Can diabetes be cured? we might want to think in terms of reversal instead
This is an interesting question, but the answer is not a yes or a no. Better would be to ask what diabetes is. We see advertisements, blog posts and scientific articles, promising diabetes remission or a actual cure. Internet is flooded with miracle supplements, herbs and special diets and treatments.
Even though some of these treatments may help, it would be incorrect to say any of them could cure diabetes. Defining remission or cure is important because it lay out the ground work for what kinds of treatment one should use. The process of treating diabetes is not as straightforward as some people would like it to be. [1, 2].
Diabetes can be defined as chronic hyperglycemia which can be controlled on a short time frame with daily treatments, diet modifications, intense exercises, medications, and herbal remedies. The distinction between successful treatment and cure however is blurred. For a remission or cure to occur we must first assume that glycemic control should become stable and permanent by itself or with the help of a drug or treatment.
Low glycemic levels on a permanent basis can be achieved by a variety of treatments including: antihyperglycemic drugs, herbal treatments, major lifestyle changes and exercises. Should we then call it remission, or “cure” if a person have lowered their blood sugar applying any of these treatments? With a chronic condition such as diabetes is hard to say weather the word cure can even be used [1, 2].
This is such an important distinction that a group of experts including pediatrics, adult endocrinologists, diabetes educators, and other related health care professionals met in June 2009 to discuss. Since no scientific actuarial evidence exist to aid the group’s discussion it was difficult to reach a conclusion in a number of areas [1, 2].
The objective was to achieve a consensus on issues such as:
- what is the definition of management, remission, and cure?
- if patients are considered “cured” would they still need to be evaluated periodically?
- if someone is considered cured do they need to maintain their lifestyle changes used to achieve cure?
Many physicians consider cure to be only possible to acute diseases. For example, acute bacterial pneumonia can be cured with antibiotics. On the other hand HIV infection best outcome is to be in remission or converted to a chronic condition. For a chronic condition such as diabetes, it would be more correct to use the term remission rather then cure. All forms of treatment employed to treat diabetes if stopped could potentially put patients at risk for relapse. This includes the genetic predisposition and physiologic abnormalities such as fatty liver disease and obesity of each person. Prolonged remission is not a term diabetics want to hear and it not as favorable as cure. If diabetes cure is considered “remission that lasts for a lifetime” then by definition we could not say that a patient is cured while still alive [1, 2]. Why are we dabbling with so much terminology?
Terminology is relevant because it gives us precision when communicating important things. Words also lay out the blueprint of what our actions and expectations will be. We should only focus on terminology as a way to think about our diabetes management. Heather cure and remission are the same is not so important as our need for real results. Putting things under a different perspective; any action which produces results can be seen as some form of cure. So lets not get too involved in specific names and evaluate what is available and truly effective and can classify as cure. Maybe there is a better word altogether. There is actually two: prevention and remission.
Prevention should be the first line of defense. Think of prevention as the most effective form of cure. Intense lifestyle changes are much more powerful and extremely effective before the onset of diabetes . Before the onset of diabetes is the best chance to delay, or freeze diabetes altogether. Cure could be re defined as “not becoming diabetic”. This requires more emphasis in routine testing [8, 4] .
The recommendations are:
- Ongoing support for weight loss programs for individuals with A1c of 5.7 – 6.4%
- Target of 7% of body weight loss
- Increase physical activity to at least 150 min/week. (best is weight lifting)
- Follow up and counseling
- Therapy with glucose lowering agents (preferably natural agents)
- Constant monitoring of pre diabetes
Lowering diabetes conversion rates
These interventions can significantly reduce the risk for developing diabetes. A diabetes decrease of 58% after 3 years have been noted when these recommendations were adopted. Three large studies on lifestyle intervention showed sustained reduction in the rate of conversion to type II diabetes. Reductions in conversion were noted in 34% of the subjects at 10 years in a U.S. study . The use of drugs such as metformin – glusosidase inhibitors, and thiazolidinediones have decreased the incidence of diabetes in various degrees for high risk individuals. The same effect can be achieved by the use of herbals and special nutritional supplements. It might be more difficult to use herbs regularly but a number of benefits beyond glucose lowering can be achieved with herbal use. Oral anti-hyperglycemics have been found to be less effective then lifestyle changes and herbal remedies [8, 4].
Unfortunately many people walk around with diabetes for years without knowing they have it. High blood sugar is not always evident and a person can feel just fine while high. By the time they feel something and go to the doctor, its too late and diabetes become much harder to control. If prevention was not possible or you simply are diabetic we must have another strategy. The best way now is to think in terms of reversal. Unlike “cure” or “remission” reversal is a good way to think about diabetes treatment.
Type II diabetes has for a long time been regarded as a chronic and progressive condition, only capable of being improved but never cured. Reversing diabetes however is more possible the most people think, specially if caloric intake reduction are applied early. At least this is what one study have found . This study is consistent with the hypothesis that insulin resistance and abnormalities in insulin secretion are both caused by excess fat accumulation in the liver and pancreas.
Diabetes is caused by two main problems: beta cell failure and insulin resistance. In other words, lack of insulin and a inability for cells to use insulin properly. Diabetes is also characterized by a weak response in insulin release in the presence of a rapid rise in plasma glucose. What follows is a decline in beta cell function progressing to insulin therapy.
In a study published in 2011 , it was shown that acute lowering in energy consumption alone could reverse diabetes type II. The participants in the study were age 35 – 65, diabetes duration less then 4 years. During a 8 week intervention, the subjects were fed a liquid diet consisting of 46.4% carbohydrate, 32.5% protein, and 20.1% fat.
With only 7 days of acute reduction a series of metabolic responses were observed. Fasting blood glucose and hepatic insulin sensitivity were back to normal. Liver fat content which is responsible for lower insulin sensitivity decreased by 30%. With 8 weeks of low energy consumption beta cell functions increased to normal and pancreatic fat decreased [3, 5].
What this study is demonstrating is that lowering energy intake, at least in a controlled experiment can revert diabetes. It is possible to use these same principles to stop diabetes, but it will depend on many variables presented by the differences found in everyone’s life. Difficulty in following or even finding the right diet are just a few obstacles. Lack of motivation, and other physical conditions might also play a part.
Diabetes can be cured depending on how you interpret the word “cure”. In my view the best approach when thinking about diabetes is the word “reversal”. In this way we think of diabetes not as a disease but as a condition that can be simply – reversed. We can reverse our health status to a time pre diabetes time. Or we can think in terms of reverting our internal functions to their natural state. By providing and simulating a diet that will force our bodies to reverse to a minimum energy intake while maintaining the same level of activity.
- How Do We Define Cure of Diabetes?
- Type 2 diabetes: prevention and cure?
- Reversal of Nonalcoholic Hepatic Steatosis, Hepatic Insulin Resistance, and Hyperglycemia by Moderate Weight Reduction in Patients With Type 2 Diabetes
- Prevention of Type 2 Diabetes With Troglitazone in the Diabetes Prevention Program
- Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol
- 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes
- Reversal of muscle insulin resistance by weight reduction in young, lean, insulin-resistant offspring of parents with type 2 diabetes
- Standards of Medical Care in Diabetes—2011
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