Rising Interest In Diabetes Remission
In the past few years, scientific journals have seen an explosion of interest in diabetes remission.It is well established that gastric sleeve surgery can put diabetes into remission.
However, many of the recent publications describe education, diet, and exercise interventions. These interventions are causing people with type 2, adult-onset diabetes to go months and even years with normal HbA1C values, without needing glucose-lowering medication.
The exercise and diet plans are what doctors might expect and probably even what they have been teaching for years. Intensity and support stand out as the new features making old advice more effective. Exercise and diet interventions with high success rates involve multiple visits spread over weeks or months for education, guided exercise, and support. Studies are measuring remission and partial remission rates at 50% to 79% of participants.1,2 After the education programs end, remission rates drop to 25% to 30%.
However, this is still triple the usual long-term remission rates. Patients most likely to achieve remission have recent, adult-onset, type 2 diabetes. The longer diabetics go without major changes in diet or exercise, the lower the odds of remission.2 Nevertheless, programs that even approach remission are likely to improve various health out comes for patients.
General Practitioners can provide their patients access to intensive type 2 diabetes rehab through CDMP and T2D referrals to exercise physiology at Advanced Physiotherapy. With state-of-the-art facilities and special interest in treating metabolic conditions, exer cise physiologists at Advanced Physiotherapy can implement an effective physical activity routine that is realistic and client centred, working towards long-term habit forming.
Our approach includes:
• Identifying and addressing emotional distress about diagnoses or other life events that may impact treatment goals
• Defining self-care behaviours that can be confidently achieved
• Collaborative goal setting
• Goals and milestones to be achieved
• Weight, body composition, daily activity levels, etc.
• Continued support
1. Umphonsathien M, Prutanopajai P, Aiam‐O‐Ran J, Thararoop T, Karin A, Kanjanapha C, Jiamjarasrangsi W, Khovidhunkit W. Immediate and long‐term effects of a very‐low‐calorie diet on diabetes remission and glycemic control in obese Thai patients with type 2 diabetes mellitus. Food Science & Nutrition. 2019 Mar;7(3):1113-22.
2. Ried‐Larsen M, Johansen MY, MacDonald CS, Hansen KB, Christensen R, Wedell‐Neergaard AS, Pilmark NS, Langberg H, Vaag AA, Pedersen BK, Karstoft K. Type 2 diabetes remission one year after an inten sive lifestyle intervention: A secondary analysis of a randomized clinical trial. Diabetes, Obesity and Me tabolism. 2019 Jun 5.
3. Zhyzneuskaya SV, Al-Mrabeh AH, Barnes AC, et al. 66-OR: Remission of Type 2 Diabetes for Two Years Is Associated with Full Recovery of Beta-Cell Functional Mass in the Diabetes Remission Clinical Trial (DiRECT). Diabetes. 2019; 68 (Supplement 1): DOI: 10.2337/db19-66-OR.
4. Hopkins MD, Taylor R, Lean ME. The DiRECT principles: giving Type 2 diabetes remission programmes the best chance of success. Diabetic Medicine. 2019;36(12):1703-4.
5. Qumby K, George C, Hambleton I, Olivier P, Unwin N. 3461 A community-based, low calorie dietary intervention for the prevention and remission of type 2 diabetes mellitus. Journal of Clinical and Transla tional Science. 2019 Mar;3(s1):137.
6. Lean ME, Brosnahan N, Kean S. Two-year results of the randomised Diabetes Remission Clinical Trial (DiRECT). Lancet Diabetes and Endocrinology. 2019 Feb 13.
7. Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J, Schiesser M, Nett P. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018 Jan 16;319(3):255-65.
8. Markle‐Reid M, Ploeg J, Fraser KD, Fisher KA, Bartholomew A, Griffith LE, Miklavcic J, Gafni A, Thabane L, Upshur R. Community Program Improves Quality of Life and Self‐Management in Older Adults with Diabetes Mellitus and Comorbidity. Journal of the American Geriatrics Society. 2018 Feb;66(2):263-73.