The concept of a reversal of diabetes has become very popular recently. Several commercial organisations have jumped on the bandwagon of a ‘reversal of diabetes’ and are making tall claims. Therefore, it is important to consider the pros and cons of a reversal of diabetes.
First, the term ‘reversal’ of diabetes is scientifically incorrect; the appropriate term is ‘remission’ of diabetes. Reversal implies that the condition has permanently reverted to normal and a cure has been achieved. ‘Remission’ implies that diabetes has only gone away temporarily. We know for instance that cancer can go into remission, but can come back in a more virulent form.
Remission and type 2 diabetes
Diabetes is not a single condition but consists of several types. When we talk of remission of diabetes, we are referring most often to type 2 diabetes. However, there are other forms of diabetes such as type 1 diabetes where long-term remission is very unlikely to occur.
Can everyone with type 2 achieve remission? Some diabetes reversal programmes claim that they can reverse type 2 diabetes at any stage of the disorder. This is not true.
There are certain individuals with type 2 diabetes who are more likely to achieve remission. This can be identified by the letters ABCDE. A refers to A1c (glycated haemoglobin) which should not be very high; B refers to Body Mass Index (BMI) or body weight. If it is high, you are more likely to achieve remission due to weight loss; C stands for C-Peptide, a measure of insulin secretion. If it is good, you can achieve remission more easily; D stands for Duration of diabetes; the shorter the duration, the greater the chances of remission; and E stands for an Enthusiastic individual who is keen to achieve remission.
One should remember that even if one achieves remission of diabetes only for a few months or years, it is still worthwhile because it leads to a good ‘legacy effect’ which provides protection from complications caused by diabetes.
What about those who cannot achieve remission? Should they be disheartened? Definitely not. Indeed, in my experience, the majority of people with type 2 diabetes would find it difficult to achieve long-term remission of their diabetes. Even among those who do so, in the majority of cases, diabetes returns after a few months; the severity of the diabetes is often much worse than when it was before the person went into remission.
Leading a long and healthy life
I would like to reassure people who do not achieve remission that nothing is lost. My experience over the last four to five decades has taught me that all that is needed to have a long and healthy life despite diabetes is to follow another set of ABCD-linked mantras: A: A1c or glycated haemoglobin should be below 7% (or if possible even below 6.5%); B: Blood Pressure should be less than 130/80 mm/Hg L or as appropriate for the age; C: Cholesterol (LDL cholesterol) should be less than 50 mg/dl or at least below 70mg/dL; D: Discipline which includes healthy diet, exercise and frequent check-ups with your diabetologist.
We were among the first to show that if ABCD is maintained, people with diabetes can live long and healthy lives. Indeed, 50 or 60-years of survival with diabetes and with no complications whatsoever, is possible.
The ultimate aim of the treatment of diabetes is to have a diabetes complications-free life. Today, diabetes remains sub-optimally controlled which is why it is the leading cause of blindness, amputation, heart attacks, stroke, kidney failure and impotence. Very often we find people in the prime of their life affected by one or more of these devastating complications which affects not only the individual but also his or her family. It can ultimately even impact the economy of the country.
Data on India
According to our recent Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study, there are currently 101 million people with diabetes and 136 million people with prediabetes in India. In those with prediabetes, preventing the majority of these individuals from developing diabetes for a considerable number of years is possible with just lifestyle modifications. In those who already have diabetes, we should, of course, try to achieve remission of diabetes. But if this is not possible, meeting the ABCD guidelines of the treatment of diabetes will ensure that they can all live a long and healthy life without any diabetes-linked complications.
Even though we may not be able to make India ‘diabetes free’, my dream is that we can at least have a ‘diabetes complications-free India’. On the occasion of World Diabetes Day (November 14), let us rededicate ourselves to achieve this dream.
Dr. V. Mohan is Chairman, Dr. Mohan’s Diabetes Specialities Centre and the Madras Diabetes Research Foundation, Chennai
