Both type 1 and type 2 diabetes are often called chronic diseases, meaning that they’re conditions that last at least a year and “require ongoing medical attention or limited activities of daily living or both,” says the CDC (Centers for Disease Control and Prevention). Other examples of chronic diseases include heart disease, stroke, cancer, and arthritis. In some instances, chronic diseases may get worse over time. Chronic diseases can be controlled, or managed, but not cured.
Type 2 diabetes
Unlike its counterpart, type 1 diabetes, type 2 diabetes results from a number of modifiable factors, including being overweight or obese; eating a diet that consists of processed foods, refined carbs, and unhealthy fats; smoking; having a high amount of fat around the mid-section; not being active enough; and having high blood lipid (cholesterol and triglyceride) levels. Other risk factors are family history, being of a certain ethnic or racial group, and age — obviously, these are not modifiable.
Type 2 diabetes can be prevented using proven achievable lifestyle changes, such as a small amount of weight loss and regular physical activity. People who have prediabetes or who are at risk of type 2 diabetes are encouraged to join a program called the National Diabetes Prevention Program (DPP). And people who have prediabetes can reverse their condition with the help of lifestyle and behavior change. (For more information about the National DPP, visit the CDC’s website.)
Reversal, remission, and cure
The terms “cure,” “reversal,” and “remission,” are frequently used interchangeably when it comes to type 2 diabetes. Some people claim that their type 2 diabetes has indeed been “cured,” although more often than not, people talk about it being “reversed.” Let’s take a closer look at what these terms really mean.
What does it mean if someone is cured of their chronic condition? In terms of cancer, for example, the National Cancer Institute considers cancer to be cured when “there are no traces of your cancer after treatment and the cancer will never come back.” Obviously, diabetes is different than cancer, but with a few tweaks, this definition could apply to type 2 diabetes. In other words, diabetes would be “cured” if it has gone away with treatment, no more treatment is needed, and it won’t come back. Unfortunately, there are no guarantees (at this time) that type 2 diabetes will never come back. So, most health care professionals avoid using the term “cure.”
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Reversal versus remission
The terms “reversal” and “remission” are often loosely used interchangeably. One program, Virta Health, focuses on “helping people reverse their type 2 diabetes and other chronic conditions,” doing so with the use of technology, nutrition science, and continuous care from physicians and behavioral experts.
However, the American Diabetes Association, the Endocrine Society, Diabetes UK, and the European Association for the Study of Diabetes prefer to use the term “remission,” instead. This past month, these organizations released a consensus statement, jointly published in the journals Diabetes Care, the Journal of Clinical Endocrinology & Metabolism, Diabetologia, and Diabetic Medicine. The American Diabetes Association’s website says that “People with type 2 diabetes can achieve ‘remission’ by sustaining normal blood glucose levels for at least three months without taking diabetes medication.” Here are some of the criteria that the authors have listed in the consensus statement, as outlined on the American Diabetes Association’s website:
- Remission is a HbA1c (A1C; average blood glucose) of less than 6.5% at least three months after stopping diabetes medication.
- If the HbA1c isn’t reliable, a fasting plasma glucose of less than 126 mg/dl or an estimated HbA1c less than 6.5% calculated from CGM values can be used.
- Testing of the HbA1c to document a remission should be done prior to an intervention and no sooner than three months after initiation of the intervention or withdrawal of medication.
- Subsequent testing to determine long-term maintenance of a remission should be done at least yearly, along with testing for potential complications of diabetes.
Why not use the term “reversal,” then? Reversal implies that improvement in glycemic control is permanent and at this time, permanence is not a guarantee.
The consensus statement is encouraging news, although not everyone with type 2 diabetes will be able to be in remission. Nevertheless, any improvement in blood sugars and A1C levels, as well as weight loss, if needed, can help to lower the risk of long-term complications such as heart and kidney disease, eye problems, and nerve damage. Plus, improvements in glucose control usually mean a reduction in the number and/or amount of diabetes medication that you need to take (that means less money you have to shell out, as well as fewer potential side effects to deal with).
How do people reach remission?
One of the main drivers is significant weight loss. The Diabetes Remission Clinical Trial (DiRECT) looked at whether intensive weight management would achieve remission of type 2 diabetes. This study showed that 86% of the participants who lost more than 33 pounds “reversed” their diabetes, and more than half who lost between 22 and 33 pounds went into remission.
In order for remission to occur, fat inside the liver and pancreas must revert back to normal amounts. Other researchers believe that achieving a 10% to 15% weight loss helps to reactivate beta cells in the pancreas (these are the cells that make insulin). Structured weight-loss programs, low-carb eating plans, and bariatric surgery are some of the ways to help achieve weight loss.
Not everyone can reach remission. The longer you’ve had type 2 diabetes, the harder it may be to do so. However, talk with your health care provider about reaching remission and your own, individual circumstances. Try not to get discouraged if it doesn’t happen for you — remember that any amount of weight loss can yield so many health benefits and improvements in quality of life.