Type 2 diabetes can be reversed with intensive medical treatment, study shows

Type 2 diabetes can be reversed with intensive medical treatment using oral medications, insulin and lifestyle therapies, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Type 2 diabetes is typically thought of as a chronic condition. As it progresses, individuals with type 2 diabetes often need to use a healthy diet, exercise and an increasingly complex combination of medications to manage the condition.

"By using a combination of oral medications, insulin and lifestyle therapies to treat patients intensively for two to four months, we found that up to 40 percent of participants were able to stay in remission three months after stopping diabetes medications," said the study's first author, Natalia McInnes, MD, MSc, FRCPC, of McMaster University and Hamilton Health Sciences, in Hamilton, Ontario, Canada. "The findings support the notion that type 2 diabetes can be reversed, at least in the short term—not only with bariatric surgery, but with medical approaches."

One in 10 American adults has type 2 diabetes, according to the Society's Endocrine Facts and Figures report. The condition occurs when an individual doesn't produce enough insulin—the hormone that allows cells to absorb glucose in the blood—or the pancreas isn't making insulin as efficiently as it could. As a result, blood sugars build up in the body and the cells do not receive the energy they need.

To study ways to put type 2 diabetes into remission, the researchers randomly divided 83 individuals with the condition into three study groups. Two of the groups received an intensive metabolic intervention where they were provided with a personalized exercise plan and a suggested meal plan that reduced their daily calorie intake by 500 to 750 calories a day. These study participants met regularly with a nurse and dietitian to track their progress and received oral medications and insulin at bedtime to tightly manage their blood glucose levels. One group underwent the intervention for eight weeks, while the other was treated intensively for 16 weeks. After the intervention, individuals in both groups stopped taking diabetes medications and were encouraged to continue with lifestyle changes.

The two intervention groups were compared to a control group of individuals with type 2 diabetes. Participants in this group received standard blood sugar management advice from their usual healthcare provider for the duration of the trial, and they received standard lifestyle advice. Participants in all three groups received usual diabetes care if they experienced a diabetes relapse.

Study participants had their average blood glucose levels from the past two to three months measured using a HbA1C blood test at eight, 20, 28 and 52 weeks to gauge how well their blood sugar was controlled. They also undertook oral glucose tolerance tests.

Three months after the intervention was completed, 11 out of 27 individuals in the 16-week intervention group met HbA1C criteria for complete or partial diabetes remission, compared to four out of 28 individuals in the control group. Three months after finishing the eight-week intervention, six out of 28 individuals in that group met the same criteria for complete or partial diabetes remission.

"The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for any signs of relapse," McInnes said. "The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes and to achieve normal glucose levels with the help of medications. This likely gives pancreas a rest and decreases fat stores in the body, which in turn improves insulin production and effectiveness."

The senior investigator on the trial, Hertzel C. Gerstein, MD, MSc, FRCPC, of McMaster University and Hamilton Health Sciences added, "We chose to use metformin, acarbose and basal insulin glargine in this trial as these medications have all been shown to slow or prevent the development of type 2 diabetes. However, other drug combinations could lead to higher remission rates and need to be systematically studied with regard to this outcome."

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Comments

  1. Faruz Ur Tev Faruz Ur Tev United States says:

    Big pharma LIES!  I reversed my Type II diabetes with diet and exercise.  I followed a strict regimen of limited carbs and daily exercise, dropped 40 lbs and beat the disease.  You can, too! Discipline -- not drugs.

    • Randy Dandy Randy Dandy United States says:

      Type II diabetes is not "The condition occurs when an individual doesn't produce enough insulin . .", as stated by the author.  It is a lack of insulin sensitivity in the receptor cells.  Insulin is abundant but not useable.
      Type II diabetes is a lifestyle illness, only requires cutting out carbs, increasing good fat and lots of exercize.  It will resolve on it's own.

  2. Randy Dandy Randy Dandy United States says:

    To begin with the author says:  "The condition occurs when an individual doesn't produce enough insulin . ."
    This is incorrect.  The author is describing Type I diabetes.  Type II diabetes is the loss of insulin sensitivity by receptor cells making it difficult to absorb sugar.  The condition causes an excess of insulin in the system causing a cascade of other maladies.
    Second:  Type II diabetes is a lifestyle illness.  Cut out carbs, increase GOOD fat intake, excersize and 90% of Type II diabetes cases are resolved without medication or surgery.

  3. Sally Sue Sally Sue United States says:

    Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.

  4. Colleen Baker Colleen Baker United States says:

    I was told almost 2 years ago that I have type 2 diabetes.  I went on Metformin, lost 25 pounds with changes to my eating.  Worked in my yard  a lot for exercise.  Then I got some kind of arthritis in both feet and have not been able to do as much activity.  Long story short..I started sitting more, eating carbs more and more and now I am flabby have gained back almost 8 lbs over the last year and I have huge bags under my eyes that I swear get bigger daily.  I do I get back to when I was first diagnosed.  I go to my Dr's in April and she will be mighty disappointed when she sees me.

  5. Colleen Baker Colleen Baker United States says:

    I meant to ask HOW do I get back to when I was first diagnosed.  Any way to kick start myself?

    • J Thompson J Thompson Canada says:

      Colleen, I have some suggestions that worked a treat for me. Understand: I'm in the same boat as you; I am not a doctor. I have however been frustrated & poorly served by many MDs & specialists & had to figure out a treatment regime that worked, & none of it is harmful. My prob is more T3D (yeah, it exists, though it certainly isn't widely recognized yet).  Apologies if I get something in the discussion below inaccurate: I'm a researcher by trade but not a medical researcher, but someone will likely correct errors pretty fast, and I'm pretty confident the bulk of this is very defensible. It's all pulled from better-quality peer-reviewed medical journals. I'll be interested to see whether this web site truncates my answer; if so, look up "Ketogenic Diet" & Dom D'Agostino &/or Tim Ferriss, then research everything they say. So, butt covered if they abbreviate, read on:
      T1D (type 1 diabetes): your pancreas quit, likely being attacked by immune system, but you're f*@ked: you need insulin, & we can't cure it (yet). Mostly occurs age 12-25.
      T2D: the receptor cells for insulin in your muscle tissue & elsewhere lose receptivity for insulin. They can process some, but respond insufficiently well/quickly enough to metabolize glucose before it has toxic effects on tissue. Your pancreas still works - in fact, you're likely overproducing insulin, in an attempt to break down glucose - but too much insulin is toxic too. Happens in middle-age traditionally but increasingly in youth, so incidence could be related to diet. As noted by others more eloquently than me, this appears to be quite treatable, perhaps to some degree reversible. Suggestions follow.
      T3D: analogous to T2D but the receptor cells in your neurons become insulin-resistant. New discovery; unless your MDs & Endocrinologists do more reading after graduation than any I've encountered, you're screwed, but there does appear to be a way to treat that effectively too (worked for me: I'm about 3 yrs. into it & mostly recovered. No thanks to my MDs, but some to the Neurologist who vetted my research, OK'd the treatment & monitored it with me).
      There's more! Gestational Diabetes, Type 1.5 Diabetes... Forget them for now.
      So, Treatment for T2D:
      1. Use an insulin receptor-cell agonist that boosts insulin receptivity in muscle tissue. I understand you've done that: great! Meformin has traditionally been the drug of choice; appears to help. There are a couple of new drugs getting more limelight this year; I don't know whether that's because they work better, are simply new & novel, or because pharma companies behind them are selling hard (metformin is long off-patent so cheap & not making anyone rich) & MDs are hearing about them. Check Google for new metformin alternatives & stick to good medical journals for research trial results & sources like WebMD for info on efficacy, dosage, side effects & hazards, then discuss with your MD/Endocrinologist.
      2. Losing weight: usually suggested as a starting point, 'cause people with this metabolic disorder are frequently overweight. You've done this: great! Losing weight changes your metabolism over time. There may be even more you can do in that regard, though:
      3. This is a metabolic disorder - you have a problem burning sugar - so it can help enormously to reduce - even stop - sugar intake. That's not a really easy thing to do, but there are some tricks to it that seem to help a lot. Your body craves sugar because we've been feeding it sugar & it has become dependent on it. News flash: you don't need sugar - in fact, don't need any carbs (you do, however, need fat, protein, fibre & nutrients, but you can function just fine without carbs - ask an Inuit). Exercise will make you healthier - don't neglect it - but likely won't reduce weight or substantially change the way your body chemistry works; for that, diet is more direct.
      What powers cells & all chemical reactions between cells, is mitochondria, a kind of cell-within-a-cell found in all animals much as chlorophyll is found in plants. Chlorophyll converts water+sunlight directly to energy+oxygen. Mitochondria convert glycogen (glucose), obtained directly from our foods or from our liver as it attempts to convert other sugars into glucose, into ATP which powers cellular processes: makes them work. There may be other body processes that metabolize (not just store) sugar, but this is the main one.
      Primitive man (that'd be all of us thousands of years ago, or indigenous peoples much more recently, or indigenous people still living on a traditional diet) lived pretty much without sugar. Sure, N American natives had access to berries for a few weeks each fall, but that'd be it. In the tropics there are more fruit, but most of those contain mostly fructose (anything ending in -ose is a sugar) & we - or rather our mitochondria - can't directly process any sugars but glucose. Instead, we store excess or non-glucose sugar as fat (all over but especially in the liver) against possible need later: remember, man's natural state is a lot of low-calorie foraging (subsistence - unpleasant) or starvation (really unpleasant) with the occasional feast (eat the whole animal before it rots). So indigenous man lived almost entirely without sugar. On fats. No simple carbs to speak of, either: grain agriculture came late, millions of years after we swung out of the trees. So our mitochondria can burn fat/oils, instead of fast carbs (as glucose or glycogen from fast carbs). In fact, it appears they burn fat - especially certain types - better - but only in the absence of sugar. Burning sugar is easier & therefore preferential, but it means we burn sugar and store fat: not good. And while we can switch to burning fat, it takes our cells (i.e. mitochondria in them) a few days in the complete absence of sugar to switch over to burning fat. Meanwhile you feel like sh!t. Example: first few days of a serious fast you feel like the flu, after which you feel much better & can actually go for a week or two without food while your body burns fat. Not that I'm advocating that - could produce problems for you - just pointing out that in general our bodies are quite capable of going w/out food for some time. Had to: we made a habit of it in the bush.
      So, how do we get our cells to burn fat? The chemical process in which mitochondria burn fat in our cells - turning it into ketones then ATP to power muscle tissue, neurons etc. - is "ketosis." The diet that helps is called a ketogenic diet.

      Simply put:
      - No sugars (or really close to none); until you're used to going without sweeteners you use sparing amounts of stevia or erythritol (other non-sugar sweeteners may pose a prob - jury is still out);
      - No fast carbs that the body will turn into sugars quickly: starches, grains (breads etc.), rice, potatoes & starchy veg, most fruit. You don't need them;
      - Low protein: palm-of-your-hand sized good protein, like oily fish, chicken, dairy & beef (grass-fed makes a difference in both apparently - different fatty acids result - so pay extra for the small amount you'll need or quit meat), & some nuts;
      - lots of slow carbs like beans;
      - All the green veg you can eat;
      - Healthy oils: you treat beans & vegetables as oil-delivery vehicles, & stick to really healthy oils like butter, animal fat, coconut & avocado oil, some nut oils... you'll be amazed at how much fat you eat but again, what kind is crucial.

      You may find an Atkins or Paleo diet will do the trick without going full-Keto. But while you can lose weight doing that, you may not get over the hump - you may still be too insulin-dependent. If so, maybe try a step further by pushing the diet into ketosis, where cells burn fat as ketones, instead of burning sugar. The traditional trigger was starvation, or near-starvation. This works because your body makes the switchover as a survival technique, to burn stored fat. We can live on incredibly low caloric intake, but it isn't easy to get good nutrition doing it, and it isn't fun. It can apparently boost your immune system a little & is proven in mammals (mice & dogs) to increase lifespan as much as 40%, but no one is going to maintain the protocol for decades; still, medical researchers believe it would work. So caloric restriction pushed really hard works, & has been used medically (see below) but is too demanding for most people, and takes 3-4 days to kick in, during which you feel like crap ("keto 'flu"). BTW, one reason Metformin works for T2D is it appears to induce many of the same benefits as caloric restriction. Ketosis does this too, but going on a subsistence diet to trigger it isn't something you will stick to.
      You can push the body into ketosis same-day, however, by using a strict ketogenic diet and adding medium-chain triglyceride oils (MCT oils) distilled from healthy oils like coconut. Works fast & eliminates "keto 'flu." Body builders have used this trick for decades to push from 12-15% body fat (achievable with diet & hard work) down to 3-5% (insane, not healthy, but looks great on a Mr. Universe podium). Problem is sufficient MCT oil to do the trick causes gastro-intestinal distress (Tim Ferriss calls this 'disaster pants'). New development: Quest Nutritionals has figured out a way to spray an atomized mix of MCT oil & fibre into a vacuum, producing freeze-dried MCT Oil Powder. It mixes with coffee or water etc., has no flavor, and is less likely to cause digestive problems. Cool stuff. Not cheap (costs me ~$1.50/day), but way less $ than T2D medication costs; get it on Amazon. There are several competing prods, but most are more expensive and (in my experience) don't appear to work much better. Understand: I am NOT advocating going off T2D meds if you're on them, but this may help reduce your need for them over time. Read lots then discuss with your MD.
      The ketogenic diet is safe: been the standard of care for epilepsy in meds-resistant children for decades (stops seizures), but getting them into it with caloric restriction wasn't ever fun, & you need to watch nutritional intake. Used by bodybuilders for decades too, but they aren't always good nutritional role models. Used by the US Navy to help divers avoid seizures at depth. So: safe to use sensibly.
      Oil intake makes you feel full, stay satiated (not hungry) longer, & after a month or two you'll quit craving sugar (really). You'll likely lose some weight. You'll feel WAY better. Your insulin levels will drop precipitously: you don't need it to burn fats, so will produce very little, giving your pancreas a rest. Further tissue damage (T2D side-effects) caused by free sugar & insulin in your system attacking body cells, stalls.
      There are ways you might potentially reverse T2D side-effects (liver & kidney damage, neuropathies, etc.) but how much is likely person-specific & dependent at least on how much & how long damage has occurred. Research on this is more limited, and the whole discussion is a different topic - but it is possible.

      Regarding Osteoarthritis: there's research that suggests almost everything so far touted to work, doesn't work, but this year's new solution (collagen) might, a little - or perhaps that just hasn't been researched well enough & shot down yet. My physiotherapist & a podiatrist agree that pushing through pain can help: increased blood-flow helps reduce inflammation. An elderly friend with OA in her fingers would knit constantly when attacks occurred. Not a real treatment, but helps symptoms a little & reassures me that gentle activity doesn't contribute to damage. Blood tests can ID different types of arthritis, & while there are treatments for them that actually work (not so much yet for OA), they're pretty nasty & the sooner identified, the better. Figure out what you're dealing with ASAP - it isn't hard to do.

      Most diets shrink fat cells the body has stored against future need, but they weren't eliminated so bloat up again fast when you fall off the wagon. Proponents of the ketogenic diet claim it actually starts burning stored fat; recent research suggests a possible mechanism, as they've shown that some white fat cells (the vast majority) can switch to brown fat cells that burn fat & raise your metabolism (it was thought we each had a fixed number of those), and it appears metabolic shifts such as those discussed may be what induces the switch. Certainly I've found going keto made it easier to keep lost weight off. Watching that happen (pretty quickly, too) is pretty motivating: keep a journal. Kudos to you though as it sounds like you kept most of your weight loss off. The other thing that helps is I quickly felt much, much better, & it helped observably stop & then reverse nerve damage. And when I fall off the wagon - eat carbs I shouldn't - I generally feel like crap afterwards, which helps me stay strong next time they're offered. Finally, just losing weight (likely over 10%+ by the sound of it: that's impressive) also appears to subtly change your metabolism, & remember T2D is a metabolic disorder. D'Agostino (see below) claims the metabolic shift takes time - months, maybe years - before your body can fully realize the benefits: he's documented that. So early effects - they'll be pronounced - promise further benefits over time.

      Find websites by Tim Ferriss & especially Dom (Dominic) D'Agostino, a prof at U of S Florida & nutritional expert on the ketogenic diet & its medical uses. Start with their podcasts on YouTube. Maria Emmerich has website & books offering recipe help, but Ferriss is right, I think, to argue your actual meal plans can be very simple and quite repetitive: don't over-complicate things. Hang in there: this can work.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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