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5 Reasons Diabetes Can't be Reversed

This Proof Points edition is based on the article Can Type 2 Diabetes be Reversed? Here’s What the Research Says. Read it here.

by Hope Chang, PharmD, AAHIVP

Now that the term “diabetes reversal” has hit the mainstream media, what does that mean for people living with diabetes?

These days, patients are benefitting from tremendous advances in medications and monitoring so there is good reason for hope. For cardiometabolic conditions where the diseases are highly correlated with lifestyle, it makes sense that patients would believe that if they embrace healthier behaviors and new treatments that their condition could be reversed or cured.

Unfortunately, setting the expectation that a diabetes diagnosis can vanish forever is potentially harmful. Read on for five ways this misleading messaging can affect patients.

Reversal gets confused with “cure”

When in doubt, turn to the experts. According to a consensus report by the ADA, the expert panel agreed that the appropriate term is diabetes remission. Experts at Diabetes UK agree too, dedicating part of their website to caution against using the term “diabetes reversal” because “there’s no guarantee that your diabetes has gone forever.”

Even though diabetes patients can achieve a normal glucose state with weight loss and lifestyle changes, experts at the Joslin Diabetes Center still clearly state that “type 2 diabetes cannot be cured.”

They also opt for the term “remission” rather than “reversal.” As we can see, experts are in lockstep on this.

Achieving and maintaining remission is challenging as it is

The ADA's consensus report also provides a definition for diabetes remission. What it boils down to is individuals in remission have, for the time being, stopped their diabetes from getting worse, but continue to require ongoing monitoring and support. That can include checking HbA1c at least annually, lifestyle modifications, managing stress from other illnesses, and continued routine monitoring for diabetes-related complications (i.e. retinal screenings, foot evaluations, and kidney function tests).

Despite diabetes affecting more than 37 million Americans, a study found that only 1.5% of people with diabetes actually achieved at least partial remission over a 7-year period. The rate of prolonged remission (lasting at least 5 years) was even more rare: 0.007%.

Studies show remission declines with time

The truth is that even for patients who achieve remission, maintaining it is very hard, as described above. If patients believe they’re cured, it’s possible they could slip back into old habits.

Take weight loss, for example, which is often a key part of reaching the point of diabetes remission. According to the National Weight Control Registry, of the people who maintain weight loss, 90% exercise at least one hour every day and 75% weigh themselves at least once a week.

However, long-term studies that follow patients who achieve type 2 diabetes remission through significant weight loss show that remission declines with time.

Researchers found that 70% of participants who lost more than 15 kg were able to achieve diabetes remission at two years. Unfortunately, only 11% of the population achieved and sustained their weight loss.

That’s because weight loss is hard for everyone. Even with weight loss medications, such as Glucagon-like peptide 1 (GLP-1) receptor agonists, individuals are at risk of regaining weight once off medication.

It sets up unrealistic expectations

Since prolonged remission is so exceedingly rare, touting permanent reversal can set up wildly unrealistic expectations for people living with diabetes. Telling patients that diabetes can be reversed sets a standard that is not achievable for all patients. This isn’t something to ignore.

On the one hand, studies show that positive outcome expectations are more likely than negative outcome expectations to induce helpful health behaviors. However, ideal expectations, or hoping for the most desirable, but not necessarily the most probable outcome, seems to be negatively correlated with health outcomes.

We run the risk of furthering blame and self-doubt

If people living with diabetes have unrealistic expectations about being able to cure themselves, we also risk reinforcing a culture of blame and self-doubt that permeates the type 2 diabetes community. People with diabetes are already twice as likely as the general population to experience depression. Setting the bar too high could run the risk of furthering the emotional hurdles patients already face when it comes to navigating their diabetes management.

Until a cure exists, type 2 diabetes remains a chronic condition and should be treated as such.

It’s an exciting time in diabetes management as more and more people have been able to maintain normal levels of glycemia without diabetes medications and achieve diabetes remission. As an appealing option for patients, clinicians should be sure to educate their populations about remission, and ensure their patients understand what it is and what it isn’t.

Learn more about Omada's approach to diabetes management.

This Proof Points edition was originally published on LinkedIn on 7/25/23.