Can diabetes be reversed?

 In an era where metabolic health is increasingly being talked about, the rising prevalence of diabetes emerges as a significant global concern. Projections indicate a staggering increase from 483 million to approximately 700 million affected individuals worldwide. In India alone, where 77 million diabetes cases are documented and 80 million individuals are in a pre-diabetic state, it becomes imperative to reassess strategies for addressing this escalating health crisis.

The spectrum of diabetes symptoms, from fatigue to increased thirst and weight gain, significantly impacts individuals' lives. The manifestation of diabetes symptoms varies based on factors such as blood sugar levels, overall health, and the effectiveness of diabetes management. Common symptoms include fatigue, increased thirst, and frequent urination due to fluctuating blood sugar levels. Other effects encompass unintended weight changes, blurred vision, and numbness or tingling in the extremities. Slow wound healing, heightened hunger, and mood fluctuations are also prevalent side effects.

Understanding Diabetes: Diabetes occurs when the body struggles to utilize sugar properly, with two main types—Type 1 and Type 2. Type 1 results from the immune system attacking insulin-producing cells, leading to insufficient insulin. Type 2 involves cells not responding effectively to insulin, resulting in elevated blood sugar levels. In both types, the core issue lies in sugar not entering cells as it should, causing elevated blood sugar levels. The origins of diabetes involve a combination of genetic predisposition, lifestyle choices, and environmental factors. While genetics play a role, lifestyle factors significantly contribute to diabetes onset. Uncontrolled diabetes poses serious risks to vital organs, potentially leading to complications such as heart disease, kidney issues, and vision problems.

Is Diabetes Reversal Possible? Yes, there is hope. Studies indicate promising prospects for reversing Type 2 diabetes through comprehensive lifestyle modifications and, in some cases, medical interventions. Weight loss achieved through methods like bariatric surgery, very low-calorie diets, and exercise has shown remission and reversal of diabetes in some individuals, challenging the notion of Type 2 diabetes being irreversible. In Type 2 diabetes, the prevailing notion is that the body struggles to use insulin, leading to higher insulin levels and β-cell problems. Research suggests a persistent decrease in the number of β-cells over time, contributing to challenges in managing Type 2 diabetes.

Diabetes and Fat Accumulation: Recent research highlights the impact of excessive fat in the liver on insulin production in the pancreas. Continuous exposure to high-fat levels harms β-cell function, reducing their ability to handle increased sugar levels. This discovery holds significance for better understanding and managing Type 2 diabetes.

The Weight-Loss Connection: The relationship between weight loss and diabetes improvement is becoming clearer. Studies indicate that remission and even reversal can be achieved through bariatric surgery, very low-calorie diets, and exercise. Calorie restriction using very low-calorie diets directly influences glycemic levels, providing avenues for remission.

Bariatric Surgery as an Option: For individuals with a BMI exceeding 35 kg/m² or a BMI over 30 kg/m² with significant health issues, bariatric surgery emerges as a viable option. Studies on diabetic obese adolescents undergoing this surgery show impressive rates of Type 2 diabetes remission, offering new hope for those grappling with the condition.

Dietary Approaches: In cases of severe obesity where traditional interventions may fall short, calorie restriction through very low-calorie diets has shown remarkable efficacy. Among severely obese patients, improved hepatic insulin sensitivity and restored insulin secretion occur swiftly, offering hope for addressing underlying defects in Type 2 diabetes.

The Integrated Approach: The combined approach of lifestyle modifications, medical interventions, and bariatric surgery marks a promising shift in managing Type 2 diabetes. However, exploring the long-term sustainability of these strategies is crucial. The landscape of Type 2 diabetes management is undergoing a transformative shift, presenting hope and new possibilities. Lifestyle changes, innovative dietary interventions, and targeted medical approaches open doors to remission and reversal. While these developments hold promise, ongoing research is vital to validate their sustained effectiveness, ushering in a new era in the battle against Type 2 diabetes.

Dr. Narendra BS, Lead Consultant – Endocrinology & Diabetology, Aster Whitefield Hospital, Bengaluru