Remission in Type 2 Diabetes Defined
Remission. It's a loaded term. It's held out there as the ideal goal for people with type 2 diabetes. But it can feel like a desert mirage. Even though you think you can see it, somehow, you can never quite get there.
Different meanings: reversal, cure, and remission
Until now, there hasn't been a single, clear, agreed-upon definition for remission. On top of that, "reversal" and "cure" have been used interchangeably with "remission," — adding confusion to the discussion. But with the publication of the Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes, this is expected to change.1
What is remission in type 2 diabetes?
In short, remission of type 2 diabetes happens when a person's glucose levels stay within the normal range for at least 3 months in a row without using any glucose-lowering medications. The normal range for glucose levels is defined as sustaining an A1c less than 6.5 percent. Glucose-lowering medications include metformin, sulphonylureas, and insulin.1
Remission is not the same as reversal. Reversal is a health process. Remission is a state of health.
Remission is not a cure
Since it's not clear how long remission can last, remission is not a cure. There's still a lot that we don't yet understand about what can lead to type 2 diabetes ending. A cure is an end-state that's not expected to change. A person considered in remission from type 2 diabetes still needs to monitor their glucose levels.1
How can type 2 diabetes remission be achieved?
3 new therapies for type 2 diabetes, in particular, have been identified as potentially leading to remission.
Lifestyle change programs
Lifestyle change programs, most notably the CDC-recognized National Diabetes Prevention Program (DPP), provide a structured, research-based program incorporating healthy eating and exercise into daily life.
While weight loss is a primary potential benefit of the program, participants can also achieve improved glucose management. For the effect of lifestyle change programs to be sustained, the individual must maintain new eating and exercise habits.2
Historically used to achieve weight loss, bariatric surgery can also lead a person to type 2 diabetes remission. This type of surgery changes the digestive system so that a part of it is restricted or bypassed altogether.
Bariatric surgery is a major surgery that requires significant changes in eating and health habits to be sustained for the long term and ongoing medical monitoring.3
GLP-1 receptor agonists, a class of drugs used to treat people with type 2 diabetes, in combination with healthy eating and exercise, can lead to weight loss and improved glucose levels.4
Why is remission being defined now?
In response to new therapies for type 2 diabetes and their sustained effects on glucose levels, an international consortium of medical organizations worked on an agreement to define what it means to achieve type 2 diabetes remission.
After years of debate and discussion, the American Diabetes Association (ADA), the Endocrine Society, the European Association for the Study of Diabetes (EASD), and Diabetes UK all agreed on defining and medically identifying remission in type 2 diabetes.1
In addition, their published consensus statement acknowledged that there's much left to learn about diabetes, its causes, and its mechanisms. They make it clear that the consensus statement doesn't isn't offered as a treatment guideline but rather as a definition to bring consistency to the medical treatment of type 2 diabetes.1
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