Usually when you hear comments about people's diabetes being “cured”, it is only in relation to type 2 diabetes and I would like to point out some of the finer considerations to some of these claims.
Diabetes is a clinical diagnosis based on blood test results +/- classical symptoms (tired, blurred vision, increased urination, increased thirst etc). Blood glucose measures are the essential component of diagnosis and can be measured in more than one way.
When people talk about “curing diabetes”, I really think they are talking about remission.
Remission – is a concept where a disease (ie diabetes) is treated to the point where test results no longer meet the biochemical diagnostic criteria.….. a similar concept to some blood cancers where when undergoing intensive initial intervention, the ultimate goal is a cure but after the 1st round of treatment the doctors talk about the disease being in remission…. there is always a risk of relapse.
How is Diabetes Remission Possible?
The multiple causes that leads a person to a diagnosis of diabetes is varied and complex….. it can include :
• genetic vulnerability (family history of diabetes, personal history of gestational diabetes),
• increased weight around the middle,
• decreased physical activity (sedentary lifestyle) and
• certain eating patterns (think typical Australian diet!).
It is possible to change some of these causes/contributions, but for most people the vulnerability towards diabetes….. once discovered is likely to always be in the background.
Expert groups have defined diabetes remission as a HbA1c (a measure of long-term blood glucose levels) below 48mmol/mol or 6.5% for at least six months.
NOTE: Diabetes remission is now well-recognised in clinical guidelines, with ongoing research focusing on long-term sustainability and individual responses, but patients remain at risk of relapse.
There are two main methods used to try and reverse type 2 diabetes:
1. Weight loss
2. Carbohydrate intake modification – both total quantity of carbohydrate and type.
WEIGHT LOSS - Small amounts of weight loss ie 5% in people who are overweight or obese can significantly improve blood glucose control. It can also improve blood pressure and cholesterol levels. Small amounts of weight loss are more realistic and sustainable.
HOWEVER, it appears that at least 10% weight loss is needed for diabetes remission.
LOW CARBOHYDRATE eating - Diabetes can be considered an imbalance between the challenge of carbohydrate intake and the body’s reduced ability to process the resultant high blood glucose due to insulin resistance. A low carbohydrate diet means the body is no longer challenged where it is faulty.
For some people following a low carbohydrate eating plan is one intervention to help them lose weight but low carbohydrate eating is not the only way to help with weight control.
Type 2 diabetes is usually associated with excess body weight or at least excess fat tissue around the middle.
I believe weight loss is difficult but keeping the weight off is even harder.
For diabetes remission to be maintained, interventions need to be sustainable.
This is where working with a qualified dietitian can be extremely helpful. Dietitians understand the influences and basis of how you usually eat and help you tweak this into a healthier eating pattern. Dietitians consider your food preferences, your social and cultural influences and practicalities such as budget or the need to feed a family as well as time constraints.
A personally prescribed eating plan or advice is much more likely to be sustainable than following a radical generic diet that is very different from a person's usual or previous habitual eating.
TAKE HOME MESSAGES
· Remission is more likely if you were diagnosed with a very high BMI
· Remission is more likely if you lose a substantial amount of weight ie > 15kgs
· Remission is more likely if you attempt to do so earlier in your diagnosis
FOR MORE INFORMATION
Comments