What is Type 2 Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both.
Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications leading to a 2-fold to 4-fold increased risk of cardiovascular diseases.
According to 2017 International Diabetes Federation (IDF) statistics, there are approximately 425 million people with diabetes worldwide. In the United States, there are an estimated 30.3 million adults living with diabetes, and its prevalence has been rising rapidly, with at least 1.5 million new diabetes cases diagnosed each year.
Type 2 diabetes (T2D) has long been identified as an incurable chronic disease. The best outcome that has been expected is the amelioration of diabetes symptoms or slowing its inevitable progression. Approximately 50% of T2D patients will need insulin therapy within ten years of diagnosis.
Is Diabetes Reversal Possible?
Although in the past diabetes has been called chronic and irreversible, the paradigm is changing. In 2016 the World Health Organization (WHO), in its global report on diabetes added a section on diabetes reversal and acknowledged that it can be achieved through weight loss and calorie restriction.
While the exact criteria are still debated, most agree that a hemoglobin A1c (HbA1c) under the diabetes threshold of 6.5% for an extended period of time without the use of glycemic control medications would qualify. Excluding metformin from the glycemic control medications list, as it has indications beyond diabetes, may also be a consideration.
It is important to note that the term “cure” has not been applied to T2D, as there does exist the potential for re-occurrence, which has been well documented in the literature.
Specific interventions aimed at reversal all have one thing in common: they are not the first-line standard of care. This is important because there is evidence suggesting that standard of care does not lead to diabetes reversal. This raises the question of whether the standard of care is really the best practice.
A significant number of studies indicate that diabetes reversal is achievable using bariatric surgery, while other approaches, such as low-calorie diets (LCD) or carbohydrate restriction (LC), have also shown effectiveness in an increasing number of studies.
New Study Results
A study published in the journal Nutrients by Sarah J. Hallberg and colleagues found that weight loss reversed type 2 diabetes in participants, even though their body mass index (BMI) was in a moderate range. The study authors believe that lowering levels of fat around the organs may be more important than lowering BMI.
The study involved just 23 people. Of these, 12 individuals had a type 2 diabetes diagnosis with an average age of 58.3 years and an average BMI of 24.5. The remaining 11 did not have diabetes and were of similar age and BMI. This group acted as the control.
All participants followed a low-calorie diet for 2 weeks, consuming no more than 800 calories each day. The researchers then supported them to maintain their new weight for 4–6 weeks.
They completed this cycle two or three times until all participants had reduced their body weight by 10–15%. The researchers measured each participant’s visceral fat and insulin sensitivity before, during, and after the study.
The researchers found that the individuals with diabetes lost more than twice as much fat in the liver compared with the controls. Also, fat in the pancreas was reduced from 5.1% to 4.5%.
The most significant change was that two-thirds of the participants found that their type 2 diabetes went into remission and could stop taking their medication.
The results of the study are very important for the current standard of care for patients with diabetes. Although the study size was small and larger clinical trials are needed, we can no longer continue with the same treatment plan for diabetes due to the rising rates of diabetes and yearly increase in the number of patients with chronic complications.
Patient education needs to be a fundamental part of the patient care offered by providers. But in order for this to be achieved more providers need to be aware that the reversal of diabetes is possible.
Hallberg, S.J.; Gershuni, V.M.; Hazbun, T.L.; Athinarayanan, S.J. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients 2019, 11, 766.
Goyal R, Jialal I. Diabetes Mellitus Type 2. [Updated 2021 May 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513253/
Timothy Huzar. (2021, Sep 30). Reversing diabetes: Visceral fat more important than overall weight. Medical News Today. Retrieved from: