TYPE 2 diabetes is often described as a progressive disease. If left unchecked, it can gradually deteriorate over time and more medication will be required to manage this disease.
But what about the opposite? With the right lifestyle changes and a resolute mind to be better at looking after one's health, can you "reverse" the disease or more accurately, put it into remission?
Reversal implies a permanent cure and unfortunately for type 2 diabetes, there is no known cure. However, it is proven that the disease can be controlled and in some successful cases, go into remission.
What remission means in type 2 diabetes is that your blood sugar levels are healthy once more without the need to take any medication to control it. More specifically, your A1C (your estimated average blood sugar level or glucose level) has been reduced to the level of someone without diabetes (less than 6.5 per cent) and therefore you are able to either limit the medication you are taking or eliminate it altogether for over six months or longer.
Knowing this can mean hope for a lot of type 2 diabetes patients but what exactly needs to be done?
This was the focus of a recent webinar co-organised by the Center of Transformative Nutrition and Health (CTNH) at International Medical University (IMU) with the Malaysian Endocrine and Metabolic Society (MEMS), and the Malaysian Dietitians' Association (MDA) which was attended by over 550 participants who were physicians, dietitians, diabetes educators, nurses and other healthcare professionals from Malaysia, Singapore, Middle East and the United Kingdom.
Diabetes remission is quite a new idea and a lot more research is required before it can be fully understood.
"In this part of the world, there has been an upsurge in type 2 diabetes and its related risk factors, which include rising levels of obesity, unhealthy diets, and widespread sedentary lifestyles. Growing urbanisation and changing lifestyle habits are contributory factors as well," says the Ministry of Health's head of endocrinology services, Datuk Dr Zanariah Hussein.
However, with the right management for your diet and lifestyle, the risk of the disease is significantly reduced, she explains.
For those living with diabetes, being on top of both factors can improve your quality of life.
"Lifestyle modification is the primary step once diabetes is diagnosed," stresses Dr Zanariah.
She cites the latest version of Management of Type 2 Diabetes Mellitus that recommends patients with type 2 diabetes with aims of achieving diabetes remission to consider meal replacement therapy (MRT) and very low-calorie diets (VLCD).
But how exactly does losing weight encourage diabetes remission?
First, we need to understand what extra weight does to the body. Fat can build up around important organs like the liver and pancreas, making it difficult for these organs to work. This can lead to the development of type 2 diabetes though other factors come into play as well such as age, ethnicity, and family history.
And the vice versa is true as well: losing fat affects diabetes remission.
University of Oxford Professor of Diet and Population Health, Professor Dr Susan Jebb, who has been studying the impact of weight loss in a primary care setting for type 2 diabetes patients, says there is a linear relationship between weight loss and the likelihood of achieving remission.
She also emphasises that while the recommendation is Total Diet Replacement (TDR), it is not suitable for everyone.
"For the last 10 years or more, we've been working hard on the effectiveness of weight loss for remission. It is important to realise that there are a range of different ways to lose weight.
Encouraging people to manage their weight themselves is modestly effective though the weight loss is limited. But if the whole population did that, you can imagine the benefits accrued from that," says Dr Jebb.
But it's important to know that remission is not a one-off event. It needs to be maintained because if not, there is always the chance that your diabetes might return, says Professor Dr Paul Aveyard, Professor of Behavioural Medicine from the University of Oxford.
This is where healthcare practitioners come in to provide support for their patients, he adds.
He also highlights that aside from diabetes remission, weight loss also has other long-term benefits in terms of cardiometabolic effects. Hence efforts to lose weight in diabetes are all worthwhile due to this legacy effect.
Whether it is an accelerated approach to weight loss or a gradual approach, the idea is simply to get started and find one that works for you.
In fact, diet is not the only way for type 2 diabetes remission; some patients have had bariatric or weight-loss surgery. It is important to speak to your healthcare provider for help because support plays an important role too, whether from the person helping you manage your diabetes or your loved ones.
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