission for 1 year. A total of 68.75 percent were still in remission at 2 years.
These high remission rates do not necessarily mean that intensive lifestyle therapy is better than the very low-calorie approach. All the participants in this study were recently diagnosed with diabetes, making it easier to reverse.
A gastric bypass operation may be required if blood sugar levels are still dangerously high after unsuccesful lifestyle and medication treatments.
Lifestyle change should always be the first approach to managing type 2 diabetes. However, some people are unable to lose enough weight this way.
Even with medication, their blood sugar levels may remain dangerously elevated. In cases like this, weight-loss surgery may be the best option.
According to Diabetes UK, international guidelines recommend weight-loss surgery for individuals who:
- have a body mass index (BMI) over 40, regardless of how well their blood sugar is managed
- have a BMI of 35-40, if blood sugar levels can't be managed with lifestyle changes and medication
In the United States, people with a BMI of 35-40 who have another disease, such as diabetes, are recommended to have weight-loss surgery.
Gastric bypass and laparoscopic gastric banding are the two main types of weight-loss surgery. Gastric bypass shrinks the stomach and shortens the path to the intestines. Laparoscopic gastric banding squeezes the stomach with a belt or takes out a part of the stomach so that it will feel full faster. Both limit the number of calories that people can consume.
Aside from weight loss, these two types of surgery can help bring about remission in other ways:
- They can increase the amount of bile the body secretes. This makes cells more sensitive to insulin.
- They can alter the gut's production of various hormones that are involved in breaking down sugars and fats.
A study published in the New England Journal of Medicine compared patients treated with weight-loss surgery with patients treated with medication alone. At 12 months after surgery, about 78 percent of gastric bypass patients and 51 percent of laparoscopic patients were able to stop their diabetes medication. None of the medication-only patients achieved remission.
The authors explain that previous studies have shown higher remission rates of between 55 and 95 percent. However, the participants in this study were in much more advanced stages of diabetes.
The American Diabetes Association divide remission into three levels:
- Partial remission: blood sugar levels are elevated, but remain below diabetic levels for at least a year without medication.
- Complete remission: blood sugar levels remain at a normal range for at least a year without medication.
- Prolonged remission: when someone has been in complete remission for 5 or more years.
Achieving prolonged remission can be difficult. Having diabetes even for a short time makes people more at risk from insulin resistance and deficiency. For this reason, it's important to avoid regaining weight by sticking to a healthful diet and exercise routine.
Diabetes Ireland offer some simple diet and exercise guidelines. They suggest that people should:
- choose lower-fat options when eating meat, poultry, and dairy
- include a variety of fresh fruits and vegetables in your diet
- stick to unrefined and whole grain starches
- stay away from high-sugar and high-fat foods
- exercise moderately for 30 minutes a day, 5 days a week
- for weight loss, this level of exercise can be increased to 60-90 minutes a day
Following more specific dietary restrictions can also be an option. However, there is controversy over which kinds of restrictions are most effective. While many doctors and dieticians suggest a low-carb diet, others believe that low-calorie or low-fat diets are equally or more effective.
A recent New York Times article explains that there is strong evidence for the short-term success of low-carb diets in keeping blood sugars in check. However, further long-term studies are needed to find out whether these benefits will last, whether they are significantly different from those of a low-fat or low-calorie diet, and whether a lack of healthy carbs could have any harmful effects.
Some doctors believe that as long as weight loss is achieved and sustained, the specifics of a diet plan aren't too important. The most important thing is for people to choose a diet plan that is healthful, well-proportioned, and that will be possible to stick to.