Type 2 diabetes has long been thought of as a chronic, irreversible disease that can be controlled, but never cured. In recent years though, research has shown that bariatric surgery can effectively cure type 2 diabetes, and clinical trials of lifestyle interventions have seen moderate success too.
But surgery is a drastic step only for dangerously obese patients, and intensive exercise and dietary changes may not be practical for all patients. Is it still possible to reverse type 2 diabetes in the real world without these drastic measures?
To find out, Elbert Huang, MD, Associate Director of the Chicago Center for Diabetes Translation Research, and his colleagues looked at real-life clinical data from more than 120,000 adults with type 2 diabetes in the Kaiser Permanente health system in California, to see how many patients achieved complete remission of type 2 diabetes without getting bariatric surgery.
Over seven years of data, just 1.47 percent of these patients achieved partial remission by lowering their hemoglobin A1C (a common measure of blood glucose control) to sub-diabetic levels, and a tiny fraction more were able to lower their A1C to normal levels and stop taking medications for a year or more.
While those numbers are disappointing, Huang said they show that remission is possible in a real-world setting outside of surgery or special intervention programs. They also point to opportunities for physicians to reduce medications from some patients who are able to manage their diabetes well.
Huang referred to the concept of “clinical inertia,” a phrase popularized in the 2000s that usually refers to the unwillingness of doctors to add or change medications for high blood pressure. In the case of diabetes, he said the same idea influences doctors’ decisions to remove medications for patients who are under good control.
“The rates of remission appear very low in this study, but I suspect part of it may be because doctors in real clinical practice may keep people on medications because they don’t believe remission is possible,” he said. “They may also believe that the lower sugars the better, at any cost, even if it means leaving people on medications.”
He and his colleagues from Kaiser Permanente and George Washington University were inspired to research this data by the Action for Health for Diabetes (Look AHEAD) study, a randomized, controlled trial involving lifestyle interventions like exercise and dietary counseling in adults with type 2.
The Look AHEAD trial saw relatively high remission rates, with 11.5 percent of participants able to stop taking medications after one year. Huang said the big gap between those results and the data in this latest study leaves him to wonder how many more patients with good control of their diabetes could achieve “remission” in regular clinical settings if more doctors were willing to take them off medications.
“Doctors have been quite nihilistic about diabetes management for a long time. Some doctors have felt that we just need to put people on medications as quickly as possible, and just forget about the idea of living free without medications,” he said. “I think the future is trying to figure out whether or not we can push that number up by actively removing medications from patients with really tight glucose control, especially among very old patients where there may be opportunities to reduce the complexity of their overall medication regimen.”
And for others, Huang said that these studies demonstrate it is possible to turn back type 2 diabetes, even if the statistics look grim.
“For patients who are really motivated to make changes, I think that you can change the course of this disease without bariatric surgery,” he said.