Debunking Myths and Exploring realities of Diabetes Reversibility

Debunking Myths and Exploring Realities of Diabetes Reversibility
Authored by  Dr Mohammad Hayat  and Dr Saima farooq
Diabetes, a chronic metabolic disorder characterized by elevated blood glucose levels, has emerged as a global health crisis of monumental proportions. Its prevalence has reached unprecedented levels, with millions of individuals grappling with its consequences worldwide. To begin with, it is crucial to understand the essence of diabetes and its underlying mechanisms. Diabetes mellitus encompasses a spectrum of disorders characterized by inadequate insulin production, impaired insulin action, or both, leading to elevated blood glucose levels. Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells in the pancreas, necessitating lifelong insulin replacement therapy. Conversely, type 2 diabetes typically manifests due to a combination of insulin resistance and relative insulin deficiency, often associated with lifestyle factors such as obesity, sedentary behaviour, and poor dietary choices. While the management of diabetes primarily focuses on control and prevention of complications, a pressing question looms large in the minds of both patients and healthcare professionals alike: Is diabetes reversible?
This question has ignited vigorous debates, driven by a multitude of contradictory information, misunderstandings, and optimistic stories.
DIABETES REMISSION – First, the term ‘reversal’ of diabetes is scientifically incorrect; the appropriate term is ‘remission’ of diabetes. Remission’ means not having an active disease, with the implication that neither symptoms nor new complications should develop. American Diabetes Association (ADA) defines type 2 diabetes mellitus remission as having an HBA1C lower than 6.5% measured at least three months after cessation of glucose-lowering pharmacotherapy (at least 6 months after starting a lifestyle intervention)”. This remission can be achieved through significant lifestyle changes, including weight loss, dietary modifications, and increased physical activity.
BARIATRIC SURGERY IN DIABETES REMISSION -While bariatric surgery can lead to diabetes remission in many cases, it’s not a guaranteed outcome for everyone. Success depends on various factors including the type of surgery, individual health status, and adherence to post-operative lifestyle changes. Weight loss is a significant factor, but bariatric surgery also triggers changes in gut hormones such as GLP-1, which enhance insulin secretion and improve blood sugar also results in metabolic adaptations that promote glucose utilization and reduce excess glucose production by the liver, contributing to better blood sugar levels. that directly impact diabetes. These changes improve insulin sensitivity and glucose control, contributing to diabetes remission. Studies show that diabetes remission post-bariatric surgery can be sustained long-term, especially with ongoing lifestyle modifications. While relapse is possible, many individuals experience lasting benefits in glycemic control and reduced reliance on diabetes medications. Like any surgery, bariatric procedures carry risks, but for many individuals with severe obesity and poorly controlled diabetes, the benefits outweigh the risks. Bariatric surgery can significantly improve quality of life and reduce the risk of diabetes-related complications.
Diabetes remission, achieved through interventions like bariatric surgery or lifestyle changes, may not always be sustainable due to various factors. Firstly, the underlying mechanisms causing diabetes, such as genetic predisposition or pancreatic beta-cell dysfunction, may persist despite initial remission. Additionally, relapse can occur if individuals revert to unhealthy habits, such as poor diet and sedentary lifestyle, leading to weight regain and worsening insulin resistance. Furthermore, aging, stress, and other health conditions can exacerbate metabolic dysfunction, increasing the risk of diabetes recurrence. Therefore, maintaining long-term diabetes remission requires ongoing commitment to healthy behaviors and regular monitoring to address potential risk factors and ensure optimal metabolic health.
IS DIABETES REVERSIBLE? The word ‘reversal’ seems to be used very loosely next to diabetes, and that’s not an accurate way to look at it, the phrase “diabetes reversal” may be familiar to you. Can the illness be “reversed” in reality, though? “The definition of “reversal” in the dictionary is “a change in an opposite direction, position, or course of action or back to a former state,” hence the term itself is misleading. Recently, this has seemed to be used very haphazardly about diabetes, which is not a realistic way to look at it.
For what reason is it inaccurate? For “diabetes reversal,” stopping the medication would mean that the patient would no longer have the illness. Unfortunately, many patients rarely experience this situation in real life. Granted that a small percentage of patients, such as those with prediabetes, can “reverse” their diseases for an extended length of time (if they keep a healthy lifestyle), individuals with chronic, long-term diabetes sometimes struggle to even continue taking the lower dosages of insulin. The term “reversal” may refer to nothing more than “better control and management initially, then gradually tapering off medications, to finally try and take them off with further work aimed at a situation where you do not go back to medications.” We can probably declare that type 2 diabetes has been reversed if the patient can maintain this condition of not using any medications and their blood reports remain within normal ranges for five years.
Here are some myths and facts about diabetes reversal that you must know-
MYTH 1- Joining a program can help you reverse type 2 diabetes in 6-8 weeks-
FACT – Diabetes reversal programs have generated a lot of buzz in recent months, particularly from sponsored advertisements during well-known interviews on social media.
Something like this seems impossible to believe. However, individuals believe it because they are desperate to get rid of the ailment and will go to any length to find a ray of hope, making it risky. Fad diets, or even severe diets, can result in improved blood tests and weight loss (4-5 kgs per month). However, this rapid transition might lead to further problems later in life, such as chronic deficits.
Patients are also weaned off of their medications while they are on the program because their blood reports appear to be improving. However, when the program concludes and the individuals who are unable to maintain the adjustments experience a spike in their blood sugar levels. As a result, the patient experiences the greatest amount of suffering on many levels, and what at first seemed to be a glimmer of hope for the patient ultimately turns out to be a ray of devastation.
MYTH 2- Reverse your diabetes by fasting-
FACT -This could be an exaggeration rather than a myth. Fasting makes sense because you’ll consume less food overall (less than 12 hours; you’ll likely skip one large meal). During the fasting phase, one will first lose weight and have some relaxation in the pancreas and stomach. Fasting is a long-standing custom that can be beneficial when followed. It relies on several factors, including the individual’s diabetes, insulin dosage, coexisting medical problems, and blood sugar fluctuations. Consuming “anything and everything” or two kilograms of fruit during mealtime is not advised because these behaviors won’t be effective. Also, be cautious of your gut, muscle, and even metabolism if you are fasting consistently for weeks or months at a time. These aspects can all deteriorate. The general health of the patient should improve when fasting is utilized as one of the strategies for improved diabetes management under the proper supervision.
MYTH 3-Reverse type 2 diabetes by avoiding carbohydrates, fruits, and sugar-
FACT- Low-carbohydrate diets can be effective for managing diabetes by helping to regulate blood sugar levels and promote weight loss. However, they are not a cure for diabetes. Diabetes is a chronic condition that requires lifelong management, including medication, lifestyle modifications, and regular monitoring of blood sugar levels. Low-carb diets should be adopted as part of a comprehensive diabetes management plan under the guidance of a healthcare professional. Reversing diabetes is extremely unlikely, aside from the nutritional advantages they will be missing out on. Refined carbs and sugar, found in cakes, pastries, sodas, and even packaged foods, are the main cause of issues like inflammation and insulin resistance. Although it varies from person to person, fruits and grains can raise blood sugar levels. well sugars are controlled if they are balanced with fiber, proteins, and fats. Thus, consider including a balanced meal instead of going overboard and cutting everything (which again becomes tough to continue). This will not only help your blood sugar levels but also enhance your general health
MYTH 4- Because diabetes runs in my family, can’t cut back on my medication or stop taking it entirely-
FACT -A person’s predisposition to diabetes is greatly influenced by their family history, particularly if both parents have the disease. However, it is not the sole cause of diabetes. Actually, what eventually causes you to develop diabetes is your lifestyle—the daily routines you repeat over time. Thus, you may also need to be more careful and self-sufficient. Despite the family history, one can hope to observe a decrease in the amount of medications if done consistently. Naturally, prevention or delay is preferable than reversal, so if people adopt a more sustainable and healthful lifestyle, they can avoid diabetes for a longer period of time or, in the event that they do get it, manage it with fewer medications. Increased control can also lessen the likelihood of problems.
MYTH 5 -There is no way I can reverse the diabetes if I start taking medication or insulin-
 FACT -I think it’s important to dispel this myth as quickly as possible. Certainly, the management of diabetes typically involves a combination of lifestyle modifications, medication, and/or insulin therapy to achieve and maintain optimal blood glucose levels. While these interventions are crucial for controlling the condition and preventing complications, it’s important to understand that they do not offer a guaranteed route to reversing diabetes. The medication will not receive the necessary support if the patient declines to make simple lifestyle adjustments like improving their diet, exercising frequently, getting enough sleep, and controlling their stress. When it comes to managing their blood sugar and glycosylated haemoglobin (HbA1c), about 60% of people with established diabetes still require medication in addition to lifestyle changes. These medications must, however, be secure and ideally safeguarding for the kidneys, heart, and vascular structure. In spite of excellent blood sugar management, diabetics frequently experience heart attacks, heart failure, strokes, and renal failure. These complications are particularly common in long-term patients.
 The choice of drugs is thus very important for improving the condition of diabetic patients both with and without established vascular and renal complications. Diabetes mellitus type 1 is a disease caused by the lack of insulin. Thus, Insulin is the main treatment agent for type 1 and is typically administered via subcutaneous injection. There are several types of insulin available nowadays. These diabetics are insulin-dependent throughout their lives.
Type 2 diabetes, on the other hand, is diagnosed in adulthood and is because of a deficiency of insulin. These individuals are often obese with a family history of diabetes, it is the most common type of diabetes . Many of them need agents other than insulin to both control blood sugar levels and reduce vascular complications. There are several agents available for this purpose.. These drugs work in multiple ways:. Treatments include agents that (1) increase the amount of insulin secreted by the pancreas, (2) increase the sensitivity of target organs to insulin, (3) decrease the rate at which glucose is absorbed from the gastrointestinal tract, and (4) increase the loss of glucose through urination. 5) They slow the movement of food through the stomach and reduce appetite.
 Metformin, a biguanide, has become the most commonly used agent for type 2 diabetics. Among common diabetic drugs, Metformin is the only widely used oral drug that does not cause weight gain.
The new therapeutic targets, in fact, are no longer simply glycemic control, the reduction in glycated Hb (HbA1c), or minimization of the hypoglycemic risk. Instead, they are now increasingly oriented toward reducing the cardiovascular risk (CVR) and the overall mortality of diabetic patients, thus moving away from a glucocentric toward a cardio-metabolic approach. Such ambitious goals are currently achievable by these  two classes of new antidiabetic drugs, i.e., sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA)
SGLT2 (sodium glucose cotransporter-2) inhibitors: Canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. The  metabolic effect of these gliflozins is to inhibit reabsorption of glucose in the kidney and therefore lower blood sugar. Apart from blood sugar control, gliflozins have been shown to provide significant cardiovascular benefit in people with type 2 diabetes. studies have shown that  canagliflozin, was found to enhance blood sugar control as well as reduce body weight and systolic and diastolic blood pressure.. It is recommended that all type 2 diabetics take these agents unless there is a urinary or genital infection that can be aggravated because of the excretion of sugar through urine.
GLP1 (glucagon-like peptides 1) agonists- these agents benefit by delaying gastric emptying and inhibit inappropriate post meal glucagon release ,thus the risk of hypoglycemia is low . In terms of cardiovascular effects, GLP-1 agonists can improve left ventricular ejection fraction, myocardial contractility, coronary blood flow, cardiac output, and endothelial function while reducing infarction size and overall risks for a cardiovascular event. Besides reducing vascular issues and sugar levels, these drugs also reduce body weight significantly. They are typically administered via subcutaneous injection.Semaglutide, Tirzepatide, Dulaglutide, and other once-weekly alternatives have recently been available as well . Following groundbreaking research, an oral preparation of semaglutide has been created to enable the delivery of a protein in a pill. Rybelsus is the oral version of this.
MYTH 6-  Skipping a meal can control sugar levels –
Fact: “Another misconception among diabetics is that if they don’t eat a meal, their sugar levels will get controlled and they won’t require medicines, while the fact is once the sugar levels are high, skipping meals is not the way to treat it. The total calorie intake of the day is important rather than just avoiding carbohydrates and maintaining a diet hygiene is more fruitful,”
MYTH 7- My sugar levels have always been on the higher side for years but it’s ok since I don’t have any symptoms-
Fact: “Diabetes unfortunately does not manifest with overt symptoms unless severe and late in the course. Early diagnosis and sticking to FBS (Fasting Blood Sugar) of 80 to 120 and PPBS of 140 to 180 with appropriate antidiabetic agents saves heart, kidney, retina, nerves and various other organs,”
MYTH 8: I don’t need to take medicines as my blood sugar levels are in control for a long time now-
Fact: “Majority of patients stop taking their prescribed medicines once sugar is controlled thinking they no longer require it while the fact is that the sugar is controlled because of the medicine and as soon as they stop the treatment, sugar levels start increasing again,”
MYTH 9: I don’t need to check sugar levels frequently as they are generally in control-
Fact: Diabetes is a progressive disease. The medicines and doses that worked for you before may not work now. Even if sugars are well controlled at least once a week checking of FBS/PPBS with a glucometer is important. Meet your diabetologist at least once in 60 days. Your doctor needs to check end-organ damage if it has started like kidney disease, neuropathy, heart disease retinopathy etc.
In conclusion, dispelling myths surrounding diabetes irreversibility requires a fundamental shift in mindset. It’s time for individuals to discard doubts and take ownership of their health journey. By actively engaging with healthcare professionals, adopting healthy lifestyle practices, and embracing emerging medical advancements, we can pave the way for a future where diabetes reversal is not just a possibility, but a tangible reality. Let’s seize this opportunity to rewrite the narrative of diabetes management, empowering individuals to reclaim control over their health and unlock the potential for a brighter, healthier tomorrow.