Diabetes is not a lifelong disease, it is actually possible to reverse it! What are the mechanisms and strategies for reversal?

In the traditional concept, diabetes is a "lifelong" disease, once you get it, there is no way to "cure" it. Therefore, glucose-lowering medication cannot be stopped ......

However, in the 21st century, with the increase in the number of treatments for diabetes and the improvement in treatment philosophy, more and more doctors are realizing that the previous concept is not entirely correct.

In fact, there is hope that diabetes can be reversed, and the light is becoming clearer.

How is diabetes reversal defined?

Currently, there is not really an agreed-upon standard for diabetes reversal worldwide.

However, since 2000, a growing number of medical organizations and experts have recognized the need to define what constitutes a reversal of diabetes and have continued to refine this definition.

Earlier, in 2002, the World Health Organization (WHO), together with the American Diabetes Association (ADA), proposed a definition of diabetes reversal. Specifically, a fasting blood glucose level of 7.0 mmol/L or less and a glycated hemoglobin level of less than 6.5% after at least 2 months of discontinuation of all hypoglycemic drugs.

However, it seems that medical experts subsequently found in practice that this standard may be too l enient.

So in 2009, the ADA reorganized its experts to come up with a joint expert statement on the definition of diabetes reversal. In it, diabetes reversal was further differentiated into "partial reversal " and "complete reversal".

Partial reversal is defined as a fasting blood glucose level of 7.0 mmol/L or less and a glycated hemoglobin of less than 6.5% after at least 1 year of discontinuation of hypoglycemic drugs.

A complete reversal, on the other hand, requires a fasting blood glucose level of 5.6 mmol/L or less and a glycated hemoglobin of less than 5.7% after at least 1 year of discontinuation of hypoglycemic drugs.

Once the complete reversal is maintained for more than 5 years, it can be further considered as achieving "long-term reversal"!

However, it seems that this version of the definition has not been widely adopted, and many physicians believe that this version of the criteria is too stringent and few patients are able to achieve it.

In 2014, a large clinical study that included more than 100,000 diabetic patients found that after 7 years of follow-up, only 1.5% of diabetic patients achieved partial reversal, and only 0.14% achieved complete reversal.

So, in 2019, experts from the British Diabetes Association suggested that the criteria for diabetes reversal should be relaxed to: stopping glucose-lowering drugs for more than 6 months, fasting blood glucose within 7.0 mmol/L and glycosylated hemoglobin less than 6.5%.

Although, it seems that this definition keeps changing and doctors are still not sure where the correct standard is.

However, there is one crucial point that should be noted: medical experts generally agree that it is possible for people with diabetes to stop taking their medication after treatment, and that there is hope that blood glucose can be maintained at a low level after a period of discontinuation.

Unlike what many people used to think, if you have diabetes, you can only watch it deteriorate, and the treatment only has a delaying effect.

So, why is it that diabetes can be reversed after treatment? What are the mechanisms involved?

Why is it possible for diabetes to be "reversed"?

In our body, insulin, which is secreted by the pancreatic beta cells, is the main hormone that lowers blood sugar. It can be said that the essence of diabetes is a "relative" or "absolute" deficiency of insulin secretion.

The so-called "relative deficiency" can be understood as follows: the amount of insulin secreted itself is normal or even excessive, but the body's responsiveness to insulin has decreased and is not sensitive. As a result, even though there is a lot of insulin or even a lot of insulin, the blood sugar still cannot be lowered.

This phenomenon is also called "insulin resistance" and is common in many early stage diabetic patients who still have good pancreatic beta cell secretion.

In the case of "absolute deficiency", the function of insulin secretion by pancreatic beta cells has declined, and the amount of insulin is significantly reduced, which causes blood glucose to rise.

In fact, when "insulin resistance" appears, if no intervention is given, it becomes almost inevitable that the secretory function of the pancreatic beta cells will be gradually "dragged down".

The reason is actually very simple, when the secretion function of the pancreatic beta cells is still normal, insulin resistance will force the pancreatic beta cells to secrete more insulin each time to be able to lower blood sugar, over time, the pancreatic beta cells will be "fatigued", "tired In the long run, the pancreatic beta cells will gradually degenerate because of "fatigue" and "stress".

In addition, the properties of insulin itself will also accelerate this change. One of the pathways by which insulin lowers blood glucose is by allowing blood glucose to be converted into fat and deposited in our internal organs, especially when there is more fat in the liver, which increases the insulin resistance effect; and the liver also "transports" additional fat to the pancreas, a process that accelerates the decline of islet beta cell function.

Therefore, the key to reversing diabetes is to stop the vicious cycle caused by "insulin resistance" before the secretion function of the pancreatic beta cells is "collapsed". There are two main mechanisms.

The first is to find ways to improve insulin resistance.

The second is to control and stabilize blood glucose in a timely manner and reduce the stimulation of blood glucose fluctuations on the pancreatic beta cells.

To avoid long-term "overwork" of the pancreatic beta cells, they should be "protected".

So, how should you do this?

What are the three main strategies to reverse diabetes?

Strategy one is to intervene early.

Some experts say that if you can identify the problem in the early stages of diabetes and intervene, you have the highest probability of getting your blood sugar back to normal.

Even if diabetes has been diagnosed, theoretically, the shorter the duration of the disease, the higher the probability of reversal; the better the current insulin secretion function, the greater the hope of reversal.

Therefore, once abnormal blood glucose is detected, do not hesitate and keep delaying, but should decisively start intervention and treatment immediately! In fact, the basic treatment of diabetes is to start with a healthy lifestyle, such as diet and exercise!

The second strategy is to get your weight under control.

One thing that can be confirmed is that the sustained reversal of diabetes is closely related to maintaining weight loss.

And it has also been suggested that a body mass index BMI greater than 25 kg/m2 is one of the necessary conditions for diabetes reversal.

In other words, obese diabetics are conversely more likely to experience reversal than diabetics with lean body mass, but only if they lose the weight.

While weight loss can primarily help improve insulin resistance, reducing visceral fat can not only improve insulin resistance but also help restore pancreatic beta cell function.

Therefore, the goal of weight loss is not only to get the body mass index down, but also to get the waist circumference under control. This is because waist circumference is a common indicator of visceral fat.

The third strategy is to intensify hypoglycemic drug therapy.

As we have analyzed earlier, the essence of protecting pancreatic beta cells is to control blood sugar well with the help of drugs.

Among the commonly used hypoglycemic drugs, it has been suggested that thiazolidinediones, such as pioglitazone, are effective in reversing diabetes.

Of course, there are more and more glucose-lowering drugs available today, such as glucagon-like peptide-1 agonists and new glucose-lowering drugs such as sodium-glucose co-transport protein 2 inhibitors, which also provide more possibilities for diabetes reversal.

And for a subset of patients whose blood glucose levels are already high at diagnosis, early intensive insulin therapy can be helpful in diabetes reversal. This is why, during hospitalization, many diabetic patients are given intensive insulin therapy by their doctors, which actually helps the pancreatic beta cells to restore their function.

To conclude with you again, diabetes is not completely without chance of reversal.

If you want to increase your chances of reversing your diabetes, then make sure you start intervening as early as possible after you discover your blood sugar problem, and the key to that intervention is weight control and intensive glucose lowering.