Gerald Bernstein, MD
Gerald Bernstein, MD, internist and endocrinologist, program director, Friedman Diabetes Program, Lenox Hill Hospital, New York City.
I’ve had type 2 diabetes for a few years. Is there anything I can do to reverse or “cure” the disease?
Diabetes is a hard train to stop—but yes, it’s possible. As many as half the people in the US (and probably the world) are genetically predisposed to develop type 2 diabetes. But you don't have to be a victim of your genes. Many studies have shown that if you’re overweight or obese, losing weight—even as little as 5% of your body weight—improves your insulin sensitivity and helps keep your blood sugar under control. Some experimental studies have reported even more dramatic results—closer to the reversal you're hoping for. Example: In one recent British clinical trial, people with type 2 diabetes followed a very strict diet for two months. They drank special milkshakes three times a day and ate only low-carb veggies and no-calorie beverages to keep daily calories under 700. The average weight loss was about 30 pounds. Nearly half of them had a remission of their disease—meaning, no more diabetes at that time. In this study, remission lasted even after participants had switched to a normal, healthy diet for the remaining six months of the study. In fact, three of those who went into remission had had diabetes for more than eight years. Those who maintained their weight loss were most likely to also have maintained their remission. It's a short-term study, but it shows what may be possible. A recent Canadian study also reported that type 2 diabetes could be reversed for many patients. In that study, 83 patients were counseled with a personalized exercise program and a meal plan that helped them cut 500 calories to 700 calories a day from their diets—and they took medications (including insulin) to bring their blood sugar levels close to normal. One group did this for two months, another for four months. A third control group got normal diabetes care. At the end of the program, the patients in both intervention groups stopped taking all medications. About two-thirds (63%) in the 16-week program lost more than 5% of their body weight. That weight loss, combined with "tight" blood sugar control, was effective for many—41% of those in the four-month program still had normal or near-normal blood sugar levels (aka, they were in remission) compared to only 14% for the control group. It's a pilot program that opens the door for more research. (Note: Stopping or changing your diabetes medications should only be done in consultation with your doctor.) Another approach is bariatric surgery. Obese people with diabetes who undergo this weight-loss operation, which shrinks the stomach and slows digestion, frequently find that their disease goes into remission—sometimes even before they lose much weight. So, yes, it is possible. But even if you can't send your diabetes entirely into remission, you can dramatically reduce your risk for complications by controlling your blood sugar levels through lifestyle, medication or both. The main stressors that drive diabetes are obesity, inactivity and age. While you can't avoid getting older (the alternative, as is often quipped, is not good!), you can do something about your weight and your level of physical activity—which will go a long way toward preventing or at least delaying the progression of the disease. Aerobic exercise helps your body use insulin better. The American Diabetes Association recommends 30 minutes of moderate-to-vigorous aerobic exercise—which it describes as exercising hard enough to be able to talk but not sing—at least five days a week. Strength training is important, too. The bottom line is that even if you don't reverse your diabetes, these healthy lifestyle changes can help you avoid the many complications of the disease. And if you are successful and can go off diabetes medications—congratulations! You’ll want to keep up that good work for the rest of your long, healthier life!
