Remission or cure of type 2 diabetes: Who has a chance?

Diabetes was once considered a permanent disease with no cure. However, the term remission has recently been coined to describe patients who maintain normal blood sugar levels without medication.

Treatment for diabetic patients with foot complications - Photo: TTO

Concepts

• Disease remission: HbA1C < 6.5% for at least 3 months, spontaneously or after intervention

• Alternative concept (when HbA1C is unreliable): Fasting blood sugar < 7.0 mmol/L or blood sugar after 2 hours of normal glucose tolerance test

Measures to help reverse type 2 diabetes

• Lifestyle changes , including weight loss and increased physical activity, are key. Losing 10-15% of body weight can improve blood sugar control and insulin sensitivity, potentially reversing early disease progression.

A low-calorie (800-1000 calories/day), low-carbohydrate, or Mediterranean- and plant-based diet can also promote weight loss and improve insulin sensitivity.

• Gastric bypass or gastric-enterostomy surgery can help achieve long-term remission in severely obese patients with type 2 diabetes, thanks to significant weight loss, improved insulin sensitivity, and changes in Incretin hormones.

• Although pharmacological intervention does not induce remission by itself, it can support and maintain normal blood glucose levels during the remission phase. In particular, early insulin treatment, or the use of other drugs such as metformin, SGLT-2 inhibitors and GLP-1 RA also have a supportive role.

The mechanism of diabetic remission involves three main factors:

• Restoring pancreatic beta cell function: Interventions such as early insulin treatment and gastric bypass surgery can help restore the function of these cells.

• Improve insulin sensitivity : Weight loss and regular exercise reduce insulin resistance.

• Weight loss : Reducing excess fat in the liver and pancreas is one of the most important factors in reducing insulin resistance.

Factors that predict the likelihood of remission of type 2 diabetes are:

• Young (< 50 years old).

• Lose 10-15% of body weight.

• Early intervention (< 6 years) after diagnosis.

• Initial indicators such as low HbA1c and high C-peptide.

• Exercise at least 30 minutes/day and eat a low-calorie, low-carbohydrate, high-fiber diet

It is necessary to differentiate type 2 diabetes from:

• Temporary remission in type 1 diabetes - The "Honeymoon" phase: Type 1 diabetes typically appears fully after a few months.

• Good blood sugar control in patients with type 2 diabetes: HbA1C < 6.5% but still taking hypoglycemic drugs.

DR. NGUYEN QUANG BAY

Source: https://tuoitre.vn/lui-benh-hay-khoi-benh-dai-thao-duong-tuyp-2-ai-co-co-hoi-nay-20250924183524921.htm