Within the first 10 years after a diagnosis of type 2 diabetes, losing around 15kg (around 2 ½ stone) can reverse the changes associated with type 2 diabetes in 50% of patients.

This means blood glucose levels will be below the levels seen in type 2 diabetes without needing to take medication to lower blood glucose levels.

Because blood glucose levels will go up again if the weight goes up - we don’t usually talk about curing diabetes - but reversing diabetes and going into remission.

How does diabetes remission work?

There is a very strong link between type 2 diabetes and abdominal fat. As weight goes up with age, people with type 2 diabetes tend to accumulate fat around the abdomen. This happens just below the skin but also inside important organs like the liver and the pancreas. These fatty deposits reduce the ability of the body to make insulin and lower blood glucose levels.

Losing weight reduces the amount of fat around the abdomen and in vital organs. The pancreas is able to make more insulin and it becomes easier for the body to lower blood glucose levels. This reverses the changes that happen in type 2 diabetes.

How much weight do I have to lose to reverse type 2 diabetes?

If you are overweight, any weight loss in type 2 diabetes is helpful and is likely to improve blood glucose levels.

In Direct (Diabetes Remission Clinical Trial), participants lost an average of 14.5 Kg and more than one third of people were in remission for 2 years. For these people, the pancreas went back to working normally and was able to make as much insulin as someone without diabetes.

What is the most effective way to lose weight?

To reverse type 2 diabetes, the most effective intervention is to speak to a medical professional about trying a very low calorie diet. This can lead to rapid weight loss but it needs to be done under medical supervision.

Less drastic diets can also be effective. Low calorie or low carbohydrate diets are both helpful, and may be slightly more effective than low fat diets. Different strategies work for different people and regimes that use portion control or fasting can be effective.

For people with diabetes and a BMI of 35 or more, bariatric surgery can also be considered.

What are the risks?

If you are currently taking medication to lower blood glucose levels, going on a diet may increase the risk of getting very low blood glucose levels (hypoglycaemia). Very low calorie diets can also cause fatigue, nausea, diarrhoea or constipation. However, if done with appropriate guidance,  weight loss can be effective and any side effects are temporary.

Is there a permanent cure for diabetes?

In the future, it may be possible to help the pancreas regenerate with new technology like stem cell transplants or using an artificial pancreas - but these are currently not viable treatments. For now, weight loss and diabetes remission is the most effective strategy we have.

Diabetes remission is a relatively new concept, so we do not have a lot of long-term data about how long the benefits last. The main challenge is keeping the weight off once it has been lost. If the weight loss is maintained, it is likely that diabetes will stay in remission for many years - even if it can’t be banished forever (yet).

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References:

Taylor R, Ramachandran A, Yancy W S, Forouhi N G. Nutritional basis of type 2 diabetes remission BMJ 2021; 374

Nagi D, Hambling C, Taylor R. Remission of type 2 diabetes: a position statement from the Association of British Clinical Diabetologists (ABCD) and the Primary Care Diabetes Society (PCDS). British Journal of Diabetes 2019;19:73-6

Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care 2016;39:808-15

Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011;54:2506-14.

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Reviewed by Dr. Kingshuk Pal