It was a hot summer evening in 2008 when I received a panic call from a friend. She was breaking down and couldnt explain herself clearly. All I could figure out was that her 24-year-old son Saurabh had been found to have a blood sugar of 400+. Could he really be a diabetic? What would be his future? I saw Saurabh the same evening. He did not seem sick at all, except that he was about 20 kg overweight, despite losing some weight over the last few weeks.
Saurabhs HbA1c concentration was 13 per cent. HbA1c is a measure of blood sugar as a three-month average. The normal range is <5.7, 5.7-6.4 is considered prediabetes, and 6.5 or above is labelled as diabetes. As is the protocol for young patients with such high blood sugar values, insulin treatment was initiated. His laboratory tests came back and he was found to have Type 2 diabetes, the common type of diabetes that usually affects older adults and does not always require insulin for treatment.
Saurabh worked in a law firm, had 10-14 hour days, ate in the office, partied on weekends. Sleep hours were erratic and interrupted. He had a family history his mother had developed diabetes at the age of 50. Diabetes hit him earlier because of his obesity and lifestyle.
Since that day, Saurabh turned a new leaf. He gave up junk food altogether and started regular exercises. He lost 12 kg over the next six months with lifestyle modification and behavioural discipline. In a few weeks, his insulin was discontinued. His blood sugar values remained under control on progressively lower doses of oral medication. Another six months passed and Saurabh lost an additional 6 kg. Soon, he was able to maintain normal blood sugar levels without any medication. To date, he continues to monitor his blood sugar and all his other parameters every few months. All parameters are within range. He has not regained his body weight. For the last 12 years he is off all medication and continues to be normal.
Is this a miracle? Can this be reproduced? Let me first state that some patients of Type 2 diabetes can go off medication, and remain fine for years. Its not called cure or reversal, which implies permanency. Rather, the term remission is used, since we dont know if it is permanent. Type 2 diabetes is an ongoing, progressive disease and it is expected to make a comeback at some point. Clearly, however, several years of postponement of diabetes is possible. This has tremendous benefits for our long-term health and well-being.
The key to achieving a remission in Type 2 diabetes is weight loss. Weight and diabetes have a direct and powerful connection. Much of the increase in diabetes prevalence worldwide is linked to increasing obesity. Shedding off those extra kilos can reverse many metabolic processes and can induce remission in diabetes, particularly if diabetes is of recent onset. Type 2 diabetes results from a combination of insulin resistance (resistance to insulin action at the cellular level) and insulin deficiency (the pancreatic beta cells are unable to make enough insulin). Weight loss can partially reverse both of these processes.
Studies have shown that very low-calorie diets can help achieve weight loss and remission of diabetes. About 600-800 calories per day, consumed for two to three months, followed by a maintenance diet were able to normalise blood glucose levels in about half the participants and also maintain them, for at least a year.
A large community-based clinical trial called DiRECT (Diabetes Remission Clinical Trial) was conducted in the UK. DiRECT enrolled people with Type 2 diabetes for less than six years and not receiving insulin treatment. They were provided either standard diabetes care or low-calorie meal replacement diet (825850 kcal/day) for three to five months, followed by stepwise food re-introduction and a long-term weight maintenance programme. At a one-year follow-up, 46 per cent of patients had achieved diabetes remission (HbA1c <6.5 per cent without medication). At two years, the remission rate was 36 per cent.
The diets used in these trials were quite restrictive, requiring strong, sustained motivation, and could only be followed under close medical supervision. The long-term effects of such severe diet restriction are unknown at present. Some individuals achieve calorie reduction by following different types of intermittent fasting protocols. Although remission is reported with long standing diabetes too, the shorter the duration of diabetes (usually less than 5-6 years) the greater the chances of success.
What about exercise? Exercise keeps us healthy in many ways and helps control our blood glucose too. But exercise alone, even 10,000 steps a day, is not enough to induce remission. It has to be combined with calorie restriction.
Weight loss (bariatric) surgery has been known to induce remission in patients with diabetes. The signs of diabetes reduce or disappear within a few days, even before any major weight loss, suggesting that severe limitation in food intake or changes in gut hormones could be a reason. In the long term, weight loss seems to be the main factor responsible for better diabetes control.
Are such aggressive measures always required to induce remission in diabetes? In our experience, many patients like Saurabh who are overweight or obese and initiate calorie restriction (not necessarily drastic, as in the UK trials), early in the course of diabetes, are able to achieve remission. I dont believe it is always necessary to resort to very low-calorie diets. Any combination of diet and exercise that helps one knock off the extra kilos in a young individual with recent onset diabetes has the potential to induce remission. Even a 10 per cent patient weight loss is sufficient in some cases to normalise blood glucose.
More recent approaches that have shown good results include custom-designed diets and programmes based on a large number of data points acquired through continuous monitoring of body parameters.
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Can you reverse diabetes with weight loss and a rigid diet? How some patients of Type 2 diabetes actually went off medication - The Indian Express
