Diabetes reversal: Myth or reality

Abstract

The rising prevalence of diabetes mellitus increases the burden of morbidity and mortality worldwide. The conventional view has been that T2DM is irreversible and progressive. However, in 2016, the WHO Global Report on Diabetes added for the first time a section on diabetes reversal and it could be achieved through a number of therapeutic approaches. Although the terms “reversal” and “remission” are used interchangeably, recent consensus supports the use of “remission” in the context of T2DM. The term “remission” is defined as the most appropriate descriptive term, and HbA1c <6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy. Many studies indicate that diabetes reversal, and possibly even long-term remission, is achievable, belying the conventional view. As the cost of diabetes has escalated, society can no longer afford to ignore the pandemic of lifestyle diseases, so understanding T2DM remission becomes more of a priority. The current standard of care has done little to check the pandemic of diabetes. Therefore, various approaches to reversing T2DM are highlighted for the practitioner like low-carbohydrate diets, very low-calorie diets, exercise, and bariatric surgery. Remission appears to be induced by intensive glycemic control and significant lifestyle changes prior to irreversible β-cell changes. By implementing short-term intensive insulin therapy in hyperglycemia at an early stage of the disease, β-cell function improves, and remission of T2DM can be secured for a considerable period. In patients who are overweight at the initial stage of diagnosis, remission can be reached in more than half of patients if significant weight loss is induced by methods such as metabolic surgery or VLCD. New drugs, such as SGLT2 inhibitors and GLP1-RAs, have a weight loss effect, so they can help achieve this remission goal more safely. We must grasp this paradigm shift in our understanding of T2DM for the benefit of our patients as endocrine experts.

Keywords: Diabetes remission, Diabetes reversal, type 2 diabetes mellitus