Can diabetes go away?

The routine treatments provided through our health system address the symptoms of type 2 diabetes, but in some cases the condition can be beaten into remission.


In these cases, success means losing weight, and keeping it off.


Type 2 diabetes is a progressive condition that can lead to heart disease, nerve damage, kidney disease and blindness.  


Some type 2 cases are driven not so much by a person's weight, but by genetic factors. In these cases, the strategy required to address type 2 and to minimise its impact and the trend to complications is less straightforward.


But for the majority of people, turning type 2 around means that with sustained weight loss it may be possible to reduce or eliminate the need to take insulin or to throw your tablets away.


That would be a huge boost to people's health and savings personally, as well as to our national health budget, because about 5 per cent of people have type 2 diabetes.


For most people with type 2, getting your blood glucose levels back into the healthy range, and keeping them there, means you need to lose about 10 per cent of your body weight, and keep it off.


In an analysis paper in the BMJ, (British Medical Journal), Dr Mike Lean, professor of nutrition at Glasgow University, argues that giving medication to reduce blood glucose (the main treatment for type 2 diabetes) only addresses the symptoms.


"Virtually everyone with type 2 diabetes is at least 12 to 19kg above their ideal weight," Dr Lean said.


"One of the great tragedies is that we've known this for about 100 years and all the treatments have ever done is reduce the blood sugar. This is the consequence, but what drives it is the weight."


Dr Lean says the easiest indicator of someone at risk of type 2 diabetes is a fat tummy. A man with a waist over 91cm or a woman with a waist over 80cm could both be on the path to the condition.


Another paper in Frontiers in Endocrinology describes a program of high-intensity exercise as a way of preventing type 2 diabetes developing in people with risk factors. But once it's developed: "You can't run off diabetes," said Dr Lean.


He believes evidence suggests most people need to lose more than 12kg. Studies show woeful remission rates (0.14% of 120,000 US patients who were followed up for seven years).


Dr Lean is more optimistic, as his team is involved in a program called Counterweight Plus, which a pilot study showed led to a third of people losing more than 12kg.


The program involves drinking formula shakes with a total of 820 calories for six to eight weeks, before reintroducing food that includes a lot less fat, and ideally no alcohol.


The program is being further evaluated. Dr Lean says he is not pushing his own solution. People should ask their GPs or health practitioners for advice about any evidence-based weight-loss program.


The rewards of weight loss are high. A remission of type 2 diabetes (as long as you don't regain weight) means not only no insulin or tablets for diabetes and a lower risk of complications, but often the reversal of high blood pressure, too.

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