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We have great news, the remission and reversal of Type 2 Diabetes is possible with weight loss! The diagnosis of Type 2 Diabetes can often be frightening and discouraging to patients. It is often seen as an lifelong chronic condition by most patients and doctors that only leads toto more medications and medical problems as time goes on. Type 2 diabetes treatment typically involves controlling the damage to the body caused by chronic elevated blood glucose levels, which is toxic to tissues especially the eyes, heart, nerves and brain. Patients are often given multiple prescription medications because the risks of co-morbid diseases are so high once the diagnosis of Type 2 Diabetes is made. Lifestyle interventions are often a side-note, an afterthought, not the first focus of the treatment. While I believe the predisposition to this problem will always be present, there is much that can be done to reverse the metabolic imbalances so that a diagnosis does not lead to a lifetime of chronic diseases.
In a recent December 2017 issue of The Lancet, the DiRECT trial (Diabetes Remission Clinical Trial) put a weight loss program to the test as the main treatment option for Type 2 diabetes. The outcome for the patients was not only being weight loss, but remission of Type 2 Diabetes as evidenced by improvement in A1C% to a normal range. (A1C% is a measure commonly used as the average blood sugar over 3 months). One randomly selected group of patients was given the standard of care, the other randomly selected group was given a low calorie, meal replacement for 3-5 months (825-853 kcal/ day), followed by a food reintroduction phase, and finally a structured plan to maintain the weight loss. These patients were followed for one year. In the intervention weight loss group, 46% of the patients achieved remission of their Type 2 Diabetes as defined as A1C in the “normal” range (< 6.5% was utilized) and were taken off ALL of their oral diabetes medications. The average weight reduction was 10 kg. In the group of patients who achieved > 15 kg of weight loss, their percentage remission rate was 86%!
It will be interesting to see the long-term outcomes of this trial. With the use of low calorie (low fat) diet interventions, biological adaptations that occur can contribute to eventual weight re-gain. In my opinion, a more moderate fat, low glycemic food plan as seen in other studies shows more long-term weight loss success and reduction of Type 2 Diabetes symptoms. I may disagree with “how” the weight was lost, however the results demonstrate that it is possible to reverse and balance the metabolic issues regarding Type 2 Diabetes. The patients in this study were diagnosed within 6 years of the intervention and were not on insulin, only oral medications for diabetes. I think this is important to highlight that I often see patients who are under the assumption that they will have to be on these medications for life. It is simply, and thankfully, not always the case! Empowering patients with tools for success and giving them hope for the possibility of remission is key. Weight loss results in decreased visceral adipose tissue (“belly fat”) and improves the sensitivity of cells to the effects of insulin. I would also argue that many of the medications used in the treatment of Type 2 Diabetes work on the pancreas to increase the production of insulin which signals the body to store fat. In the intervention group, medications were stopped at the onset of the dietary changes. This may have also contributed to the weight reduction in the intervention group.
It is my hope more studies like this one are done demonstrating the efficacy of non-pharmacological lifestyle interventions to empower patients to seek remission of Type 2 Diabetes. IT IS POSSIBLE under the supervision and support of your doctor to come off of your medications for Type 2 Diabetes.
Contact us today to learn about how functional medicine and osteopathic medicine can help you better manage and treat your Type 2 Diabetes.
Reference:
Lancet. 2017 Dec 4. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomized trial; Leslie et.al
