Is Type 2 Diabetes Reversible?
Paris Roach, MD, responds:
When it comes to medical conditions, the terms “reversible” and “curable” mean that everything returns to normal after treatment has been discontinued.
What To Know
High blood glucose caused by specific medical problems (such as elevations in certain hormone levels) or medications (including steroids such as prednisone) often returns to normal when the medical problem is treated or the medication is discontinued. Type 1 diabetes is not yet reversible or curable, but this is the focus of intensive research, most of which is aimed at convincing the immune system to stop attacking beta cells very early in the disease process. The answer to whether typical type 2 diabetes is reversible is more complicated and largely depends on how you define “reversible.”
When type 2 diabetes is mild, blood glucose can return to normal, nondiabetic levels through lifestyle changes—namely, eating fewer calories and exercising regularly. The primary goal is weight loss, which can lessen insulin resistance.
If you consider lifestyle changes a treatment, then diabetes isn’t reversible; when the treatment ends and body weight increases, the diabetes will return. That’s why diabetes that is managed with lifestyle changes alone is referred to as “diet-controlled” or “lifestyle-controlled” diabetes. It’s a reminder to people with diabetes and their care providers that diabetes, while controlled, is still present and that high blood glucose will return if lifestyle changes and weight loss are not maintained. The earlier in the course of type 2 diabetes that people make lifestyle changes, the higher the chance they’ll be able to control blood glucose without medication.
Blood glucose levels in type 2 diabetes often return to normal very soon after weight-loss surgery (bariatric surgery). This is likely a result of changes in certain hormones produced by the intestine in addition to the decrease in food intake and the weight loss that occurs after the surgery. But similar to what is seen when lifestyle changes fall by the wayside, diabetes can recur if weight is regained after bariatric surgery. Therefore, the term “remission” is applied to type 2 diabetes that is controlled without medications following bariatric surgery, a reminder that diabetes can come back if weight is regained.
Type 2 diabetes can be controlled without medications in many cases, but because it can recur, the terms “reversible” and “cured” are not used once the diagnosis of type 2 diabetes has been made.