“The typical impact on morbidity and mortality for those with type 2 diabetes is rather grim and in excess of many cancers. The average 10-year survival rates for breast cancer and non-Hodgkin lymphoma are 84% and 55%, respectively; the average 10-year lifespan for type 2 diabetes is 50%. While the goal for most patients with cancer is remission, the patient with type 2 diabetes is taught that they need to live with this incurable disease. This need not be the case.
Increasing evidence points to the ability of patients to not only halt the onset of type 2 diabetes, but also to enter remission after a type 2 diabetes diagnosis. Bariatric surgery (RYGB, BPD) has been shown to result in durable remission in the majority of patients with type 2 diabetes, and research has demonstrated that counseling patients to engage in modest caloric reduction using portion control and limited use of meal replacements resulted in roughly 10% of patients experiencing remission after 2 years.
The Diabetes Remission Clinical Trial (DiRECT) in particular provides compelling evidence for the efficacy of structured, diet-induced weight loss on type 2 diabetes remission outcomes. The randomized controlled trial’s intervention consisted of withdrawal of antidiabetic/antihypertensive drugs, total diet replacement for 12 to 20 weeks, stepped food reintroduction (2 to 8 weeks), and then structured support for weight-loss maintenance. At 24 months, 36% of intervention group participants had remission of diabetes, lower weight (average 8 kg), lower blood pressure, a 50% reduction in cardiovascular disease risk, lower health care costs, and better quality of life. Post-hoc analysis of patients experiencing remission found a return to normal pancreas volume, morphology, and beta cell capacity. Importantly, the trial was conducted entirely in primary care practices, assisted by nurses and dietitians.”