According to the Centers for Disease Control and Prevention, an estimated 26 million Americans have Type 2 diabetes. Until recently, the condition was seen as a progressive disease that could be managed, but not cured. The only documented reversals of the disease have involved weight loss surgery or extreme diets that mimic such surgery. As a result, the treatment of Type 2 diabetes has been believed to require a “lifetime commitment” to blood sugar monitoring and medications or insulin therapy, in conjunction with healthy eating practices and regular exercise.
But a new study from the CDC itself seems to indicate the last two therapies – diet and exercise – can reverse the condition and in a small percentage of cases produce full remission.
The study, published along with a strong supporting editorial in this week’s Journal of the American Medical Association, followed the health of 4,500 adults aged 45 to 76, over a period of four years. All of the subjects were obese, and all had been living with Type 2 diabetes for an average of five years before the study began.
The subjects were randomly divided into two groups. Half were assigned to an intensive lifestyle-change program, during which they attended weekly counseling sessions for the first six months and biweekly sessions for the remainder of the study. This “lifestyle change” group was also given specific weight loss and physical exercise goals. The other half of the participants received only three sessions providing dietary information and covering the need for physical activity per year, and were not given any specific weight or exercise goals that they had to meet.
After a year of this counseling, 11.5% of the first counseling group saw their Type 2 diabetes reverse, as indicated by their blood sugar levels decreasing to pre-diabetic levels, and required no medication. Only 2% of the subjects who received no counseling partially reversed their condition in this same way. Subjects in the counseling/lifestyle change group lost 8.6% of their weight in the first year, as compared with a loss of only 0.7% in the control group. Over the four-year period of the study, overall the counseling group lost 4.7% of their weight, as compared to 0.8% in the control group.
But what was that about “remission?”
Although many in the counseling group saw their conditions reverse, 1.3% of them actually achieved what is considered full remission from the disease and achieved fully normal blood sugar levels. The actual rates of remission corresponded to the degree of weight loss, and were 15-20% higher among subjects who lost considerable weight and significantly improved their fitness levels. The remission rates were also higher for those who had been diagnosed with Type 2 diabetes most recently, which is encouraging because it indicates that early treatment can lead to increased remission from the disease.
The study authors warned not to place too much emphasis on the remission measures, because the definition of “remission” is somewhat arbitrary. But the fact that so many of the subjects were able to reverse the progress of their disease – many to pre-diabetic levels and a few more drastically, to non-diabetic levels – is encouraging, and proves the need to emphasize proper diet and exercise when treating Type 2 diabetes.
The important finding is that with proper counseling even obese diabetics can be encouraged to lose weight and thus keep their blood sugar levels at reduced levels. As one reviewer of the study puts it, “If the great majority of people are losing weight and their sugars are going down, whether or not we call that a remission…it’s great news.”