Although the use of very low-carbohydrate diets for diabetes reversal shows promising results, the lack of longer-term follow-up studies remains a limitation. Follow up is limited to two years, and therefore longer-term studies are needed to determine the sustainability of the metabolic improvements. Determining the appropriate method of support may be a key to the overall success with disease reversal.
Additional evidence has become available in recent years suggesting that diabetes reversal is a possible alternative to consider in place of traditional diabetes treatment and management.
In this paper, we provide a review of three methods that have been shown to successfully reverse type 2 diabetes. The current body of evidence suggests that bariatric surgery is the most effective method for overall efficacy and prolonged remission, even though concerns associated with surgical complications, treatment cost and complete lifestyle modification after surgery remain challenges for wide adoption of this approach.
While both the LCD and LC dietary approaches are convincing for reversing diabetes in the short term up to two years , long term maintenance of diabetes remission is still unproven. There are limited available data supporting long term maintenance of weight loss and its associated glycemic improvements in response to LCD; similarly, long-term adherence to a low carbohydrate diet will likely remain an obstacle without the development of proper patient education and optimal support for long-term behavioral change.
Moreover, research in understanding the mechanism of diabetes reversibility in all three approaches and its overlapping mechanistic pathways are lacking; this is an area for future research emphasis. There are similar identified negative predictors of remission for all three approaches.
These factors include longer diabetes duration and increased severity, lower BMI, advanced age, poor glycemic control, and low C-peptide levels indicating decreased endogenous insulin production [ ]. Further exploration into the heterogeneity of these factors will help personalize the approach, determine realistic goals for each patient, and should be considered during treatment discussions. Ongoing research into algorithm development will be helpful in this regard.
Overall, as a society we can no longer afford or tolerate the continued rising rates of diabetes. Despite many barriers within the healthcare system as a whole, providers are responsible on a daily basis for the lives of patients caught up in this unprecedented epidemic. The current standard of care may be suitable for some, but others would surely choose reversal if they understood there was a choice.
The choice can only be offered if providers are not only aware that reversal is possible but have the education needed to review these options in a patient-centric discussion. Conceptualization, S. Investigation, S. Writing—original draft, S. Writing—review and editing, S. All authors approved of the final manuscript. National Center for Biotechnology Information , U.
Journal List Nutrients v. Published online Apr 1. Author information Article notes Copyright and License information Disclaimer. Received Feb 27; Accepted Mar This article has been cited by other articles in PMC. Abstract Background: Type 2 diabetes T2D has long been identified as an incurable chronic disease based on traditional means of treatment. Keywords: diabetes, diabetes reversal, bariatric surgery, very-low-calorie, low-carbohydrate. Introduction According to International Diabetes Federation IDF statistics, there are approximately million people with diabetes worldwide [ 1 ].
Results and Discussion 3. Bariatric Surgery Bariatric surgery has long been recognized as a potential treatment for both morbid obesity and the metabolic processes that accompany it, specifically T2D.
Open in a separate window. Figure 1. Low-Calorie Diets LCD As diabetes rates have risen to unprecedented levels [ 1 , 2 ], the number of studies examining diabetes reversal using non-surgical techniques has increased. Carbohydrate-Restricted Diets LC Before the discovery of insulin in , low carbohydrate LC diets were the most frequently prescribed treatment for diabetes [ 69 , 70 ]. Summary Additional evidence has become available in recent years suggesting that diabetes reversal is a possible alternative to consider in place of traditional diabetes treatment and management.
Conclusions Overall, as a society we can no longer afford or tolerate the continued rising rates of diabetes. Author Contributions Conceptualization, S. Conflicts of Interest S. References 1. IDF Diabetes Atlas. International Diabetes Federation; Brussels, Belgium: International Diabetes Federation.
Home P. Insulin therapy in people with Type 2 diabetes: Opportunities and challenges. Diabetes Care. Davies M. Management of hyperglycemia in Type 2 diabetes, Ramos-Levi A. Which criteria should be used to define type 2 diabetes remission after bariatric surgery. BMC Surgery. Xiang A. Diabetes Prevention Program Research Group Long-term effects of metformin on diabetes prevention: Identification of subgroups that benefited most in the diabetes prevention program and diabetes prevention outcomes study.
Buse J. How do we define cure of diabetes? Karter A. Steven S. Reversal of Type 2 diabetes after bariatric surgery is determined by the degree of achieved weight loss in both short- and long-duration diabetes. Diabet Med. Rubino F. Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by International Diabetes Organizations.
Anhe F. Medina D. Distinct patterns in the gut microbiota after surgical or medical therapy in obese patients. Magouliotis D. Murphy R. Kaska L. Improved glucose metabolism following bariatric surgery is associated with increased circulating bile acid concentrations and remodeling of the gut microbiome.
World J. Penney N. The role of bile acids in reducing the metabolic complications of obesity after bariatric surgery: a systematic review. Sweeney T. The human gut microbiome: A review of the effect of obesity and surgically induced weight loss. JAMA Surg. Potential of surgery for curing type 2 diabetes mellitus. Cohen R. Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index. Federico A. In Vivo. Peat C.
Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature. Best Pract. Gastrointestinal Complications after Bariatric Surgery. Metabolic surgery to treat type 2 diabetes: Clinical outcome and mechanisms of action.
Abraham A. Trends in bariatric surgery: Procedure selection, revisional surgeries, and readmissions. Tack J. Complications of bariatric surgery: Dumping syndrome, reflux and vitamin deficiencies. Best Prac. Eisenbarg D. ASMBS position statement on postprandial hyperinsulinemic hypoglycemia after bariatric surgery. Pories W. The surgical treatment of type two diabetes mellitus. Surg Clin. Purnell J. Salminen P. Effect of laparoscopic sleeve gastrectomy vs.
Schauer P. Bariatric surgery versus medical therapy in obese patients with diabetes. Their diabetes is in remission. Diabetes Canada does not have a guideline about remission. The American Diabetes Association uses the following definitions: footnote 1. Remission is most likely in the early stage of diabetes or after a big weight loss.
It can also happen after bariatric surgery for weight loss, which can trigger healthy changes in the body's insulin system. Remission is less likely in the later stages of diabetes, because the body may slowly lose its ability to make insulin over time. Whether your diabetes is under control or in remission, the keys to keeping high blood sugar down are weight control, exercise, and a diabetes-healthy diet. There's no way to know in advance if your body can "reverse" your diabetes.
It happens for some people and not for others, despite the same diet, exercise, weight loss, or even bariatric surgery. Experts don't fully understand why. Your goal is to do whatever it takes to keep your blood sugar in your target range. You may go into remission, or you may not.
Keep these guidelines in mind. Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
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