Type 2 diabetes is often described as a progressive disease. If left unchecked, without the right healthcare intervention and lifestyle changes, it can gradually deteriorate over time and more medications will be required to manage the disease.
But what about the opposite? With the right lifestyle changes and a resolute mind to be better at looking after one’s health, can you “reverse” the disease or more accurately, put it into remission? Reversal implies a permanent cure and unfortunately for Type 2 diabetes, there is no known cure. However, it is proven that the disease can be controlled and in some successful cases, it can go into remission.
What remission means in Type 2 diabetes is that your blood sugar levels are healthy once more without the need to take any medication to control it. More specifically, your A1C (your estimated average blood sugar level or glucose level) has been reduced to the level of someone without diabetes (less than 6.5%) and therefore you are able to either limit the medication you are taking or eliminate it altogether for over six months or longer.
Knowing this can mean hope for a lot of Type 2 diabetes patients but what exactly needs to be done? This was the focus of a webinar co-organised by the Centre of Transformative Nutrition & Health (CTNH) at International Medical University (IMU) with the Malaysian Endocrine and Metabolic Society (MEMS), and the Malaysian Dietitians’ Association (MDA), titled “Diabetes in Malaysia and Southeast Asia: Is Remission Possible?”
Moderated by Prof Winnie Chee, professor of nutrition & dietetics at IMU, the webinar featured notable speakers with valuable experience and knowledge in the disease such as Datuk Dr Zanariah Hussein, Head of Endocrinology Services from the Ministry of Health, Malaysia, and immediate past president of MEMS, Dr Anthony Leeds from the University of Copenhagen and adjunct faculty at IMU who also practices bariatric medicine in the UK’s NHS in Diabetes and Endocrinology Department at the Central Middlesex Hospital in London, Prof Dr Susan Jebb, Professor of Diet and Population Health, and Prof Dr Paul Aveyard, Professor of Behavioural Medicine, both from the University of Oxford. It was attended by over 550 participants who were physicians, dietitians, diabetes educators, nurses and other healthcare professionals from Malaysia, Singapore, the Middle East and the UK.
It needs to be stated that diabetes remission is quite a new idea and that a lot more research is required before it can be fully understood. However, the strongest evidence suggests diabetes remission is by weight loss and maintenance.
The webinar discusses some proven dietary approaches for remission. The fact remains that Type 2 diabetes is a lifestyle disease that is also on the rise. “In this part of the world, there has been an upsurge in Type 2 diabetes and its related risk factors, which include rising levels of obesity, unhealthy diets, and widespread sedentary lifestyle. Growing urbanization and changing lifestyle habits are contributory factors as well,” says Datuk Dr Zanariah Hussein.
However, with the right management for your diet and lifestyle, the risk of the disease is significantly reduced. For those living with diabetes, being on top of both factors can improve your quality of life. According to Datuk Dr Zanariah, “Lifestyle modification is the primary step once diabetes is diagnosed.” She cites the latest version of Management of Type 2 Diabetes Mellitus that recommends patients with Type 2 diabetes with aims of achieving diabetes remission to consider meal replacement therapy (MRT) and a very low-calorie diet (VLCD).
But how exactly does losing weight encourage diabetes remission? First, you need to understand what extra weight does to your body. Fat can build up around important organs like the liver and pancreas, making it difficult for these organs to work. This can lead to how Type 2 diabetes develops, though other factors come into play as well such as age, ethnicity, and family history. And the vice versa is true as well: Losing fat affects diabetes remission.
Dr Anthony Leeds backs up this fact by sharing how studies in the UK and the Middle East showed that dietitian-led enabled weight loss programmes using Total Diet Replacement (TDR – a formula diet providing all food) achieved more than 15kg of weight loss in a year, which led to diabetes remission. Participants in the UK study called the DiRECT trial under TDR had a greater reduction in liver fat and reduced inflammation, and their pancreas reverted to normal morphology. “The key message is that with more than 10kg in weight loss maintained at two years will help two out of three people achieve diabetes remission,” says Dr Leeds.
Further encouraging weight loss as a way to remission, Prof Susan Jebb says, “Even people who lose up to only 5kg, a small proportion of them will be successful.” Together with Prof Paul Aveyard, Prof Jebb has been studying the impact of weight loss in a primary care setting for Type 2 diabetes patients. “The point I want to make is that there is a linear relationship between weight loss and the likelihood of achieving remission.”
She also emphasises that while the recommendation is Total Diet Replacement (TDR), it is not suitable for everyone. “For the last 10 years or more, we’ve been working hard on the effectiveness of weight loss for remission. It is important to realise that there is a range of different ways to lose weight. Encouraging people to manage their weight themselves is modestly effective though the weight loss is limited. But if the whole population did that, you can imagine the benefits accrued from that,” shares Prof Jebb.
It is important to know that remission is not a one-off event. It needs to be maintained because if not, there is always a chance that your diabetes might return, says Prof Aveyard. This is where healthcare practitioners come in to provide support for their patients, he says. “With the right ‘script’, patients responded much better,” says Prof Aveyard. He also highlights that aside from diabetes remission, weight loss also has other long-term benefits in terms of cardiometabolic effects. Hence efforts to lose weight in diabetes are all worthwhile due to this legacy effect.
Whether it is the accelerated approach to weight loss or a gradual approach, the idea is simply to get started and find one that works for you. In fact, diet is not the only way for Type 2 diabetes remission; some patients have had bariatric or weight-loss surgery. It is important to speak to your healthcare provider for help because support plays an important role too, from the person helping you manage your diabetes to your loved ones.