Remission of diabetes is defined as achieving an HbA1c level of less than 48 mmol/mol (or 6.5%) for at least three months, having stopped all diabetes medication. Remission of prediabetes requires an HbA1c of less than 42 mmol/mol (6.0%).
The first evidence that diabetes can be reversed came from people who were obese and had type 2 diabetes, who underwent surgery to reduce the size of their stomach or small bowel to help them lose weight. As they lost weight, they also lost their diabetes. This observation led a team of researchers in Newcastle to see if it is possible for people to reverse type 2 diabetes, but without the surgery. Instead, they were asked to follow a very low-calorie diet for eight weeks. Over that time, they lost an average of 15 kilograms (about 33 pounds) and they all reversed their diabetes. It was observed that as they lost weight, there was a loss of excess fat stored in the liver and the pancreas, and reduction of levels of insulin and glucose in the blood.
Going on a very low-calorie diet is an effective way of reversing diabetes and achieving remission. However, it is then important not to return to the old unhealthy way of eating, as otherwise the weight will go back on – and the diabetes will return. An alternative way to achieve remission is to make changes to reduce the amount of carbohydrates in the diet. Research from different countries has shown that reducing carbohydrate intake – especially avoiding sugary foods and drinks and large portions of starchy foods – is effective in helping people reverse their diabetes. In order to stay in remission, these changes need to be permanent, and so it is important that the new diet is satisfying and sustainable in the long term.
The greatest chance for remission is in the first year or so after diagnosis of diabetes. However, it is important to recognise that people who have had diabetes and been on medication for many years – including insulin – can come off that treatment if lifestyle changes lead to normal glucose levels, and in some cases can achieve remission. It is never too late to have an ambition for remission!
If you wish to achieve remission of type 2 diabetes or prediabetes, I can provide a a full assessment and recommend a management plan to help you achieve your goal, backed up by regular review by expert dietitians at London Medical.