Diabetes remission vs. cure vs. reversal

WRITTEN BY: T’ARA SMITH, MS, NUTRITION EDUCATION

Finally, we have a clear definition of “diabetes remission.” A hot topic among people with Type 2 diabetes, there’s been an ongoing debate about what actually counts as remission and if it’s the same thing as curing or reversing diabetes.

This is thanks to a consensus report by several international diabetes organizations: American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Diabetes UK, the Endocrine Society, and the Diabetes Surgery Summit.

WHAT IS REMISSION?

Type 2 diabetes remission is defined as the return of A1C—the blood test measure of average blood sugar levels over about three months—to less than 6.5 percent after at least three months without usual diabetes medications. The term “remission” implies that a person with diabetes may need ongoing support to prevent a relapse, including lifestyle changes and regular monitoring to allow for treatment if high blood sugar returns.

The definition of remission changes slightly when surgery or lifestyle changes have been part of treatment:

  • Surgery: At least 3 months after the procedure and 3 months after stopping the use of medication with your doctor’s approval.
  • Lifestyle changes: At least 6 months after beginning those changes and 3 months after stopping the use of medication. This is due to the benefits of lifestyle changes being slower and can take up to 6 months to see a true, sustainable improvement.

REMISSION VS. CURE, REVERSAL, AND RESOLUTION

Cure and reversal are often used interchangeably with remission. However, those terms are not the same because:

  • Diabetes “cure” suggests that all aspects of diabetes are completely normalized and that no clinical follow-up, care, or management is needed to prevent further hyperglycemia (high blood sugar) and other health risks associated with diabetes. There is no cure for diabetes.
  • Diabetes “reversal” describes the process of returning to glucose levels below those used to diagnose diabetes but doesn’t imply further support is needed to prevent high blood sugars, whereas remission does.
  • Diabetes “resolution” implies the original diagnosis was in error or that an entirely normal state has been permanently established.

CAN ANYONE ACHIEVE REMISSION?

Every case of diabetes is different. Research on remission is ongoing and shows diabetes remission may not be possible for everyone with Type 2 diabetes or be permanent in those who do achieve it. Also, as shown in other studies, remission is typically achieved with intense medical supervision and treatment. It is unclear if the heavy medical support provided in a clinical trial could translate to real life. Still, any person can take the steps toward remission to improve insulin sensitivity and lower blood sugars by:

  • Making lifestyle changes with nutrition and physical activity
  • Having medical or surgical intervention such as gastric bypass surgery
  • A combination of both

Whether treatment needs to be discontinued before making a diabetes remission diagnosis depends on the treatment. Typically, lifestyle changes and other interventions have lasting health benefits that extend beyond diabetes remission, including improvement in overall health.

If you have questions about your personal likelihood of being diagnosed with diabetes remission, please contact your healthcare provider. For more information on clinical trials studying remission, check out the Diabetes Remission Clinical Trial.

IF YOU’RE STILL USING DIABETES MEDICATIONS FOR OTHER HEALTH CONDITIONS…

Can you be diagnosed with diabetes remission while using diabetes medications (even if for other health benefits)? In short, no.

Some diabetes medications are used for other health conditions and have benefits outside of lowering glucose.

  • Metformin can be used for weight maintenance, lower risk for cancer and cardiovascular disease, and treat polycystic ovary syndrome (PCOS).
  • GLP-1s can be used for weight loss and to reduce the risks of major cardiovascular events.
  • SGLT-2s can be used to treat heart failure and offer protection for your kidneys.

A diabetes remission diagnosis can only be made if:

  • you have no longer needed diabetes-related medications for at least three months—long enough to assess the impact on your blood sugar levels
  • AND your A1C is less than 6.5 percent

Even if your glucose levels/A1C are normal and below 6.5 percent, if you’re taking any diabetes medications, then a remission diagnosis cannot be made.

However, the experts in the consensus report noted a person can be diagnosed with remission if they are taking medications that have a modest glucose-lowering impact, such as weight loss drugs, but are not used to treat diabetes.

REMISSION AND DIABETES COMPLICATIONS

Even while experiencing remission, diabetes complications such as retinopathy, nephropathy (chronic kidney disease), neuropathy, and cardiovascular disease can occur. There’s no long-term evidence that check-ups for complications can be safely discontinued, therefore those in remission should remain under medical supervision for complications. The risk of worsening retinopathy, caused by a rapid drop in blood sugar levels after a long duration of high blood sugar, is a potential major risk factor of diabetes remission noted by the experts.

Ongoing monitoring means people with Type 2 diabetes in remission should:

  • Have an A1C test done at least once a year.
  • Maintain a healthy lifestyle.
  • Avoid medications that promote hyperglycemia (high blood sugar) such as glucocorticoids (steroids) and certain antipsychotic medications.
  • Schedule your annual diabetes eye exam every year to watch for the earliest signs of retinopathy.
  • Maintain regular check-ups on your kidney function, foot health, and blood pressure levels

There is already so much misunderstanding around what it means to live with Type 2 diabetes—from healthcare professionals to the general public, using words like “cure” or “reversal” is often unhelpful. Now that diabetes organizations have come together to clearly define what diabetes remission means, we are hopeful this will provide more clarity for everyone living with and treating the disease.

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The patient still needs to be fully aware that there is a constant push/pull between patients and companies that have a product or service to sell and take the definitions to the limit, oftentimes crossing the line in hopes of convincing the patient there is a magic bullet that will “cure” them.

Is diabetes “remission” definition maybe relevant for those who need medical exams for, say, military or flight ratings?

I know many rules summarily barring diabetics from employment or getting a license that existed 40 years ago when I was diagnosed, are less absolute today.

I wish there was a remission for type1.

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Well there’s honeymoon period, if we call that a remission. And islet transplants, that can be more like a cure (except for follow on of immune suppressant drugs).

I am pleased that the diabetes medical mainstream has finally made a positive decision on this topic.

Even though I have personally witnessed the transformative effects of using carbohydrate limits to management my T1D glucose levels, I never felt comfortable with the low-carb community’s adoption of the term, reversal, to characterize a successful restoration of normal glycemia in the context of T2D.

Remission is the correct term to label this situation. It’s interesting that this group of experts included an oncologist. People have widely accepted remission in cancer settings to characterize the disappearance of a measurable cancer state, yet recognize that it may return. This is the right choice in this instance.

If you want to read the whole article, here’s a link to the pdf version: https://care.diabetesjournals.org/content/early/2021/08/17/dci21-0034.full-text.pdf

Type 2 Diabetes has 3 causes:

  1. heredity
  2. age
  3. weight

There is not much one can do about your genes or your age, but one can lose weight, and some Type 2 Diabetics go into remission or recovery if they lose enough weight.

Type 1 means your pancreas took early retirement, so the only treatment is insulin, and the only cure is a transplant. Last time I looked, no one had a clue why some pancreases (or at least the islets) decide to stop working. Lots of theories, but nothing solid. (I came down with Type 1 a few months after coming down with varicella, so I’m guessing that caused it, but no way of knowing for certain.)

Some type 2’s are not over weight. My sister is preD. She is skinny. So she has the gene. Her doctor said we as siblings live long enough we might all get it. Nancy50