With approximately two out of ten Malaysians having type 2 diabetes mellitus, there is no reason that we should not worry about the rising diabetes incidence in the country. While we all know the drills of a diabetic treatment: take the antidiabetic pills, injecting insulin, restrict carbohydrate intake and lose weight; the treatment for diabetes is usually lifelong. One huge concern for the diabetic patients in Malaysia is the hefty treatment cost, which is estimated to be RM2,750/year. And we haven’t calculated the indirect loss as a result of diabetes treatment (days away from work, unpaid leaves etc.), which can amount to RM1,523.84 per year! So the question has to be asked: is it possible to reverse diabetes?
Remission -- yes; reversal? Nope.
The strongest scientific evidence we have to date suggests that it is possible to put diabetes into remission through weight loss. This is when your blood sugar levels (HbA1c level) are below the diabetes range (48mmol/mol or 6.5%) for six months*; and you don’t need to take diabetes medication anymore.
*This standard is based on the consensus of a team of international experts from here at Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes. The definition of diabetes remission may be slightly different depending on who you ask.
However, calling it ‘diabetes reversal’ is inaccurate because it implies that it’s permanent, which we don’t have enough scientific evidence telling us that such remission is long lasting. Simply put, it is possible to put diabetes into remission and stop taking medications anymore, but it can come back. This is why it is so important to continue your diabetes appointments with your doctor while in remission.
Diabetes remission is quite a new idea. A lot of research is needed before we fully understand it. But let’s not pretend that putting diabetes into remission is not a big deal -- it can bring life-changing benefits to your health and well-being!
Losing weight for type 2 diabetes mellitus
As mentioned, if you are obese/overweight and is diagnosed with type 2 diabetes mellitus, losing weight is one of the great things you can do to bring substantial impact to your diabetes treatment.
It is suggested that all obese or overweight patients with diabetes lose 5-10% of initial body weight over a 6-month period. This can be achieved by:
-
A reduced calorie diet that reduces daily energy by 500 - 1000 kcal. The goal is to achieve an initial weight loss of 0.5 - 1kg per week.
-
Physical activities of 30 minutes for five days or more, per week.
-
Meal replacements (MRPs) can be used as part of a comprehensive meal plan for weight loss and maintenance
-
A combination of the above
You are strongly encouraged to not shed your weight too drastically as it may harm your health. If you are not sure whether you are overweight or obese, calculate your BMI here. For many people living with obesity, aiming for a healthy BMI may not be realistic. Hence, waist size/circumference is also an important indicator for your health. A healthy waist size should be:
-
less than 80cm (31.5in) for all women
-
less than 90cm (35in) for South Asian men.
Take note that beside the aforementioned approaches, no other methods have been proven effective for losing weight safely, especially for diabetes patients. That’s why you should be cautious about any other products or treatment methods which are marketed as weight loss products.
If you do want to start losing weight quickly to work towards remission, it's important to talk to a healthcare professional before you begin, to make sure it’s right for you. Also, you may need to reduce or stop any medications – insulin or sulfonylurea, for example – before you begin losing weight. Your healthcare professional will advise you on that regard.
Benefits of losing extra weight as a type 2 diabetes patient
There are so many benefits of weight loss in type 2 diabetes patients. Even if you are unable to go into remission, losing weight can significantly improve your blood sugar control and significantly improve your life.
-
Improve your insulin resistance. Extra weight around your waist means fat can build up around your organs, like your liver and pancreas. (that’s why we mention that you should also strive for a healthy waist size!) These fats that wrap around your organs can reduce insulin resistance. Getting rid of these fats improves insulin resistance, which could help the insulin you produce or the insulin you inject work properly.
-
Lower the dose of your diabetes medications, or even getting rid of them (Of course, it’s under the scrutiny of your doctor)
-
Injecting less insulin
-
Possible to reduce the risks of diabetes complications, such as heart disease, nerve damage, blindness, leg amputation etc.
-
Improve your blood pressure and cholesterol levels, which are also linked to risks of heart diseases
Diet is not the only way you can lose weight as a diabetes patient. Some have had bariatric or weight-loss surgery done by certified surgeons. You can find more information about bariatric surgery in Malaysia here.
Can anyone with type 2 diabetes go into remission?
There’s lots we’re still trying to understand. For example, we don’t know how or whether every person with type 2 diabetes can go into remission. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. But, we know some people have put their diabetes into remission 25 years after being diagnosed. Diabetes UK is funding further research to try and find ways for more people to go into remission. For example, the ReTUNE study is looking at how people who don’t have obesity can put their diabetes into remission.
References:
-
Diabetes UK - Can you reverse type 2 diabetes? https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse
-
Diabetes UK - Diabetes remission. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission#remission%20research
-
Diabetes UK - https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/whats-your-healthy-weight/lose-weight
-
Academy of Medicine, Malaysia - CPG Management of Type 2 Diabetes Mellitus (5th edition)
-
National Institute of Diabetes and Digestive and Kidney Diseases - Achieving Type 2 Diabetes Remission through Weight Loss. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/achieving-type-2-diabetes-remission-through-weight-loss
