Top 10 reads: Diabetes reversal is now a reality!

Diabetes is infamous for being an incurable and chronic condition. But recent studies have shown that diabetes can be reversed. Sanofi has curated the top 10 articles that can help you understand how to support your patients in diabetes reversal. Read on to know more. 

A. DIABETES REVERSAL: OVERVIEW AND DIFFERENT APPROACHES

Hopes regarding remission of diabetes have been raised. Diabetes remission is promoted as an ideal endpoint of therapy.

1. What’s in a Name? Redefining Type 2 Diabetes Remission 1

(Diabetes Therapy. 2021 Jan 24)

Diabetes remission is a concept that is marked by ample attention, but lack of unanimity. T2D remission is defined as a healthy clinical state characterized by achievement of HbA1c below the targeted level, maintained for at least 6 months, with or without continued use of lifestyle modification and/or metformin, provided that this is not due to complications, comorbid conditions or concomitant therapy. This opinion piece explores existing definitions of diabetes remission and proposes a contemporary and comprehensive framework to help define this clinical state.

2. Lifestyle intervention effects in relation to duration of pre-diabetes 2

(BMJ Open Diab Res Care 2022)

The impact of lifestyle intervention was assessed in normoglycemic offspring of parents with T2D who developed incident pre-diabetes during prospective follow-up. Starting lifestyle intervention within 3 months to 8 years of incident pre-diabetes was associated with robust prevention of progression to diabetes and reversal of pre-diabetes in high-risk patients with parental T2D. Routine clinical practice of proactive screening and prompt lifestyle intervention in people with incident pre-diabetes would be effective in preventing T2D or reversing pre-diabetes in most individuals.

3. Testosterone therapy for prevention and reversal of type 2 diabetes in men with low testosterone 3

(Current Opinion in Pharmacology. 2021 Jun 1)

Men with obesity and/or T2D have a high prevalence of TD. The landmark testosterone for diabetes mellitus trial, the largest randomized controlled trial of TTh to date, confirms the beneficial effects of TTh on fat loss and gain in muscle mass, and that TTh for 2 years significantly reduces the risk of incident T2D, and may also reverse T2D.The testosterone for diabetes mellitus trial suggests that testosterone therapy reduces the risk of T2D and results in greater improvement in sexual function and wellbeing, beyond lifestyle intervention alone.

4. Vaccines For Type 1 Diabetes Prevention or Reversal? 4

(Current Diabetes Reviews. 2021 Jan 1;17)

T1DM is an autoimmune disease which leads to destruction of pancreatic β-cells, thereby causing insufficient insulin production. Globally, around 98, 200 children and adolescents below 15 years of age and almost 128,900 subjects below 20 years of age develop T1DM annually, along with severe complications deteriorating their quality of life. In India alone, around 15,900 incident cases below 15 years have reported annually. Hence, its prevention and reversal are significant. Vaccines can be one of such strategies in the journey to prevent T1DM. It would not only benefit greatly to reduce the sufferings caused due to diabetic complications but could also help to reverse T1DM, by modulating the immunological autoantigenic reactions and prevent further degradation of pancreatic β-cells.

B. DIABETES REVERSAL: PATHOPHYSIOLOGY

This session covers the effects of a lifestyle intervention on T2D reversal or remission and its effects on the underlying pathology.

5. Type 2 diabetes and remission practical management guided by pathophysiology 5

(Journal of Internal Medicine. 2021 Jun)

The likelihood of achieving remission after 15% weight loss has been shown to be mainly determined by the duration of diabetes, with responders having better beta-cell function at baseline. Remission is independent of BMI, underscoring the personal fat threshold concept that T2D develops when an individual acquires more fat than can be individually tolerated even at a BMI which in the nonobese range. Diagnosis of T2D can now be regarded as an urgent signal that weight loss must be achieved to avoid a progressive decline of health.

6. The Effect of a Lifestyle Intervention on Type 2 Diabetes Pathophysiology and Remission The Stevenshof Pilot Study 6

(Nutrients 2021, 13)

Although lifestyle interventions can lead to diabetes remission, it is unclear to what extent etes T2D remission alters or improves the underlying pathophysiology of the disease. Achieving diabetes remission in individuals with a longer T2D duration is possible, but underlying pathology is only minimally affected, possibly due to an impaired beta cell function. Thus, even when T2D remission is achieved, patients need to continue adhering to lifestyle therapy. This article assesses the effects of a lifestyle intervention on T2D reversal or remission and the effects on the underlying pathology.

C. DIABETES REVERSAL: ROLE OF DIET AND WEIGHT

There is strong evidence suggesting that nutrition, diet and weight management has an important role in remission of diabetes.

7. Remission of Type 2 Diabetes with Very Low-Calorie Diets—A Narrative Review. 7

(Nutrients. 2021 Jun)

VLCD are hypocaloric dietary regimens of approximately 400–800 kcal/day that result in 20–30% reductions in body weight, sometimes in just 12–16 weeks. A body of evidence demonstrates that adherence to VLCD in adults with T2D can result in marked improvements to glycemic control and even full T2D remission, challenging the convention that T2D is a lifelong disease. This article summarizes the new understanding of T2D and consider how different changes to food intake can achieve the necessary weight loss and maintenance required for remission of diabetes.

8. Nutritional basis of type 2 diabetes remission 8

(bmj. 2021 Jul 7)

T2D mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified that remission is achieved when HbA1c concentrations of 48 mmol/mol are recorded after weight loss and at least six months later without any anti-diabetic medications. This article summarizes the new understanding of T2D and consider how different changes to food intake can achieve the necessary weight loss and maintenance required for remission of diabetes.

9. Association of Weight Loss with Type 2 Diabetes Remission Among Adults in Medically Underserved Areas A Retrospective Cohort Study 9

(American Journal of Health Promotion. 2022 Jan)

Strong evidence demonstrates that obesity management is critical in diabetes treatment. Many studies have shown that modest and sustained weight loss is effective in improving glycemic control and reducing the need. This study examines the incidence of and factors associated with remission among patients with T2D from medically underserved areas. The results of the study demonstrate that weight loss is significantly associated with diabetes remission among patients living in medically underserved areas, but complete remission is rare.

10. Weighing in on Type 2 Diabetes Remission 10

(Diabetes Care. 2022)

Indicators of more advanced T2D, including increasing age, duration ofT2D, number of glucose-lowering medications, baseline HbA1c, and insulin use, predict T2D nonremission and are incorporated into predictive tools such as the diabetes remission (DiaRem) score and advanced DiaRem score. Although early intervention is very likely important for T2D remission, those with more advanced T2D can achieve remission with >20% weight loss. This article provides important information on the amount of weight loss needed to induce initial T2D remission. This information can guide clinical decision-making by patients and health care providers.

TD: testosterone deficiency; VLCD: Very low-calorie diets; TTh: testosterone therapy

    1. Kalra S, Singal A, Lathia T. What’s in a name? Redefining type 2 diabetes remission. Diabetes Therapy. 2021 Mar;12(3):647-54. 

    2. Caliber M, Saad F. Testosterone therapy for prevention and reversal of type 2 diabetes in men with low testosterone. Current Opinion in Pharmacology. 2021 Jun 1;58:83-9. 

    3. Desai S, Buchade S, Chitlange S, Sharma H, Bhombe D, Shewale S, Pujari P. Vaccines for type 1 diabetes: prevention or reversal?. Current Diabetes Reviews. 2021 Jan 1;17(1):30-6. 

    4. Taylor R. Type 2 diabetes and remission: practical management guided by pathophysiology. Journal of Internal Medicine. 2021 Jun;289(6):754-70. 

    5. de Hoogh IM, Oosterman JE, Otten W, Krijger AM, Berbée-Zadelaar S, Pasman WJ, van Ommen B, Pijl H, Wopereis S. The Effect of a Lifestyle Intervention on Type 2 Diabetes Pathophysiology and Remission: The Stevenshof Pilot Study. Nutrients. 2021 Jul;13(7):2193. 

    6. Juray S, Axen KV, Trasino SE. Remission of Type 2 Diabetes with Very Low-Calorie Diets—A Narrative Review. Nutrients. 2021 Jun;13(6):2086. 

    7. Taylor R, Ramachandran A, Yancy WS, Forouhi NG. Nutritional basis of type 2 diabetes remission. bmj. 2021 Jul 7;374. 

    8. Chen M, Surbhi S, Bailey JE. Association of Weight Loss With Type 2 Diabetes Remission Among Adults in Medically Underserved Areas: A Retrospective Cohort Study. American Journal of Health Promotion. 2022 Jan;36(1):29-37. 

    9. Meerasa A, Dash S. Weighing in on Type 2 Diabetes Remission. Diabetes Care. 2022 Jan;45(1):28-30.

MAT-IN-2200218