Diabetes

Is There a Cure for Diabetes? A Look at the Remission Potential for Each Type

Sheryl Huggins Salomon
Moira Lawler
By
and
Sandy Bassin, MD
by
 courtesy of American College of Lifestyle Medicine
glucose monitor sneakers arrows pills measuring take
Exercise, weight loss, and medication are three ways to help lower A1C and potentially put type 2 diabetes in remission.Canva; Everyday Health
If you or a loved one has been diagnosed with diabetes, you may be wondering if you have a chance of being cured.

 While there is no cure for any type of diabetes per se, you may be able to reverse course and return your blood sugar back to a healthy level. This is called remission.

Defining Diabetes Remission

Remission is defined by a hemoglobin A1C test of below 6.5 percent at least three months after stopping glucose-lowering medication.

 Note that this applies to people with type 2 diabetes, but not type 1. People with type 1 will need to take insulin throughout their lives.
A1C gauges how much glucose attached to the hemoglobin in your red blood cells, on average, over the previous three months, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

 Below 5.7 percent A1C is a normal result. Prediabetes is a reversible state in which insulin resistance has pushed your blood sugar between 5.7 and 6.4 percent. At 6.5 percent or above, you have diabetes.

Is Remission Possible for Me if I Have Diabetes?

Whether remission is possible depends on the type of diabetes you are living with and how far diabetes has progressed. Remission doesn’t mean giving up healthy habits, either. There’s always the possibility for relapse if you have ever been diagnosed with diabetes.

Read on for what medical experts and researchers say about the prospects of remission for the following forms of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.

Can Type 2 Diabetes Be Cured?

Can Type 2 Diabetes Be Cured?

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Type 2 Diabetes

Type 2 diabetes is by far the most common type of diabetes, accounting for over 90 percent of cases.

In the case of this type of diabetes, remission may be possible for some people by making diet and lifestyle changes. Weight loss, by way of diet and lifestyle changes or bariatric surgery, can also help.

Understanding the underlying cause of type 2 diabetes — insulin resistance — can help you understand how remission may be possible in some cases.

Insulin resistance happens when your blood glucose levels are too high because the cells in your muscles, fat, and liver have stopped responding well to insulin. Insulin is a hormone produced in the pancreas, and it helps convert glucose into energy.

 At first, the body produces more insulin to compensate, but eventually, it can’t keep up with the level of resistance.
Type 2 diabetes typically develops in people ages 45 and older, but it can happen at any age. A complex set of risk factors, including age, ethnicity, genetics, diet, and lifestyle are thought to be at play in those who develop the disease.

 It’s also strongly correlated with obesity — in fact, up to 90 percent of people worldwide who have type 2 diabetes are overweight or obese.

 (It’s important to note that the majority of overweight and obese individuals do not develop diabetes.)

Diet and Lifestyle Changes

While obesity and being overweight are caused by a complex set of factors on their own, taking steps to shed pounds if you’re not at an ideal weight may help your type 2 diabetes management.

Weight loss can improve insulin sensitivity.

 That in turn can lower your A1C.

 A study found that losing 10 percent of body weight may decrease A1C by 0.81 percent among people with type 2 diabetes.

“A lot of times, patients think it’s a futile effort, like whatever they do is not going to matter,” says Patricia Happel, DO, associate professor of family medicine at New York Institute of Technology College of Osteopathic Medicine in Old Westbury, New York. “What I try to do is empower them and educate them about what they can do to manage it, and hopefully, reverse it.”

Dr. Happel says that if your A1C is below 8, you may have a chance of returning to a normal blood sugar level, provided you make and maintain healthier eating, exercise, and lifestyle habits. As A1C increases, it’s harder to return to a normal blood sugar level without medical intervention.

Jordana Turkel, RD, CDCES, a nutritionist at Park Avenue Endocrinology and Nutrition in New York City, has also seen people go into remission from type 2 diabetes if they act early enough. But reaching remission doesn’t mean the diabetes won’t come back without continued vigilance, she says: “Even if their numbers are in check, frequent follow-up is important.”

Cutting calories is another avenue to explore for weight loss. One study looked at overweight and obese people with type 2 diabetes and showed high levels of remission among participants who lost a significant amount of weight through a low-calorie diet.

In addition, during the clinical trial, antidiabetic and antihypertensive medications were withdrawn from 149 participants with type 2 diabetes who were then placed on a diet consisting of between 825 and 853 calories daily for three to five months. Forty-six percent of participants achieved remission, meaning that their A1C was less than 6.5 percent. The results were even more dramatic in people who lost 33 pounds or more: 86 percent of them achieved remission.

That said, achieving remission this way doesn’t mean a person can let go of their healthy diet and lifestyle habits. As mentioned, diabetes may return. Glucose levels may increase with weight gain.

 One research review questioned whether sticking to a low-calorie or low-carb diet can be maintained long term. More research is needed to prove that.

Bariatric Surgery

The most effective method to achieve long-term remission for type 2 diabetes is bariatric, or weight loss, surgery.

 Research shows this is possible.

 One study included about 8,500 people with type 2 diabetes who had bariatric surgery in Sweden between 2007 and 2015. Two years after surgery, 76.6 percent of participants no longer took diabetes medication, and 58.2 percent of the individuals achieved remission.

The remission results may decrease over time. Another study, which was a follow-up to an observational, prospective study that focused solely on patients who’d had gastric bypass, found that among those who had type 2 diabetes before surgery, 75 percent were in remission after two years, 62 percent after six years, and 51 percent after 12 years.

Gestational Diabetes

In pregnancy, a woman normally develops a certain amount of insulin resistance to ensure that there is enough glucose available to provide energy for her growing baby. That develops into gestational diabetes in up to 14 percent of all pregnancies in the United States.

Diet and Lifestyle Changes, and Possibly Insulin

The condition is typically managed through diet and lifestyle changes, such as eating a healthy diet and exercising regularly. Oral medication or insulin may also be prescribed if a woman can’t regulate her blood sugar with diet and lifestyle changes alone.

You don’t want to lose weight because your body is helping the baby grow, but your doctor can help you set weight gain goals.

After Pregnancy

Fortunately, gestational diabetes usually reverses on its own after the child is born. But there’s a 30 to 70 percent chance of recurrence in subsequent pregnancies. Furthermore, half of all women with gestational diabetes will go on to develop type 2 diabetes later in life.

 “Sometimes the lifestyle stuff isn’t managed,” observes Happel, who recommends continuing with healthy eating and exercise habits even after the gestational diabetes has gone away.

Type 1 Diabetes

Type 1 diabetes is an autoimmune disorder that usually appears in childhood or early adulthood. It’s caused when the body’s immune system attacks and destroys the insulin-producing beta cells. Without insulin, the level of blood glucose climbs too high, which is known as hyperglycemia.

People who have type 1 diabetes must take injections to replace the insulin their body doesn’t make, as well as monitor and control their blood glucose level on a daily basis.

 “At present, there is nothing that a patient can do to prevent type 1 diabetes,” says Joshua Miller, MD, medical director of diabetes care at Stony Brook Medicine in New York, who also manages a personal diagnosis of type 1 diabetes. There’s no cure for type 1 diabetes.

 Nonetheless, there have been developments in donor cell transplantation, as well as artificial pancreas technology, that have shown some promise in the quest for helping these people achieve remission.
To understand some of these developments, it’s important to know what the pancreas’s islet cells (also known as islets of Langerhans) do. They make hormones that help the body break down glucose and use it for energy, including the beta cells that make insulin and allow your body to use or store glucose.

Islet Cell Transplantation

A growing field of treatment involves the transplantation of islet cells into a recipient with type 1 diabetes, in the hope that they will begin secreting the hormones that allow the independent regulation of blood sugar.

Among the most established of this type of procedure is pancreatic islet allotransplantation, in which the mature beta cells of a deceased donor are purified, processed, and transferred into a recipient.

 The islet cells begin to secrete insulin soon after transplantation, but insulin injections are usually needed until the donated cells are fully functional. After that, the recipient may need less insulin or may not need to take it at all.
Yet the same autoimmune response that attacked the recipient’s original islet cells can strike the donated ones. Additionally, as with most organ donations, the recipient must take immunosuppressive drugs to stop the body from rejecting the transplanted islet cells. These drugs come with significant side effects and can raise one’s risk of developing cancer and bacterial or viral infections.

Dr. Miller’s perspective is that despite limited successes, such procedures are “very expensive, fraught with complications and risk, and not at all ready for prime time in terms of widespread application.”

He is more optimistic about the potential for transplant procedures that use innovative, protective methods to tackle the problem of donor cell rejection. “What transplant scientists are working on is how to package beta cells in the body so that they remain viable in someone who receives them,” he explains.

For instance, Sernova is conducting a human clinical trial in the United States for a pouch that encapsulates donor islet cells to protect them; it is implanted under the skin, where it incorporates itself into the recipient’s living tissue and supports vein and tissue growth.

People with type 1 diabetes who have hypoglycemia unawareness (a potentially life-threatening condition in which they are unaware of the signs that their blood sugar has dropped too low)

 have been recruited to participate in the Sernova trial. This trial will include immunosuppressive therapy.

The company Vertex has similar therapies in development, including a pouch that uses implantable technology to protect and support transplanted pancreatic progenitor cells that are derived from embryonic stem cells. After the pouch is implanted into the recipient, the cells mature into islet cells that secrete insulin and regulate blood sugar levels.

 Preliminary data for one patient showed that this therapy helped reduce A1C levels by 0.5 percent, giving researchers hope that this therapy improves blood glucose control. But larger studies are needed to be sure.

Artificial Pancreas Devices

While artificial pancreas technology isn’t a key to putting type 1 diabetes in remission, Miller says these devices may hold the most promise for people with type 1 diabetes who wish to be free from insulin injections.

“My definition of a cure has very little to do with preventing or reversing autoimmunity, and it has very much to do with how do you use and leverage technology to mimic the normal pancreatic function,” he says. Artificial pancreas devices, also known as closed-loop insulin pump devices, employ insulin pumps, glucose sensors, and smart software to automate the delivery of the right amount of insulin at the right time for each individual.

The Medtronic 670G Hybrid Closed Loop System is approved by the FDA for commercial use in people as young as age 7 with type 1 diabetes. It measures glucose levels in the body every five minutes and automatically adjusts the delivery of insulin by either administering or withholding it. The Medtronic 670G includes a sensor that attaches to the body to measure glucose levels under the skin, an insulin pump that is strapped to the body, and an infusion patch that’s connected to the pump with a catheter to deliver insulin. While the device automatically adjusts basal insulin (background insulin) levels, it is not fully automated: Users need to manually select bolus insulin (insulin pegged to meals) doses to account for carbohydrate consumption at meals.

A small, 3.5-month before-and-after study of people with type 1 diabetes showed that the Medtronic 670G kept users within their target blood glucose range — 71 to 180 mg/dl (milligrams per deciliter) — 72 percent of the time, versus 67 percent during the baseline period when they controlled their own insulin doses.

Another closed-loop system, the Control-IQ System, was used in a 16-week trial that included 101 children ages 6 to 13 with type 1 diabetes. The system is for those with a Tandem pump, and the trial results found that the artificial pancreas system led to a 7 percent improvement in keeping blood sugar in range during the day and a 26 percent improvement at night.

 The device has received FDA approval for children as young as age 6.

This study was one of four research efforts by the NIDDK involving artificial pancreas systems, so more research is coming.

“I think that we are on the precipice of having widespread access to closed-loop technology that will allow patients to lead a normal life, preventing complications from diabetes,” says Miller.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Diabetes. Cleveland Clinic.
  2. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care.
  3. The A1C Test and Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases.
  4. Can Type 2 Diabetes Be Reversed? Joslin Diabetes Center.
  5. National Diabetes Statistics Report, 2020 [PDF]. Centers for Disease Control and Prevention.
  6. Insulin Resistance and Prediabetes. National Institute of Diabetes and Digestive and Kidney Diseases.
  7. Type 2 Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases.
  8. Type 2 Diabetes and Metabolic Surgery. American Society for Metabolic and Bariatric Surgery.
  9. Obesity Quadruples Diabetes Risk for Most U.S. Adults. Gallup.
  10. Insulin Resistance and Diabetes. Centers for Disease Control and Prevention.
  11. Understanding A1C. American Diabetes Association.
  12. Association Between Glycosylated Hemoglobin and Intentional Weight Loss in Overweight and Obese Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study. The Diabetes Educator.
  13. Primary Care-Led Weight Management for Remission of Type 2 Diabetes (DiRECT): An Open-Label Cluster-Randomised Trial. The Lancet.
  14. Achieving Type 2 Diabetes Remission Through Weight Loss. National Institute of Diabetes and Digestive and Kidney Diseases.
  15. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients.
  16. Insulin, Medicines, and Other Diabetes Treatments. National Institute of Diabetes and Digestive and Kidney Diseases.
  17. Duration of Type 2 Diabetes and Remission Rates After Bariatric Surgery in Sweden 2007–2015: A Registry-Based Cohort Study. PLoS Medicine.
  18. Weight and Metabolic Outcomes 12 Years After Gastric Bypass. The New England Journal of Medicine.
  19. Gestational Diabetes. MedlinePlus.
  20. Gestational Diabetes: Diagnosis and Treatment. Mayo Clinic.
  21. Type 1 Diabetes. Cleveland Clinic.
  22. Type 1 Diabetes: Diagnosis and Treatment. Mayo Clinic.
  23. Diabetes 101. JDRF.
  24. Pancreatic Islet Transplantation. National Institute of Diabetes and Digestive and Kidney Diseases.
  25. A Safety, Tolerability, and Efficacy Study of Sernova’s Cell Pouch for Clinical Islet Transplantation. ClinicalTrials.gov.
  26. Hypoglycemia (Low Blood Glucose). American Diabetes Association.
  27. Vertex Doses First Patient in Phase 1/2 Trial of VX-264 in Type 1 Diabetes. CGT Live.
  28. 196-LB: Stem Cell–Derived Islet Replacement Therapy (VC-02) Demonstrates Production of C-Peptide in Patients With Type 1 Diabetes (T1D) and Hypoglycemia Unawareness. Diabetes.
  29. What Is the Pancreas? What Is an Artificial Pancreas Device System? U.S. Food and Drug Administration.
  30. FDA Approves Automated Insulin Delivery and Monitoring System for Use in Younger Pediatric Patients. U.S. Food and Drug Administration.
  31. Safety of a Hybrid Closed-Loop Insulin Delivery System in Patients With Type 1 Diabetes. JAMA.
  32. A Randomized Trial of Closed-Loop Control in Children With Type 1 Diabetes. The New England Journal of Medicine.
  33. Artificial Pancreas Effectively Controls Type 1 Diabetes in Children Age 6 and Up. National Institutes of Health.

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