Is it possible to get rid of type 2 diabetes permanently? Can one be completely cured by lifestyle changes alone? In an era of increasingly effective pharmacotherapy, have we stopped remembering other ways of prevention and treatment? About the spectacular results of the Diabetes Remission Clinical Trial, among others.
In the following article we will answer the questions:
- Is permanent remission of type 2 diabetes possible?
- Are there more effective methods of prevention and treatment than pharmacotherapy alone?
- What is more important in the treatment process: diet or physical activity?
Should diabetes be a concern?
All current analyses point to the exponentially increasing number of diabetes cases worldwide. Currently, the number of people who have diabetes is approaching 10% of the total population and, unfortunately, this limit will certainly be exceeded soon. This is undoubtedly related to the parallel “epidemic” of obesity, and results in a still unacceptably high incidence and mortality from cardiovascular disease.
The last few years have seen a real revolution in diabetes pharmacotherapy. Mainly due to two new groups of antidiabetic drugs, whose main advantage is a significant reduction in the risk of cardiovascular events, renal failure and a beneficial effect on weight reduction.
The latter action is so strong that for some preparations it is the first indication for their use. This is certainly very good information. However, it may make some patients question the sense of non-pharmacological management, which invariably consists of diet and physical activity, when we have such effective drugs at our disposal.
It is worth quoting at this point the iron rule that it is definitely better, and no less importantly cheaper, to prevent than to cure. Satisfactory subsidization of pharmacotherapy for potentially 10% of the population, in the conditions of aging societies, may be unmanageable not only for the Polish, but for most health care systems.
Meanwhile, significant progress has also been made in the field of non-pharmacological management. Its various components (low-calorie diet, low-carbohydrate diet, physical activity, divided into resistance and aerobic training, supervised and independent) have been analysed very carefully together and separately, comparatively in different groups of patients.
Most of these analyses ended with positive results, in some cases even spectacular. Here are the most important ones.
Lifestyle and diabetes?
A number of studies have shown that these lifestyle changes can prevent diabetes in people with already diagnosed pre-diabetes (i.e. abnormal fasting glucose and/or abnormal glucose tolerance). To mention just one example, the US Diabetes Prevention Program Outcomes Study (DPP) indisputably shows that non-pharmacological management (adequate diet combined with exercise) is twice as effective in inhibiting the development of diabetes from a pre-diabetic state as the drug metformin.
What if the diagnosis of type 2 diabetes has already been made?
Until recently, it was thought to be an irreversible and progressive disease.
Fortunately, scientists have good news for us in this respect too. For it turns out that the beta cells of the pancreas (responsible for insulin secretion) have the ability to regenerate!
There is one condition, however – weight reduction.
In the Diabetes Remission Clinical Trial, the researchers showed that a weight loss of >10 kg not only caused a reduction in hepatic and pancreatic steatosis (very common in type 2 diabetes), but also resulted in an improvement in beta-cell function, and thus a complete normalisation of glucose levels, sustained for several years, in almost half of the participants.
A condition for success, however, was the consistent application of the diet. This therefore proves that type 2 diabetes need not be an irreversible condition at all. It should be noted, however, that success was achieved in patients with a short history of type 2 diabetes. In patients with diabetes lasting 4 years or more, success was not achieved, mainly due to permanent loss of pancreatic beta-cell function.
Interestingly, there are isolated reports of complete remission of diabetes t. 2 in people with even a small reduction in body weight, but the prerequisite for improvement is first and foremost the reduction of fat tissue of particularly negative significance, i.e. visceral fat. The amount of subcutaneous fat is of secondary importance in this context.
The role of physical activity in the management of diabetes
In view of the proven remission of diabetes through a low-calorie diet, can it be said that physical activity – both spontaneous and training – is of secondary importance?
Of course not. In the early stages of diabetes/pre-diabetes, there is a reduction in the glucose-consuming capacity of the organs, mainly the liver and skeletal muscle.
While the insulin sensitivity of the liver can be improved precisely through an appropriate diet, in the case of muscles, a far greater improvement is achieved through training.
The occurrence of insulin resistance in various tissues and organs, both as a cause and effect of overweight and obesity, makes routine and frequent attempts to determine it seem pointless. This is especially true given that the results of such determinations are characterised by considerable variability from one study to the next.
A multi-pronged approach is worthwhile
Extending lifestyle modification with appropriate physical activity can provide much more lasting improvements than diet alone, both in terms of weight maintenance and avoidance of rapid diabetes relapse.
For many years, the primary form of activity recommended for the prevention of obesity and diabetes was moderate-intensity aerobic exercise. In recent years, however, the importance of resistance training has also been recognised. Its main advantage is that it is much more effective in improving muscle metabolism and the density of blood vessels in the muscles. In addition, it has a beneficial effect not only on metabolism, but also on the normalisation of blood pressure.
Proponents of aerobic and resistance training have been ‘reconciled’ by the results of a recent study, which showed that an appropriate and individualised selection of exercises from both categories produces by far the best results. This comes as no surprise, as of the 5 health-relevant elements of fitness, as many as 3 independently influence mortality reduction.
These are pulmonary and cardiac fitness, muscular endurance and body composition. While pulmonary and cardiovascular endurance is more associated with aerobic endurance training (especially HIIT – high-intensity interval training), the next two elements are difficult to achieve without resistance training.
It is worth mentioning that the evaluation of the training categories also took into account whether or not the workouts were supervised by physiotherapists. As one can easily guess, better results were obtained for supervised workouts.
For unsupervised training, the benefits were also significant and it is the latter category that is a frequent topic of discussion in public health. The organisational, financial and time constraints of the potential participants themselves, in an environment of exponentially increasing numbers of diabetic patients, mean that a feasible strategy may be to recommend home-based exercise only with periodic consultation with professionals.
Be Helfio.