Guest blog-Can Diabetes Type 2 Be Reversed? Experts Answer (Part 1 of 4)

(Due to the length of this article I will be presenting it in 4 parts--Maureen)

It is the burning question most, if not all, people with diabetes type 2 have: can my diabetes be reversed? There is so much information, thousands of articles, home remedies that promise readers the ultimate chance to reverse their diabetes. It sounds too good to be true.

However, as with all things on the net and with our health, we must be wary of what we read and what is fed to us as information. Most articles recommend healthy eating and exercising as a way of reversing your diabetes.

These are two lifestyle changes that are easy to do if you put your mind into it. Does it work though? If it does, how can you go about doing this or where should you start? We reached out to 28 experts in the field who spilled the beans to us about the reversal of diabetes type 2 and whether it is a myth or a reality. To find out more, please keep reading.

1. Cheryl Orlansky RDN LD CDE

Diabetes is a progressive disease however it CAN be reversed. Bariatric surgery results have proven that losing weight in morbidly obese patients with Type 2 Diabetes reverses the disease state. Bariatric surgery outcomes have been studied over 10 years with lower rates of mortality and morbidity. Bypass surgery patients normalize blood sugars within days of the procedure.

Other factors may play a role in this disease reversal such as; less food intake, hormonal system changes such as the incretin system, possible malabsorption of nutrients and others are being researched besides weight loss. Diabetes Care; May 2017, 40(5)

Many patients with Type 2 diabetes can manage their disease with lifestyle factors very well without medication and are very well controlled. Patients with Type 1 diabetes will always have Type 1 and will always need a sufficient supply of exogenous insulin. At this time, there is no cure for diabetes.

In patients with Type 2 diabetes that are not morbidly obese and do not undergo bariatric surgery; the disease won’t be reversed. In fact, as the disease progresses, the pancreas releases less insulin over the years and the cells of the pancreas do not regenerate. Therefore, the disease is managed differently over time.

2. Janet Howard-Ducsay RN BA/BSN CDE

In discussing self management with the person with diabetes I focus on how healthy lifestyle behaviors can change the treatment plan. Introducing healthy lifestyle behaviors by providing consistent and predictable meals, daily activity, healthy coping and consistent medication management can improve overall glucose control and may change the overall treatment plan for managing diabetes.

I review with the patient that management does not reproduce insulin making beta cells but may reduce the rapid speed in which they are utilized. I review that activity may improve the manner in which insulin is utilized.

I encourage predictable meal planning and healthy coping of their overall stress as a manner in which to reduce excessive glucose production. All of these physiologic changes are what Type 2 diabetes is.

These lifestyle behaviors are not a cure but an optimal way to manage and possibly improve and ease the overall treatment plan for the person with Type 2 diabetes.

3. Molly McElwee-Malloy, RN, CDE

There has been a good amount of attention and time spent on discussing the “reversal” of diabetes, but there’s not been a lot of good facts to explain what this means. First, type 1 diabetes (an autoimmune disease) cannot be reversed, cured or avoided – period. It can be managed with insulin and made easier with good lifestyle choices like staying active and eating a healthy diet.

Pre-diabetes and type 2 diabetes can be made easier to control through medication, smart lifestyle choices including exercise and diet. They cannot, however, be cured. The idea of “reversing” a disease is attractive because it makes us think we can get something and then “fix” it.

Once a person enters pre-diabetes where their hemoglobin HbA1c starts rising above 5.7% they have entered the disease process. The patient – if made aware that they have pre-diabetes and has access to educational support – has the opportunity to prevent the pre-diabetes from developing into type 2 diabetes.

They will always have the pre-diabetes diagnosis and have the potential to develop type 2 diabetes if aggressive dietary, exercise and or medication is not followed. It is possible to achieve a normal non-diabetic HbA1c after this – virtually not having any clinical evidence of the pre-diabetes, however the disease process is still there and being held at bay.

If the person stops the interventions or is predisposed to having diabetes due to risk factors out of their control, they can and will develop type 2 diabetes. It’s worth noting that there are genetic and other non-adjustable risk factors (ethnicity for example) that contribute to the development of type 2 diabetes.

It is also worth noting and all of this advice can be followed and a person can still develop type 2 diabetes. Following strict guidelines and taking medications is not a 100% promise that type 2 diabetes will be prevented.

A patient diagnosed with type 2 diabetes (HbA1c of 6.5% or above) will always have type 2 diabetes. Interventions such as medication (including insulin), staying active and making good diet choices must be maintained to prevent the disease from progressing further. However, even if the patient undergoes strict medication, diet and exercise adherence and manages to lower the HbA1c they will still have type 2 diabetes.

The idea of “reversing” is describing the well managed type 2 diabetes that can be maintained without the outcome of complications (eye disease, kidney disease, etc.). And it is totally possible to have type 2 (or type 1 diabetes for that matter) and have no complications – however, this takes careful management and is largely driven by the patient and their access to quality healthcare.

So, can you “reverse” diabetes? No – but you can manage it very well with the help of a Certified Diabetes Educator (CDE) and a knowledgeable primary care physician or endocrinologist. There are even prescription apps available to bridge the care that your clinicians can give you between visits and apps that offer virtual CDE’s for greater assistance.

There are a lot of choices and support for managing diabetes well and I encourage all persons with diabetes to make sure they have all the support and education they need to live the best life with diabetes they can. After 18 years of type 1 diabetes and no complications, I can promise you the hard work is worth it.

4. Madelene Richert, RN, CDE, CPT

I do not know of any way of reversing Type 2 Diabetes without surgical intervention. To clarify, become non-diabetic.

Type 2 Diabetes is controllable and the two best ways to do this is by eating real food and exercising. Food has become the celebratory enemy. Weekends are not holidays but just days off work.

Exercise is a privilege that many people are unable to do and you want to do it while you are still able to. Keeping a food journal continues to be one of the best weight loss plans. One of the most common statements I hear from patients is , “I really just don’t eat”. If that were true, you would lose weight. It takes 9 calories to sustain a pound of weight. So what you weight times nine is how many calories you are eating.

Please remember, diabetes is controllable. You can do it! Visit with a CDE and learn how you can control it!

5. Maureen Boccella, R.D., L.D.N., M.S., C.D.E.

Type 2 diabetes is on the rise and is associated with insulin resistance. There are many factors which contribute to developing this disease some of which are modifiable and some of which are nonmodifiable. Modifiable risks which individuals can impact include weight, diet and exercise. It has been reported that gastric bypass patients who have T2DM are “cured” of the disease after surgery. That is a more drastic measure which many people are not ready or willing to consider.

If the T2DM has been recently diagnosed, there is a greater likelihood of being able to reverse the disease. Doing this requires losing approximately 5-10% of current body weight, balancing carbs and protein and engaging in daily physical exercise. A diabetes educator (C.D.E.) is the expert who can help put together a plan for realistic and permanent lifestyle changes.

6. Karen Harouse-Bell MS, RDN, CDE, LDN

Take a moment to look around. One out of every three adults you see has prediabetes. If this statistic were headline news in regards to a contagious disease, people would most likely stop in their tracks and seek help. This, however, is not the situation with prediabetes.

I believe in most cases, type 2 diabetes can be prevented or delayed. But to accomplish this, we must remember… words matter.

Healthcare professionals must say it. Use the word prediabetes to emphasize the benefits resulting from a lifestyle modification program such as the DPP, finding that it is the ideal first-line treatment to halt the progression of diabetes.

Use it as a motivator to make lifestyle changes and join a class. Use it so your patients hear it. Too often “softer” words are chosen, which do not have as much value and consequence as the word prediabetes.

The dictionary defines the word “prevention” as the act of stopping something bad from happening (https://www.merriam-webster.com/dictionary/prevention). As I often tell my children to choose their words carefully, we must choose the word prediabetes to begin the journey of diabetes prevention.

7. Judith Vance, MN, MPH, FNP

In my opinion, type 2 diabetes can be reversed with use of a GLP1 agonist such as Victoza to restore beta cell mass and significant weight loss to normal BMI.

Initially a long acting insulin such as Levemir may be required to normalize blood glucose.

It is worth noting that NovoNordisk’s Victoza is the only GLP1 agent that is approved in chronic renal disease.

In my high risk diabetes practice in Green Valley, AZ, all patients on Victoza, were able to achieve a HgA1C of 7. This group of approximately 50+ senior adults previously had HgA1Cs of over 8 and up to 11-12 when referred to me.