What is diabetes remission? – Remission means that your blood sugar levels (also known as blood glucose levels) are below the diabetes range, usually without you needing to take any diabetes medication. Remission is when your HbA1c — a measure of long-term blood glucose levels — remains below 48mmol/mol or 6.5% for at least three months, without diabetes medication.
- This definition has been agreed by a team of international experts from here at Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes.
- Some people call this ‘reversing type 2 diabetes’, but we use the term remission because your blood sugar levels can rise again.
If your regular blood tests show your HbA1c remaining below 48 mmol/mol or 6.5%, talk to your healthcare team to discuss diabetes remission and how this applies to you. “Remission can feel like a fairytale. But this is something that can happen to real people.
How can a diabetic go into remission?
Remission has been shown to be due to normalization of the high fat levels inside liver and pancreas, and the only way to achieve this is by major weight loss. There are three main ways that people have put their diabetes into remission: a low-carbohydrate diet, a low-calorie diet, and bariatric surgery.
How common is diabetes remission?
Results – Between 1 April 2007 and 31 March 2018, there were 2,297,700 people with type 2 diabetes defined as a baseline HbA 1c of ≥48 mmol/mol (6.5%) or <48 mmol/mol (6.5%) with one or more prescriptions for glucose-lowering medications in the 90 days before measurement. Of these, 38,530 (1.7%) met the criteria for remission in the 21 months between 1 April 2018 and 31 December 2019 (median follow-up 91 weeks) (Table 1). People who entered remission were more likely to be older, female, living in less socioeconomically deprived areas, and of White ethnicity compared with those who did not meet the criteria for remission. They also had a shorter duration of diagnosis, lower baseline HbA 1c, and lower baseline BMI (Table 1) compared with those without remission. Baseline and follow-up BMIs were recorded for 1,746,940 people (76.0%). Among those entering remission, the mean reduction in BMI from baseline was 2.5% (SD 10.2%) compared with a reduction of 0.2% (SD 8.1%) in those with no remission. At cohort entry, 48.6% of people who later entered remission were not prescribed any glucose-lowering medication, 40.7% were prescribed metformin only, 10.0% were prescribed other noninsulin glucose-lowering medication (with or without metformin), and 0.7% were prescribed insulin. Table 1 Characteristics of people who were alive on 1 April 2018 who did and did not achieve remission of diagnosed type 2 diabetes before 31 December 2019
| Not in remission | In remission | |||||||
|---|---|---|---|---|---|---|---|---|
| All in remission | Without comorbidity* | With comorbidity† | ||||||
| n | % | n | % | n | % | n | % | |
| People, n | 2,259,170 | 38,530 | 30,465 | 8,065 | ||||
| Sex | ||||||||
| Female | 980,380 | 43.4 | 18,620 | 48.3 | 14,795 | 48.6 | 3,825 | 47.4 |
| Male | 1,278,795 | 56.6 | 19,910 | 51.7 | 15,670 | 51.4 | 4,240 | 52.6 |
| Age (years) | ||||||||
| <40 | 65,555 | 2.9 | 1,270 | 3.3 | 1,240 | 4.1 | 25 | 0.3 |
| 40–49 | 200,890 | 8.9 | 2,790 | 7.2 | 2,700 | 8.9 | 95 | 1.2 |
| 50–59 | 452,150 | 20.0 | 5,810 | 15.1 | 5,350 | 17.6 | 460 | 5.7 |
| 60–69 | 598,680 | 26.5 | 8,895 | 23.1 | 7,500 | 24.6 | 1,395 | 17.3 |
| 70–79 | 585,785 | 25.9 | 11,070 | 28.7 | 8,085 | 26.5 | 2,980 | 36.9 |
| ≥80 | 356,110 | 15.8 | 8,695 | 22.6 | 5,590 | 18.3 | 3,110 | 38.6 |
| Mean (SD) | 66.2 (13.1) | 68.6 (13.8) | 66.6 (14) | 76.1 (10.2) | ||||
| Quintiles of deprivation index | ||||||||
| Most deprived | 554,495 | 24.5 | 8,075 | 21.0 | 6,260 | 20.5 | 1,810 | 22.4 |
| Second most deprived | 504,825 | 22.3 | 8,185 | 21.2 | 6,450 | 21.2 | 1,735 | 21.5 |
| Third most deprived | 460,745 | 20.4 | 8,155 | 21.2 | 6,450 | 21.2 | 1,705 | 21.1 |
| Second least deprived | 406,645 | 18.0 | 7,595 | 19.7 | 6,040 | 19.8 | 1,550 | 19.2 |
| Least deprived | 331,810 | 14.7 | 6,510 | 16.9 | 5,255 | 17.2 | 1,260 | 15.6 |
| Missing | 650 | 0.03 | 10 | 0.03 | 5 | 0.02 | 5 | 0.06 |
| Ethnicity | ||||||||
| Asian | 261,060 | 11.6 | 2,785 | 7.2 | 2,465 | 8.1 | 295 | 3.7 |
| Black | 108,385 | 4.8 | 1,535 | 4.0 | 1,325 | 4.3 | 200 | 2.5 |
| Mixed | 23,345 | 1.0 | 330 | 0.9 | 285 | 0.9 | 45 | 0.6 |
| White | 1,511,220 | 66.9 | 27,990 | 72.6 | 21,320 | 70.0 | 6,490 | 80.5 |
| Other | 107,060 | 4.7 | 1,220 | 3.2 | 1,090 | 3.6 | 120 | 1.5 |
| Missing | 247,855 | 11.0 | 4,920 | 12.8 | 3,980 | 13.1 | 915 | 11.3 |
| Duration (years) | ||||||||
| <1 | 141,620 | 6.3 | 11,690 | 30.3 | 9,910 | 32.5 | 1,780 | 22.1 |
| 1–2 | 267,195 | 11.8 | 7,050 | 18.3 | 5,765 | 18.9 | 1,285 | 15.9 |
| 3–5 | 255,040 | 11.3 | 4,740 | 12.3 | 3,770 | 12.4 | 970 | 12.0 |
| 5–9 | 608,535 | 26.9 | 8,125 | 21.1 | 6,215 | 20.4 | 1,910 | 23.7 |
| 10–14 | 507,925 | 22.5 | 4,530 | 11.8 | 3,210 | 10.5 | 1,320 | 16.4 |
| ≥15 | 478,505 | 21.2 | 2,385 | 6.2 | 1,590 | 5.2 | 795 | 9.9 |
| Mean (SD) | 9.9 (7.6) | 5.1 (5.9) | 4.8 (5.7) | 6.6 (6.6) | ||||
| HbA 1c (mmol/mol) | ||||||||
| Mean (SD) in 2017/2018 | 57.3 (15.1) | 45.9 (8.1) | 46 (8.2) | 45.5 (7.6) | ||||
| Mean change (SD) | 0.2 (11.8) | −4.1 (7.8) | −4.2 (7.9) | −3.8 (7.4) | ||||
| BMI (kg/m 2 ) | ||||||||
| Mean (SD) in 2017/2018 | 31 (6.5) | 30.6 (6.6) | 30.9 (6.5) | 29.5 (6.5) | ||||
| Change in BMI (%) | ||||||||
| ≥10% reduction | 106,315 | 4.7 | 3,870 | 10.0 | 3,590 | 11.8 | 875 | 10.8 |
| 5–9.9% reduction | 220,725 | 9.8 | 4,130 | 10.7 | 3,930 | 12.9 | 755 | 9.4 |
| 0–4.9% reduction | 639,835 | 28.3 | 6,935 | 18.0 | 6,635 | 21.8 | 1,235 | 15.3 |
| 0.1–4.9% increase | 479,820 | 21.2 | 4,575 | 11.9 | 4,320 | 14.2 | 865 | 10.7 |
| ≥5% increase | 179,805 | 8.0 | 2,125 | 5.5 | 1,965 | 6.5 | 455 | 5.6 |
| Missing | 632,675 | 28.0 | 16,895 | 43.8 | 15,975 | 52.4 | 3,880 | 48.1 |
| Mean (SD) change 2017/2018 to 2018/2019 | −0.2 (8.1) | −2.5 (10.2) | −2.5 (10) | −2.2 (11) | ||||
| Comorbidities | ||||||||
| Heart failure | 143,105 | 6.3 | 2,585 | 6.7 | — | — | 2,585 | 32.1 |
| Cancer | 162,090 | 7.2 | 3,180 | 8.3 | — | — | 3,180 | 39.4 |
| COPD | 150,135 | 6.6 | 3,115 | 8.1 | — | — | 3,115 | 38.6 |
| Dementia | 59,135 | 2.6 | 1,220 | 3.2 | — | — | 1,220 | 15.1 |
| Any comorbidity | 408,440 | 18.1 | 8,065 | 20.9 | — | — | 8,065 | 100.0 |
| Bariatric surgery | 1,020 | 0.05 | 370 | 0.96 | 315 | 1.03 | 55 | 0.7 |
| Treatment in 2017/18 | ||||||||
| None | 179,250 | 7.9 | 18,735 | 48.6 | 15,060 | 49.4 | 3,675 | 45.6 |
| Metformin only | 816,900 | 36.2 | 15,675 | 40.7 | 12,430 | 40.8 | 3,240 | 40.2 |
| Other noninsulin glucose-lowering agents with and without metformin | 1,164,340 | 51.5 | 3,850 | 10.0 | 2,750 | 9.0 | 1,100 | 13.6 |
| Insulin with or without other glucose-lowering agents | 98,680 | 4.4 | 270 | 0.7 | 220 | 0.7 | 50 | 0.6 |
table>
See text for definition of diabetes remission. * No history of a hospital admission for heart failure, cancer, COPD, or dementia between 1 April 2015 and 31 March 2019. † History of a hospital admission for heart failure, cancer, COPD, or dementia between 1 April 2015 and 31 March 2019. The overall incidence of remission was 9.7 (95% CI 9.6–9.8) per 1,000 person-years. In people with comorbidities that may induce weight loss, incidence of remission was higher (11.8 per 1,000 person-years) compared with those without such a comorbidity (9.2 per 1,000 person-years). A history of bariatric surgery in the NHS was rare (0.06% of all people included in the analysis). In those who had bariatric surgery but no comorbidity that may induce weight loss, the rate of remission was 205.8 (95% CI 183.8–229.8) per 1,000 person-years, falling to 82.5 (95% CI 61.8–107.9) per 1,000 person-years for those with a comorbidity associated with unintentional weight loss who underwent bariatric surgery. Overall rates of remission were higher in women, older people, those living in less socioeconomically deprived areas, those from White ethnic groups, and those with a shorter duration of diagnosed diabetes than their respective comparison groups (see Fig.1). For the subgroup of 208,260 people (9.1% of the whole cohort) who had a diagnosis of diabetes for <2 years, had a baseline HbA 1c of <53 mmol/mol (7.0%), were prescribed metformin alone or no glucose-lowering drugs, and had no history of cancer, heart failure, COPD, or dementia, the overall rate of remission was 37.6 (95% CI 37.0–38.3) per 1,000 person-years. In an additional subgroup of 8,940 people (0.4% of the total cohort) who had a diagnosis of diabetes of <2 years, had a baseline HbA 1c of <53 mmol/mol (7.0%), and achieved a reduction in BMI of ≥10% from baseline, the incidence of remission was 83.2 (95% CI 78.7–87.9) per 1,000 person-years. Figure 1 
Incidence of remission of type 2 diabetes per 1,000 person-years. *Early stages of type 2 diabetes defined as diagnosed <2 years previous, baseline HbA 1c ≤53 mmol/mol (7.0%), prescribed metformin only or no glucose-lowering drugs, and no history of heart failure, cancer, COPD, or dementia. Figure 1 Incidence of remission of type 2 diabetes per 1,000 person-years. *Early stages of type 2 diabetes defined as diagnosed <2 years previous, baseline HbA 1c ≤53 mmol/mol (7.0%), prescribed metformin only or no glucose-lowering drugs, and no history of heart failure, cancer, COPD, or dementia. Close modal Incidence of remission also varied by medications prescribed at baseline. Remission rates were higher among people who were not prescribed any glucose-lowering medications at baseline (58.4 per 1,000 person-years) compared with those prescribed metformin alone (11.1 per 1,000 person-years). In people prescribed noninsulin, nonmetformin glucose-lowering medications at cohort entry remission were rare, and incidence was significantly lower (2.0 per 1,000 person-years), as was the case in those prescribed insulin (1.6 per 1,000 person-years). After adjusting for other characteristics, men had a lower odds of entering remission than women (OR 0.96 ), while those from all non-White ethnic groups had a lower odds of entering remission than those from White ethnic groups. There was a significant deprivation gradient, with people living in the least-deprived quintile of areas having an OR of entering remission of 1.13 (95% CI 1.09–1.18) compared with those in the most-deprived areas. People who were diagnosed with type 2 diabetes for <2 years had a higher odds of entering remission (OR 2.78 for those diagnosed <1 year and 1.12 for those diagnosed 1–2 years compared with those diagnosed 3–5 years). Baseline HbA 1c of <48 mmol/mol (6.5%) was associated with a greater odds of entering remission (OR 6.84 ) compared with baseline HbA 1c of 48–53 mmol/mol (6.5–7.0%). Reduction in BMI of ≥10% and 5–9.9% was associated with a greater odds of entering remission (OR 3.57 and 1.78, respectively) compared with a reduction in BMI of 0–4.9% (see Fig.2A). Figure 2 
Forest plots of ORs from a multivariable model including all factors for demographic and clinical characteristics associated with remission of type 2 diabetes in the whole cohort ( A ) and in people with early-stage type 2 diabetes (baseline HbA 1c ≤53 mmol/mol, duration of diagnosed diabetes of <2 years previous, and prescribed only metformin or no glucose-lowering medication at baseline) ( B ). ref, reference. Figure 2 Forest plots of ORs from a multivariable model including all factors for demographic and clinical characteristics associated with remission of type 2 diabetes in the whole cohort ( A ) and in people with early-stage type 2 diabetes (baseline HbA 1c ≤53 mmol/mol, duration of diagnosed diabetes of <2 years previous, and prescribed only metformin or no glucose-lowering medication at baseline) ( B ). ref, reference. Close modal Among the 208,260 people (9.1% of the cohort) in the early stages of type 2 diabetes (defined as diagnosed for <2 years, a baseline HbA 1c <53 mmol/mol, and prescribed metformin alone or no glucose-lowering medications at baseline) with no history of heart failure, COPD, cancer, or dementia, higher odds of remission were associated with older age and living in less-deprived areas. In this early-stage cohort, people from Asian and Black ethnic groups had lower odds of remission than White ethnic groups (Table 2). The multivariable-adjusted odds of remission across BMI categories were greatest in people with a baseline BMI of 20–24.9 kg/m 2 (OR 1.08 ) compared with those with a baseline BMI of 25–29.9 kg/m 2, Increasing baseline BMI >30 kg/m 2 was associated with a lower odds of entering remission (OR 0.91 for 30–34.9 kg/m 2, 0.82 for 35–39.9 kg/m 2, 0.78 for ≥40 kg/m 2 ) compared with 25–29.9 kg/m 2, Compared with a 0–4.9% reduction in BMI, a reduction of 5–9.9% and ≥10% was associated with ORs of entering remission of 1.89 (95% CI 1.77–2.02) and 3.54 (95% CI 3.28–3.82), respectively. Having a baseline HbA 1c of <48 mmol/mol (6.5%) vs.48–53 mmol/mol (6.5–7.0%) was associated with an OR of entering remission of 4.78 (95% CI 4.39–5.2) (see Fig.2B). Table 2 Characteristics of people who entered remission by remission status at the end of follow-up
| Stayed in remission | Returned to diabetic hyperglycemia | No follow-up HbA 1c | ||||
|---|---|---|---|---|---|---|
| n | % | n | % | n | % | |
| People, n | 9,175 | 3,420 | 25,935 | |||
| Sex | ||||||
| Female | 4,460 | 48.6 | 1,600 | 46.8 | 12,560 | 48.4 |
| Male | 4,715 | 51.4 | 1,815 | 53.1 | 13,380 | 51.6 |
| Age (years) | ||||||
| <40 | 265 | 2.9 | 80 | 2.3 | 925 | 3.6 |
| 40–49 | 635 | 6.9 | 225 | 6.6 | 1,935 | 7.5 |
| 50–59 | 1,390 | 15.1 | 505 | 14.8 | 3,915 | 15.1 |
| 60–69 | 2,225 | 24.3 | 815 | 23.8 | 5,850 | 22.6 |
| 70–79 | 2,700 | 29.4 | 1,095 | 32.0 | 7,275 | 28.1 |
| ≥80 | 1,960 | 21.4 | 700 | 20.5 | 6,035 | 23.3 |
| Mean (SD) | 68.5 (13.4) | 68.9 (12.9) | 68.6 (14.1) | |||
| Deprivation | ||||||
| Most deprived | 1,935 | 21.1 | 635 | 18.6 | 5,505 | 21.2 |
| Second most deprived | 1,935 | 21.1 | 660 | 19.3 | 5,590 | 21.6 |
| Third most deprived | 1,970 | 21.5 | 780 | 22.8 | 5,405 | 20.8 |
| Second least deprived | 1,805 | 19.7 | 740 | 21.6 | 5,050 | 19.5 |
| Least deprived | 1,530 | 16.7 | 600 | 17.5 | 4,380 | 16.9 |
| Missing | — | 0.00 | — | 0.00 | 10 | 0.04 |
| Ethnicity | ||||||
| Asian | 600 | 6.5 | 280 | 8.2 | 1,880 | 7.2 |
| Black | 345 | 3.8 | 115 | 3.4 | 1,065 | 4.1 |
| Mixed | 65 | 0.7 | 25 | 0.7 | 235 | 0.9 |
| White | 6,795 | 74.1 | 2,435 | 71.2 | 18,585 | 71.7 |
| Other | 255 | 2.8 | 100 | 2.9 | 855 | 3.3 |
| Missing | 1,110 | 12.1 | 470 | 13.7 | 3,315 | 12.8 |
| Duration (years) | ||||||
| <1 | 3,125 | 34.1 | 1,300 | 38.0 | 7,265 | 28.0 |
| 1–2 | 1,645 | 17.9 | 620 | 18.1 | 4,785 | 18.4 |
| 3–5 | 1,065 | 11.6 | 410 | 12.0 | 3,270 | 12.6 |
| 5–9 | 1,845 | 20.1 | 600 | 17.5 | 5,680 | 21.9 |
| 10–14 | 980 | 10.7 | 315 | 9.2 | 3,235 | 12.5 |
| ≥15 | 515 | 5.6 | 180 | 5.3 | 1,690 | 6.5 |
| Mean (SD) | 4.8 (5.8) | 4.3 (5.2) | 5.4 (6.1) | |||
| HbA 1c (mmol/mol) in 2017/2018 | ||||||
| <48 | 4,250 | 46.3 | 930 | 27.2 | 11,695 | 45.1 |
| 48–53 | 4,360 | 47.5 | 2,225 | 65.1 | 12,215 | 47.1 |
| 54–58 | 335 | 3.7 | 185 | 5.4 | 1,200 | 4.6 |
| 59–74 | 165 | 1.8 | 65 | 1.9 | 580 | 2.2 |
| 75–85 | 35 | 0.4 | 5 | 0.1 | 105 | 0.4 |
| ≥86 | 25 | 0.3 | 10 | 0.3 | 140 | 0.5 |
| Mean (SD) | 45.3 (7.6) | 47.8 (6) | 45.9 (8.4) | |||
| Mean (SD) change 2017/2018 to 2018/2019 | −4.1 (7.4) | −4.1 (6) | −4.1 (8.1) | |||
| BMI (kg/m 2 ) in 2017/2018 | ||||||
| <20 | 140 | 1.5 | 50 | 1.5 | 445 | 1.7 |
| 20–24.9 | 1,260 | 13.7 | 445 | 13.0 | 3,490 | 13.5 |
| 25–29.9 | 2,690 | 29.3 | 1,070 | 31.3 | 7,140 | 27.5 |
| 30–34.9 | 2,180 | 23.8 | 850 | 24.9 | 5,795 | 22.3 |
| 35–39.9 | 940 | 10.2 | 350 | 10.2 | 2,660 | 10.3 |
| ≥40 | 640 | 7.0 | 190 | 5.6 | 1,850 | 7.1 |
| Missing | 1,325 | 14.4 | 465 | 13.6 | 4,555 | 17.6 |
| Mean (SD) | 30.5 (6.5) | 30.3 (6) | 30.6 (6.7) | |||
| Change in BMI | ||||||
| ≥10% reduction | 970 | 10.6 | 140 | 4.1 | 2,760 | 10.6 |
| 5–9.9% reduction | 945 | 10.3 | 345 | 10.1 | 2,840 | 11.0 |
| 0–4.9% reduction | 1,695 | 18.5 | 780 | 22.8 | 4,460 | 17.2 |
| 0.1–4.9% increase | 1,080 | 11.8 | 500 | 14.6 | 2,995 | 11.5 |
| ≥5% increase | 475 | 5.2 | 190 | 5.6 | 1,460 | 5.6 |
| Missing | 4,010 | 43.7 | 1,460 | 42.7 | 11,425 | 44.1 |
| Mean (SD) change 2017/2018 to 2018/2019 | −2.6 (9.9) | −0.6 (9.6) | −2.7 (10.4) | |||
| Comorbidities | ||||||
| Heart failure | 570 | 6.2 | 215 | 6.3 | 1,800 | 6.9 |
| Cancer | 735 | 8.0 | 280 | 8.2 | 2,165 | 8.3 |
| COPD | 725 | 7.9 | 265 | 7.7 | 2,125 | 8.2 |
| Dementia | 215 | 2.3 | 70 | 2.0 | 935 | 3.6 |
| Any comorbidity | 1,830 | 19.9 | 685 | 20.0 | 5,545 | 21.4 |
| Bariatric surgery | 135 | 1.47 | 10 | 0.29 | 225 | 0.87 |
| Treatment in 2017/2018 | ||||||
| None | 4,435 | 48.3 | 2,280 | 66.7 | 12,020 | 46.3 |
| Metformin only | 3,790 | 41.3 | 890 | 26.0 | 10,990 | 42.4 |
| Other noninsulin glucose-lowering agents with or without metformin | 875 | 9.5 | 230 | 6.7 | 2,750 | 10.6 |
| Insulin with or without other glucose-lowering agents | 75 | 0.8 | 20 | 0.6 | 180 | 0.7 |
table>
Overall, 3,420 (8.9%) of the 38,530 of people who entered remission subsequently had an HbA 1c measurement of ≥48 mmol/mol (6.5%), suggesting a return to hyperglycemia in the diabetes range. Median time from entering remission of type 2 diabetes to this measurement was 190 days (interquartile range 144–247); 9,175 (238 per 1,000) people in remission had an HbA 1c measurement that indicated that they continued to meet the definition of remission of type 2 diabetes (median follow-up 294 days, IQR 222–361), and 25,940 (673 per 1,000) people did not have any further HbA 1c measurements within the study follow-up period (median follow-up time 148 days, IQR 77–235). Compared with those who stayed in remission, people who returned to diabetic hyperglycemia had a lower mean reduction in BMI (−0.6% vs. −2.6% for those that stayed in remission and −2.7% for those that did not have a further HbA 1c measurement) and were more likely to not be prescribed any glucose-lowering medication at baseline (66.7% vs.48.3% for those who stayed in remission and 46.3% for those who did not have a further HbA 1c measurement). Of those meeting the criteria for remission, only 2,110 (5.5%) had a diagnosis code for remission recorded in their electronic health record. There were no consistent differences in the characteristics of people with and without a diagnosis code for diabetes remission, but there was considerable geographical variation in coding for remission by the 160 Clinical Commission Groups (health organizations with responsibility for commissioning health care for their local population), varying from 25% to <1%. In sensitivity analysis, defining remission based on only one HbA 1c measurement <48 mmol/mol (6.5%) in the absence of a prescription for glucose-lowering medications in the preceding 90 days increased the number of people identified as in remission from 3,420 (9.7 per 1,000 person-years) to 91,405 (23.5 per 1,000 person-years). The pattern of incidence rates by demographic and clinical characteristics were similar to the primary analysis ( Supplementary Table 3 ).
What is the difference between diabetes reversal and diabetes remission?
Remission, not reversal Diabetes is a chronic, progressive condition with higher than normal blood sugar levels. Patients with diabetes may have reduced or no production of insulin or their insulin doesn’t work well (insulin resistance.) Insulin is a hormone that is necessary for managing blood sugar levels.
- The condition with no insulin secretion is known as Type 1 Diabetes.
- In other patients, although the insulin level is normal, the body cannot recognise its presence.
- Such patients are said to suffer from Type 2 Diabetes.
- The exact cause of both types of diabetes remains unknown.
- Researchers believe that Type 1 Diabetes may be due to an autoimmune condition in which the immune cells destroy the insulin-secreting cells, leaving the body deprived of insulin.
Type 2 Diabetes, on the other hand, may be due to unhealthy practices, such as physical inactivity, obesity, sedentary lifestyle, and poor eating habits. There is a rising trend of diabetes in children, possibly due to the increased prevalence of obesity or excessive weight.85% of the children with Type 2 Diabetes are obese or overweight.
- The obesity prevalence in India is around 3.6 to 11.7% and is rising.
- Over 1.1 million patients between the ages of 14 and 19 years are living with diabetes globally.
- Covid restrictions in mobility have further increased the prevalence of obesity and diabetes.
- Remission vs reversal American Diabetes Association recommends using the term ‘diabetes remission’ instead of ‘diabetes reversal’.
Clinicians and patients commonly use them interchangeably. However, there is a difference between the two. Reversal means that the disease is completely cured and will not return. Remission implies that the disease would be dormant as long as the patients maintain certain conditions.
For instance, if there is diabetes remission through weight loss, it is crucial to maintain an optimum weight to avoid recurrence of diabetes. There is no remission for Type 1 Diabetes as there is an insulin deficiency, and the child has to take medical treatment to fulfil the need. However, in children with Type 2 Diabetes, there are high chances of remission, especially in the initial stage of the disease, when the body is making adjustments for high blood sugar levels.
What is diabetes remission? | Type 2 diabetes remission explanation | Diabetes UK
Early diagnosis of the disease is challenging as the disease progresses without the patient experiencing any symptoms. Identifying early symptoms Early diagnosis of diabetes offers several advantages. It increases the chances of remission, provides more management options, and reduces the risk of complications.
Weakness and fatigueIncreased urination frequency,especially at nightWeight loss without any known reasonVision problems, including blurred visionIncreased thirstSores, ulcers, and wounds that are slow-healingNumbness and tingling sensation in feet and handsRecurrent infectionsExtreme hungerIrritabilityIf the parents notice any of the above symptoms in their child, they should consult a paediatrician. Achieving remission Several measures may help the child in diabetes remission. Some of them are:
An active life: Maintaining an active lifestyle helps improve the blood sugar level and reduces insulin resistance. Firstly, reduce the screen time from television mobiles or computer to less than 30 mins a day (other than online class time). Parents must engage their children in activities that keep them energetic and involve exercises at least 1-2 hours a day.
- It may be best to take the child for some sports activity or even jogging in the park.
- Routine vigorous exercise may help in diabetes remission.
- Healthy diet: Diet plays a crucial role in managing blood sugar levels and diabetes remission.
- Parents should keep their children away from cakes, pastries, sugar candies, packed juices, and aerated drinks.
Their diet should have a low glycemic index and contain fresh fruits and vegetables, complex carbohydrates, whole grains, healthy fats, and lean proteins. Weight loss: Obesity or excessive weight is a significant risk factor for Type 2 Diabetes. In diabetes remission, it is not only about losing weight but also about maintaining it.
- It is where most patients fail to result in the re-reversal of diabetes.
- Obese diabetic patients losing around 5 to 7% weight may help in diabetes remission.
- Motivation and persistence: High level of motivation and enthusiasm is a prerequisite for diabetes remission.
- It takes a lot for routine exercise, strict diet control, and losing weight.
Parents should motivate their children and explain to them about a healthy lifestyle in diabetes management. They should alsoexercise and be an example to children. Parents may also take the help of counsellors or diabetes educators to instil confidence in the child.
- Incorporating health in routine: Diabetes remission is a long-term process and requires continuous efforts.
- Parents must also include healthy practices in the family.
- Minimise or avoid eating junk or street food, identify healthy food options, and avoid storing processed foods in the refrigerator.
- Management through technology: Several mobile apps are available to inform you about the calories you lose and the number of steps you walk.
Evidence suggests that bariatric surgery results in Type 2 Diabetes remission in 95–100% of adolescents with diabetes. (The author is a consultant endocrinologist.) : Remission, not reversal
Can type 2 diabetes be reversed permanently?
Here’s how healthier habits may help some people reverse or better manage the disease. – Diabetes is a very common but serious medical condition. According to the Centers for Disease Control and Prevention (CDC), more than 34 million Americans have it, with about 90-95% of them having type 2 diabetes. About 88 million people have prediabetes, a precursor to type 2 diabetes.
- There is no cure for type 2 diabetes.
- But it may be possible to reverse the condition to a point where you do not need medication to manage it and your body does not suffer ill effects from having blood sugar levels that are too high.
- Making positive lifestyle changes such as eating a well-balanced diet, exercising regularly and getting down to a healthy weight (and maintaining it) are the key to possibly reversing or managing type 2 diabetes.
Other lifestyle changes may also help, including not smoking, getting enough sleep, limiting alcohol and managing stress. However, for some people this is still not enough and medication is needed to manage the condition.
Are you still diabetic if in remission?
What is diabetes remission? – Remission means that your blood sugar levels (also known as blood glucose levels) are below the diabetes range, usually without you needing to take any diabetes medication. Remission is when your HbA1c — a measure of long-term blood glucose levels — remains below 48mmol/mol or 6.5% for at least three months, without diabetes medication.
This definition has been agreed by a team of international experts from here at Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes. Some people call this ‘reversing type 2 diabetes’, but we use the term remission because your blood sugar levels can rise again.
If your regular blood tests show your HbA1c remaining below 48 mmol/mol or 6.5%, talk to your healthcare team to discuss diabetes remission and how this applies to you. “Remission can feel like a fairytale. But this is something that can happen to real people.
How long does diabetes remission last?
Studies have shown that significant weight loss, through either metabolic (also known as bariatric) surgery or calorie restriction, may lead to remission in some people who have type 2 diabetes. William T. Cefalu, MD, director of the NIDDK’s Division of Diabetes, Endocrinology, and Metabolic Diseases, discusses type 2 diabetes remission, including recent research into strategies and mechanisms by which people who have diabetes can achieve remission.
- Q: What is remission of type 2 diabetes? How do health care professionals define remission and know when a patient has achieved it? A: People with type 2 diabetes who do not have adequate glycemic control have an increased risk for diabetes complications.
- Glycemic control is monitored by measuring both blood glucose and blood markers assessing antecedent glycemia such as hemoglobin A1C, which reflects average glucose over the previous months.
We define type 2 diabetes remission as having the condition revert to a nondiabetic range as assessed with blood glucose levels or blood glucose markers and staying in that range for at least 6 months when a person isn’t taking any diabetes medications.
It’s important for both health care professionals and people who have type 2 diabetes to realize that significant weight loss either from lifestyle intervention (i.e., diet and exercise) or from certain procedures can result in blood glucose levels decreasing into the nondiabetic range, and that achieving remission can minimize or prevent future complications.
Q: Why do health care professionals use the term “remission” rather than “cure” when discussing type 2 diabetes? What happens to a person’s diabetes when he or she relapses? A: We don’t use the word “cure” when we refer to blood glucose levels reverting back to levels below the threshold used for diagnosis, as you could argue “cure” means completely alleviating the condition.
- For example, an acute condition seen with infectious diseases such as bronchitis may be considered to be cured with antibiotics.
- However, in type 2 diabetes, because blood glucose levels are on a continuum and are significantly associated with weight, it is observed that when weight regain occurs, the glucose levels may increase back to the range associated with diabetes diagnosis.
So, the correct term is “remission.” Type 2 diabetes is a progressive disorder, and, at one time, we didn’t think that weight loss or other interventions could allow people with type 2 diabetes to lower their blood glucose levels into the nondiabetic range and to stay there for an extended period of time without medication.
- However, we now understand that people with type 2 diabetes who lose significant weight and improve other factors related to diabetes can achieve remission.
- With sustained weight loss, people may stay in remission for quite some time.
- However, if they begin to put on weight, their blood glucose levels can increase and return to the diabetic range.
They may need diabetes medications or even insulin with weight regain depending on the severity of their type 2 diabetes and their glucose control. Q: What strategies can lead to remission of type 2 diabetes? A: The most important factor in achieving remission is weight loss, and two techniques—metabolic surgery and lifestyle changes that restrict calories on a daily basis to achieve weight loss—have been shown to induce remission.
Some studies, dating back many years, have observed that metabolic surgery leads to high rates of type 2 diabetes remission. Recently, the Diabetes Remission Clinical Trial (DiRECT), conducted in primary care practices in the United Kingdom, examined type 2 diabetes remission rates in participants who lost weight, starting with a very low-calorie diet and sustaining the weight loss over time.
DiRECT found high rates of type 2 diabetes remission among people who lost a significant amount of weight—more than 10 kg (about 22 pounds)—and sustained the weight loss over 12 to 24 months. Q: What research is being conducted on remission of type 2 diabetes? A: Studies have sought to understand the mechanisms of remission.
A lot of current research focuses on not only total fat in the body, but also where the fat may be located, referred to as “ectopic fat” (e.g., fat in the liver and pancreas) that may affect normal physiologic function. This research has led to some very interesting observations about potential mechanisms.
Weight loss may improve pancreas function, with better insulin secretion and type 2 diabetes remission. Q: Are some people with type 2 diabetes more likely to achieve remission than others? A: Three factors that seem to predict success in achieving remission are significant weight loss, baseline pancreatic function, and diabetes duration.
Significant and sustained weight loss—for example, in the range of 10 kg (about 22 pounds) as shown in some studies—is the most important factor. Studies in which participants lost small amounts of weight have shown lower rates of type 2 diabetes remission. However, studies in which participants lost a significant amount of weight—such as DiRECT or studies of metabolic surgery—have shown higher remission rates.
Studies of weight loss through restricting calories or metabolic surgery have found that people with type 2 diabetes who start with greater pancreatic function at baseline, prior to the intervention, are more likely to undergo remission. People who have had shorter diabetes duration are also more likely to undergo remission.
Type 2 diabetes is a progressive disease, and, after a long time with diabetes, pancreatic function may decline over time. Thus, observations suggest that after having diabetes for a long period of time, significantly improving pancreatic function and achieving remission may prove to be more difficult, compared to achieving remission early in the natural history of the disease.
Q: How and when should health care professionals talk with patients who have type 2 diabetes about remission? How can health care professionals help patients achieve remission and sustain it over time? A: First and foremost, you should emphasize the importance of managing blood glucose levels to minimize the complications of type 2 diabetes whether the patient is or is not on medications.
- Glycemic control is incredibly important in reducing the risk of complications, and you need to discuss glycemic control and a goal with the patient.
- In most cases, this means advising patients to keep their A1C level at 7 percent or below to prevent eye, kidney, and nerve complications.
- While we have very effective medications to lower blood glucose levels, lifestyle interventions (nutrition and exercise) are a cornerstone of managing diabetes.
A balanced diet that achieves weight loss not only improves blood glucose levels but also may reduce cardiovascular risk factors. Patients should also know that obesity contributes to increased blood glucose levels due to insulin resistance and that the more weight patients put on, that may mean they need more medication.
- It is important that they know if they lose weight and improve their body’s efficiency, they may require less medication.
- Let your patients know that if they lose enough weight, particularly during the early phases of type 2 diabetes, they will significantly lower their blood glucose, have less risk for diabetes complications, and may be able to achieve remission.
Overall, with significant weight loss through restricting calories or other strategies, patients have a high likelihood of achieving remission, particularly if they have a greater baseline pancreatic function and have had diabetes for a shorter time. William T. Cefalu, MD, is director of the Division of Diabetes, Endocrinology, and Metabolic Diseases at the NIDDK, and has had a 35-year career as a scientist, a health care expert, and a physician. His clinical and basic science research has focused on interventions to improve the metabolic state of people with insulin resistance and type 2 diabetes, and on the cellular mechanisms for insulin resistance.
What stage of diabetes is reversible?
A body of research putting people with Type 2 diabetes on a low calorie diet has confirmed the underlying causes of the condition and established that it is reversible. Professor Roy Taylor at Newcastle University, UK has spent almost four decades studying the condition and will present an overview of his findings at the European Association For The Study Of Diabetes (EASD 2017) in Lisbon.
Excess calories leads to excess fat in the liver As a result, the liver responds poorly to insulin and produces too much glucose Excess fat in the liver is passed on to the pancreas, causing the insulin producing cells to fail Losing less than 1 gram of fat from the pancreas through diet can re-start the normal production of insulin, reversing Type 2 diabetes This reversal of diabetes remains possible for at least 10 years after the onset of the condition
“I think the real importance of this work is for the patients themselves,” Professor Taylor says. “Many have described to me how embarking on the low calorie diet has been the only option to prevent what they thought – or had been told – was an inevitable decline into further medication and further ill health because of their diabetes.
By studying the underlying mechanisms we have been able to demonstrate the simplicity of type 2 diabetes.” Get rid of the fat and reverse Type 2 diabetes The body of research by Professor Roy Taylor now confirms his Twin Cycle Hypothesis – that Type 2 diabetes is caused by excess fat actually within both liver and pancreas.
This causes the liver to respond poorly to insulin. As insulin controls the normal process of making glucose, the liver then produces too much glucose. Simultaneously, excess fat in the liver increases the normal process of export of fat to all tissues.
- In the pancreas, this excess fat causes the insulin producing cells to fail.
- The Counterpoint study which was published in 2011, confirmed that if excess food intake was sharply decreased through a very low calorie diet, all these abnormal factors would be reversed.
- The study showed a profound fall in liver fat content resulting in normalisation of hepatic insulin sensitivity within 7 days of starting a very low calorie diet in people with type 2 diabetes.
Fasting plasma glucose became normal in 7 days. Over 8 weeks, the raised pancreas fat content fell and normal first phase insulin secretion became re-established, with normal plasma glucose control. Keep the weight off and keep the diabetes at bay “The good news for people with Type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you are likely to be able to reverse it by moving that all important tiny amount of fat out of the pancreas.
At present, this can only be done through substantial weight loss,” Professor Taylor adds. The Counterbalance study published in 2016, demonstrated that Type 2 diabetes remains reversible for up to 10 years in most people, and also that the normal metabolism persists long term, as long as the person doesn’t regain the weight.
Professor Taylor explained the science behind the mechanisms: “Work in the lab has shown that the excess fat in the insulin producing cell causes loss of specialised function. The cells go into a survival mode, merely existing and not contributing to whole body wellbeing.
- Removal of the excess fat allows resumption of the specialised function of producing insulin.
- The observations of the clinical studies can now be fully explained.” He added: “Surprisingly, it was observed that the diet devised as an experimental tool was actually liked by research participants.
- It was associated with no hunger and no tiredness in most people, but with rapidly increased wellbeing.
The ‘One, Two’ approach used in the Counterbalance study was a defined two phase programme. The Phase 1 is the period of weight loss – calorie restriction without additional exercise. A carefully planned transition period leads to Phase 2 – long term supported weight maintenance by modest calorie restriction with increased daily physical activity.” This approach consistently brings about 15kg of weight loss on average.
- After the details were posted on the Newcastle University, UK website, this has been applied clinically and people who were highly motivated have reported that they have reversed their type 2 diabetes and continued to have normal glucose levels (normoglycaemic) over years.
- A further study in general practice, the Diabetes Remission Clinical Trial (DiRECT) funded by Diabetes UK is now underway to determine the applicability of this general approach to routine Primary Care practice with findings due before the end of the year.
Patients or GPs who would like more information about the diet that reverses Type 2 diabetes see the Magnetic Resonance Centre website.
How can I reverse diabetes permanently?
Although there’s no cure for type 2 diabetes, studies show it’s possible for some people to reverse it. Through diet changes and weight loss, you may be able to reach and hold normal blood sugar levels without medication, This doesn’t mean you’re completely cured.
Type 2 diabetes is an ongoing disease. Even if you’re in remission, which means you aren’t taking medication and your blood sugar levels stay in a healthy range, there’s always a chance that symptoms will return. But it’s possible for some people to go years without trouble controlling their glucose and the health concerns that come with diabetes.
So how can you reverse diabetes ? The key seems to be weight loss. Not only can shedding pounds help you manage your diabetes, sometimes losing enough weight could help you live diabetes-free – especially if you’ve only had the disease for a few years and haven’t needed insulin.
Can HbA1c 6.6 reversed?
Type-2 diabetes is reversible! Type-2 diabetes is said to be reversed (in remission) when your HbA1c remains below 6.5% (or. This reversal of diabetes remains possible for at least 10 years after the onset of the condition.
Can metformin help reverse diabetes?
We consider diabetes reversed when someone achieves an A1c below 6.5%, without requiring diabetes medications other than metformin. Metformin is excluded from reversal criteria because it is not diabetes-specific —many patients choose to stay on this medication for reasons other than blood sugar control.
Can exercise help reverse diabetes?
Aerobic Activity to Reverse Diabetes Aerobic exercise improves insulin resistance and helps lower blood sugar, and is one of the most effective ways to reverse prediabetes.