Has the Cure for Diabetes Been Right In Front of Us All Along?

It is well established that gastric sleeve surgery can put diabetes into remission.⁷ However, many of 2019’s studies are describing interventions that are low cost, non-surgical, and drug-free.

The amazing part of this research is that there is nothing revolutionary about it. Research is proving that people can overcome diabetes by doing exactly what has been advised for years: “change diet and exercise patterns.” But if that hasn’t worked for the public for so long, why is research suddenly showing it working now? There’s one consistent difference: multiple sessions of professional support such as that available from an exercise physiologist. Even this is not surprising.

The scientific literature has for years commented about how a substantial component of some chronic disorders is beyond the reach of drug therapy, and some improvements are only possible through diet.⁸ However, it is also well established that medium to large changes in habitual diet and exercise require medium to high intensity support.^8-12  This means multiple visits with a healthcare professional spread over weeks and months.

In the current research, patients most likely to achieve diabetes remission have recent, adult-onset, type II diabetes. The longer diabetes goes 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 outcomes for patients.

 

References:

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 intensive lifestyle intervention: A secondary analysis of a randomized clinical trial. Diabetes, Obesity and Metabolism. 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).
4. Hopkins MD, Taylor R, Lean ME. The DiRECT principles: giving Type 2 diabetes re-mission programmes the best chance of success. Diabetic Medicine. 2019 Sep 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 Translational 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. McCarron D, Reusser M. Cardiovascular Risk Reduction Dietary Intervention Trial. Drug Benefit Trends. 2000; 12(5): 42-48.
9. U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale. Rockville MD: Agency for Healthcare Research and Quality, 2002.
10. Twardella D, Merx H, Hahmann H, Wüsten B, Rothenbacher D, Brenner H. Long term adherence to dietary recommendations after inpatient rehabilitation: prospective follow up study of patients with coronary heart disease. Heart. 2006 May 1;92(5):635-40.
11. West JA, Miller NH, Parker KM, et al. A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization. Am J Cardiol. 1997;79:58-63.
12. Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med. 1998;158:1067-1072.