Type 2 diabetes is often described as a progressive disease. Left unchecked, without the proper healthcare intervention and lifestyle changes, it can gradually deteriorate over time and more medication will be needed to manage the condition.

But what about the opposite? With the right lifestyle changes and a determined mind to take better care of your health, can you “reverse” the disease or, more specifically, put it into remission?

Reversal involves permanent cure and unfortunately for type 2 diabetes there is no known cure. However, there is evidence that the disease can be controlled and in some successful cases it can go into remission.

What remission means in type 2 diabetes is that your blood sugar levels are healthy again without the need for medications to control them.

Specifically, your A1C (your blood sugar level or estimated average glucose level) has been reduced to the level of a person without diabetes (less than 6.5%) and you can therefore either limit the medications you take, either eliminate them completely for more than six months or more.

Knowing this can mean hope for many patients with type 2 diabetes, but what exactly needs to be done? This was the subject of a webinar co-hosted by the Center of Transformative Nutrition & Health (CTNH) at International Medical University (IMU) with the Malaysian Endocrine and Metabolic Society (MEMS) and the Malaysian Dietitians’ Association ( MDA), titled “Diabetes in Malaysia and Southeast Asia: Is Remission Possible?” “.

Moderated by Professor Winnie Chee, Professor of Nutrition and Dietetics at IMU, the webinar brought together outstanding speakers with valuable experience and knowledge about the disease, such as Dr Zanariah Hussein, Head of Endocrinology Services at the Department of Health and Past Chairman of MEMS, Dr Anthony Leeds of the University of Copenhagen and Assistant Professor at IMU who also practices Bariatric Medicine at the UK NHS in the Diabetes and Endocrinology Department at Central Middlesex Hospital in London, Professor Susan Jebb, Professor of Diet and Population Health, and Professor Paul Aveyard, Professor of Behavioral Medicine, both from the University of Oxford.

It brought together over 550 participants who were doctors, dieticians, diabetes educators, nurses and other healthcare professionals from Malaysia, Singapore, the Middle East and the UK.

It must be said that diabetes remission is a fairly new idea and much more research is needed before it can be fully understood. However, the strongest evidence suggests that diabetes remission occurs through weight loss and maintenance.

The webinar discusses some proven dietary approaches for remission. The fact remains that type 2 diabetes is a lifestyle disease that is also on the rise.

“In this part of the world, there has been an upsurge in type 2 diabetes and its associated risk factors, which include increasing levels of obesity, unhealthy diets and a widespread sedentary lifestyle. Growing urbanization and changing lifestyles are also contributing factors, ”said Dr Zanariah.

However, with proper management of your diet and lifestyle, the risk of disease is significantly reduced. For people with diabetes, controlling these two factors can improve your quality of life.

“Lifestyle modification is the first step after diagnosing diabetes,” said Dr. Zanariah. She quotes the latest version of Management of type 2 diabetes mellitus which recommends that patients with type 2 diabetes for the purpose of achieving remission of diabetes consider meal replacement therapy (MRT) and a very low calorie diet (VLCD).

But how exactly does weight loss promote diabetes remission? First of all, you need to understand what the extra weight is doing to your body. Fat can build up around important organs like the liver and pancreas, making it harder for these organs to work.

This can lead to how type 2 diabetes develops, although other factors also come into play, such as age, ethnicity, and family history. And the reverse is also true: fat loss affects diabetes remission.

Dr Leeds confirms this fact by sharing how studies in the UK and the Middle East have shown that dietitian-led weight loss programs using Total Diet Replacement (TDR – a diet formula providing all foods) helped to lose more than 15 kg of weight in one year. , which led to diabetes remission.

Participants in the UK study called the DiRECT trial under TDR had greater reduction in liver fat and reduced inflammation, and their pancreas returned to normal morphology. “The key message is that a sustained weight loss of over 10 kg at two years of age will help two in three people achieve remission from diabetes,” said Dr Leeds.

Further promoting weight loss as a means of remission, Professor ebb said: “Even people who lose only 5kg, a small proportion of them will be successful.” Together with Professor Dr Aveyard, Professor Jebb studied the impact of weight loss in a primary care setting for patients with type 2 diabetes. “What I want to make is that there is a linear relationship between weight loss and the likelihood of achieving remission. “

She also points out that although the recommendation is total diet replacement (TDR), it is not for everyone. “Over the past 10 years or more, we’ve been working hard on the effectiveness of weight loss for remission. It is important to understand that there are different ways to lose weight. Encouraging people to self-manage their own weight is modestly effective, although weight loss is limited. But if the whole population did that, you can imagine the benefits that come with it, ”said Prof Jebb.

It is important to know that remission is not a one-time event. It must be maintained because otherwise there is always a chance that your diabetes will come back, Professor Dr Aveyard said. This is where healthcare practitioners come in to provide support to their patients, he says.

“With the right ‘script’ patients responded much better,” said Prof Aveyard. He also points out that apart from remission from diabetes, weight loss also has other long-term benefits in terms of cardiometabolic effects. Therefore, efforts to lose weight in diabetes are all helpful because of this inherited effect.

Whether it’s an accelerated approach to weight loss or a gradual approach, the idea is just to go ahead and find the one that’s right for you. In fact, diet is not the only way to remission from type 2 diabetes; some patients have undergone weight loss or weight loss surgery.

It is important to seek help from your health care provider, as support also plays an important role, from the person helping you manage your diabetes to those close to you.

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