DIABETES
March 28, 2017

A Remission Strategy for Type 2 Diabetes

A study proves it may be possible, with intensive therapy, to reverse type 2 diabetes. No meds necessary.

Type 2 diabetes is a metabolic disorder characterized by lack of or inefficient use of the body's insulin supply that's produced by the pancreas. It has been considered to be a chronic disease requiring ongoing management including diet, lifestyle and medications, but a recent study finds that intensive interventions may make it possible for the pancreas to recover function enough that the body is able to regain its insulin/glucose balance and achieve normal blood sugar control.

The excess levels of sugar in the blood, and decreased delivery of energy to the body's cells, creates many complications for people with type 2 diabetes. It can cause damage to the eyes, heart, kidneys, nerves and other organs. It has typically been seen in adults, but is becoming increasingly common among children and teens as overweight and obesity increase.

At the end of the study period, patients in the two intervention groups stopped their medications, but were encouraged to continue the dietary, exercise and lifestyle interventions.

The study patients ranged from 30 to 80 years in age. All had had type 2 diabetes for from one to three years and used up to two oral drugs to manage it. People were excluded if they already needed insulin to manage their diabetes. The 83 patients were divided into three study groups.

The control group received standard blood sugar management and lifestyle advice from their primary practitioner. A second group was given an intensive eight-week intervention that included a personalized exercise plan that provided 150 minutes per week of moderate intensity exercise; a daily menu that reduced their food intake by 500-750 calories per day; and both oral medication (metformin and acarbose) and a long-acting insulin given by injection to tightly control their blood sugar levels.

The third group received the same intensive intervention as the second group, but for twice as long — over a 16-week period.

At the end of their respective study periods, patients in the two intervention groups stopped their medications, but were encouraged to continue the dietary, exercise and lifestyle interventions. All the patients were followed to see whether their improvements in blood sugars could be maintained without medication and, if so, for how long.

After eight weeks, half of the eight-week intervention group had achieved normal blood sugar levels, while only 3.6 percent of the control group had done so. Seventy percent of the 16-week intensive intervention group had achieved normal blood sugars at the end of their intervention, compared to 3.6 percent in the controls.

Three months after the interventions had ended, 21.4 percent of the eight-week group still had complete or partial remission while 10.7 percent of the controls did. Forty percent of the group receiving the 16-week intervention showed complete or partial remission. However, these results did not last: after 52 weeks, there was no difference among the three groups.

The results suggest that it may be possible, with intensive therapy, to reverse diabetes, at least in the short term, and this may change the way we look at diabetic therapy, the authors say. Instead of the current approach of controlling blood sugar with medications, treatment for type 2 diabetes may move toward the study strategy of inducing remission and monitoring patients for relapse.

This is a pilot study and requires much more investigation into different combinations of medications and life style changes to find the optimum approach. Individuals are cautioned not to stop or change their diabetes medications without consultation with their physicians.

The study is published in The Journal of Clinical Endocrinology & Metabolism.

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