What is type 2 diabetes remission?
Remission is a term commonly used in cancer treatment to describe the period during which signs and symptoms reduce or disappear. Remission can also be achieved by people living with type 2 diabetes.
Can someone with type 2 diabetes go into remission?
Type 2 diabetes remission is achievable for some. To be considered in remission, a HbAlc blood check, which identifies your average glucose level over a three-month period, would need to be 6.5% or less. Significantly, you must also have achieved that result without the use of diabetes medications.
Being in remission means you've managed your diabetes so well, without any medications, that your blood glucose levels have reduced to a non-diabetic level.
Achieving an average of less than 6.5% with medication does not constitute type 2 diabetes remission.
While it isn't impossible for people who have lived with type 2 diabetes for some years to achieve remission, those newly diagnosed are most likely to be able to achieve it.
Does being in remission mean that your diabetes has been cured?
Unfortunately, type 2 diabetes remission doesn't mean your diabetes has been cured or reversed.
For most people who are diagnosed with type 2 diabetes, glucose intolerance/pre-diabetes has developed before a diabetes diagnosis.
Having glucose intolerance means your blood glucose level is higher than the normal range but not quite high enough to diagnose you with type 2 diabetes. This can progress into type 2 diabetes, depending on several risk factors, including family history, age, lifestyle or other medical conditions.
Some of these risk factors can be modified, but others can't. So, even when your blood glucose returns to a pre-diabetic level, these risk factors can still exist. Therefore, the diabetes is not cured but rather has gone to "sleep".
It's important to remember that type 2 diabetes is a progressive chronic disease, so yes, we can slow down its progression or even send our diabetes to sleep for a period with lifestyle management, but at this point, we can't cure diabetes.
Can life return to 'normal' after achieving type 2 diabetes remission?
To sustain remission, once achieved, you need to maintain healthy eating patterns and regular physical activity. The blood glucose level has returned to a pre-diabetic level, but your risk of diabetes and diabetes related complications can persist, so it's important to keep up the lifestyle changes to prevent their onset.
Is it possible to stay in remission?
Unfortunately, permanent remission is unlikely. As we get older, our bodies become less efficient in how we utilise and store glucose, and how our body responds to insulin.
Continuing to focus on a healthy lifestyle can help to slow it down, however, type 2 diabetes is a progressive chronic disease, and the likelihood is that even if you can achieve remission, your diabetes will re-awaken.
Is there any value in achieving remission?
There's great value in achieving remission. Remember, if you're in remission, it means you've put your diabetes to sleep without medication. Good management of diabetes at every stage of your journey is valuable.
There is research that shows diabetes remission, or intensive glucose control in people with newly diagnosed diabetes, reduces the risk of diabetes-related complications, including stroke, heart attack, peripheral vascular diseases, eye retinopathy, kidney impairment and nerve damage.
How can you achieve type 2 diabetes remission?
The majority of people living with type 2 diabetes who also have a high body mass index (BMI) are more likely to achieve diabetes remission with intensive healthy lifestyle modifications that result in body weight reduction.
Evidence suggests that reducing body weight by 10–15% increases the chance of diabetes remission.
However, it is important to remember that the relationship between diet, physical activity and weight loss is not linear.
There are many factors that can influence your weight and how easy it is for you to lose weight, including genetics, hormones, and past medical conditions, or just general constraints on living circumstances.
It's also important to remember that not all kinds of weight loss are equal. Weight loss that comes from losing muscle mass can be counterproductive for diabetes management.
The most beneficial type of weight loss is achieved through a balance of the right kind of food, frequency of exercise, and the right kind of exercise that results in weight loss but preserved muscle mass.
Emotional and psychological factors can also influence your BMI or ability to lose weight.
An appointment with an allied health professional, such as a diabetes dietitian, an exercise physiologist or a psychologist, could be beneficial to helping with weight management.
Should everyone with type 2 diabetes be striving to achieve remission?
While diabetes remission is certainly beneficial, not everyone should have remission as their primary goal.
For some, there are risks associated with intensive lifestyle modifications, especially for those who take certain diabetes medications. For example, a low-carb or no-carb diet can increase the risk of hypoglycaemia for people using certain diabetes medications.
It's very important to speak to your care team to find out if diabetes remission is advised and how to safely make changes to your diabetes management. It can be difficult to do it alone, so seek the support of your diabetes management team.
What can be done if remission can't be achieved, despite every effort?
Whether you achieve diabetes remission or not shouldn't be considered a pass or fail.
Diabetes remission isn't the only way to improve and manage your diabetes. Keeping your HbAlc within target is beneficial, as lowering it helps to delay diabetes progression and complications, especially if it's achieved through lifestyle modifications.
But don't beat yourself up if you don't achieve that 6.5% figure; any reduction is great. A reduced HbAlc is just one of many factors that make up the bigger picture of building good habits to live well and age well with diabetes.
And remember, there are numerous factors that can influence your glucose level. Having an infection, stress and poor sleep quality can all make your glucose higher than usual.
If any of these factors are present three months before an HbAlc test, they can influence the results. So don't make that 6.5% figure your only personal measure of success.
Doing any positive things to work towards remission, regardless of whether you meet the definition of remission or not, will help your long-term outcome, so have a chat with your doctor or diabetes management team to form the best plan for you moving forward.
This article has been reproduced with the permission of Diabetic Living Magazine.
