Can type 2 diabetes be “reversed?” The answer is an emphatic, yes. But what does reversal mean? Is it the same thing as remission? Here is my take on how to view these terms.
I’ll start by describing these terms with an example. Lets say you go to the doctor one day, and she tells you that you have type 2 diabetes after doing some blood work. Your A1c came back at 8.0%. Remember, one way to diagnose type 2 diabetes is through the A1c and anything 6.5% or higher is considered diabetic. A normal A1c is below 5.7% and anything between 5.7% and 6.4% is pre-diabetic.
After your visit with the doctor you decide that you are going to IMMEDIATELY change the way you eat and live because the doctor already started you on metformin and you don’t want to take more meds. HINT: this is exactly what you should do after a type 2 diabetes diagnosis.
You leave the standard American (SAD) diet behind by completely eliminating processed junk food, added sugars, and unhealthy vegetable oils. Heck you even sprinkle in a little bit of exercise. You didn’t even pick up your metformin prescription because you forgot about it while you were focusing on making true lifestyle changes. Whoops.
Three months later you check back in with your doctor and…VOILA! Your A1c comes back at 5.5%! Congratulations you have REVERSED your diabetes.
I think of reversal of type 2 diabetes as being in the acute term like the example above. You had hyperglycemia. You made lifestyle changes. Now you have normoglycemia without medication.
Remission and Partial Remission
Remission has been defined in the DiRECT trial–the first trial to demonstrate type diabetes reversal and remission– as achievement of an A1c less than 6.5% for at least two months without medication.
The American Diabetes Association (ADA) has defined type 2 diabetes remission as achievement of a normal A1c (i.e. less than 5.7%) without taking anti-diabetic medication for at least 1 year. Partial remission is defined as achievement of a non-diabetic yet hyperglycemic A1c of 5.7-6.4% without medication for at least 1 year.
The ADA defined these criteria in 2009 which was 9 years before the DiRECT trial came to light.
Arguing Over Semantics?
You say reversal, I say remission. Who cares, right? Well, we definitely need a standard and it depends on whether you were starting from a pre-diabetic or diabetic point.
I think that using reversal is appropriate in the acute term when you have seen promising results that your A1c and blood sugar have gone a level below where you were at. For example, if you had an A1c of 8% and went to an A1c of 6.0 without meds, you’ve reversed your diabetes; however, yes, you are still in the pre-diabetic range. If you started at a pre-diabetic A1c of 6.0% and then dropped it to 5.2% without meds, then you reversed your pre-diabetes.
Reversal is more flexible and agile of a term. Once you’ve sustained those results over time, then I think it’s appropriate to add remission into your vernacular.
“Reversal is more flexible and agile of a term.”
Bottom line: if you lower your A1c to below 6.5% and are off medication, you have reversed your diabetes. If you were pre-diabetic and have lowered your A1c to below 5.7%, you have reversed your pre-diabetes. If you sustain this over time, at least 2 months (per DiRECT trial), you are then in remission or partial remission depending on where your A1c falls.
Wait, Why Can’t I Do All of This With Meds?
Medications are used to lower your A1c and can be effective, so why not just reverse diabetes with meds? Well, if you lower your A1c too low (i.e. below 6%) with medication, it could actually increase your risk of death. Strange, right? There are some people who can and should achieve super tight control with medication but it’s rare. Even then, that doesn’t mean the diabetes was reversed or put into remission.
This is because those people never addressed the underlying causes of type 2 diabetes that are lifestyle-related in nature. They just used glucose-lowering drugs to, “sweep the garbage underneath the rug.” There is a case to be made that not all drugs do this (e.g. GLP-1 agonists and SGLT2 inhibitors). Still, if they didn’t change what they are eating and didn’t lose weight, then their liver and pancreas are still likely clogged with fat. If they take the meds away, their blood sugar would skyrocket.
There you have it! Diabetes reversal is possible and can be used to describe short-term results while partial remission and remission can be used to describe long-term results. Medications generally can’t do this because they don’t address the root cause and can lead to safety issues!
Have you been recently been diagnosed with pre-diabetes and type 2 diabetes and want to reverse it but don’t know where to start? Reach out to me directly!