Type 2 Diabetes Remission with Significant Weight Loss: Definition and Evidence-Based Interventions

Abstract

Type 2 diabetes (T2D) has long been regarded as an incurable and chronic disease according to conventional management methods. Clinical and pathophysiological studies on the natural course of T2D have shown that blood glucose control worsens with an increase in the number of required anti-hyperglycemic agents, as β-cell function progressively declines over time. However, recent studies have shown remission of T2D after metabolic surgery, intensive lifestyle modification, or medications, raising the possibility that β-cell function may be preserved or the decline in β-cell function may even be reversible. The World Health Organization as well as the American Diabetes Association and the European Association for the Study of Diabetes recognize remission as an appropriate management aim. In the light of the state of evidence for T2D reversal, physicians need to be educated on treatment options to achieve T2D remission so that they can actively play a part in counseling patients who may wish to explore these approaches to their disease. This review will introduce each of these approaches, summarizing their beneficial effects, supporting evidence, degree of sustainability, and challenges to be addressed in the future.

Global research trends of diabetes remission: a bibliometric study

“…Various strategies have been proposed to realize diabetes remission, encompassing metabolic surgery, lifestyle intervention, insulin intensive therapy, and non-insulin hypoglycemic drugs ( 14 ). Metabolic surgery is the most efficacious, with a maximum remission rate of approximately 70%–80% at 1–2 years after surgery ( 97 , 98 ), followed by lifestyle interventions with caloric restriction, with a 40%–80% average remission rate at 1 year after intervention ( 95 ), and intensive insulin therapy, which can also provide remission in 30%–70% of patients with T2DM ( 66 , 99 ). However, the efficacy of oral hypoglycemic drugs as an intervention for diabetes remission understudied, with limited research indicating remission rates predominantly below 30% ( 14 , 100 ).…”

Initial Combination Therapy in Type 2 Diabetes

“…Glycemic control is a crucial component of diabetes management, as hyperglycemia is a significant risk factor for disease progression and vascular complications [ 2 , 3 ]. Although multiple clinical trials have demonstrated that intensive glycemic control reduces the risk of complications [ 4 - 6 ], it remains challenging to achieve long-term durable glycemic control in clinical practice [ 7 , 8 ]. This challenge stems from both the lack of fundamental therapies addressing progressive β-cell dysfunction and therapeutic inertia experienced by healthcare providers and patients [ 9 ].…”

Remission effect of Canagliflozin in patients with newly diagnosed type 2 diabetes mellitus: a protocol for a multicenter, parallel-group, randomized, controlled, open-label trial

“…Currently, three main methods are effective for remitting T2DM. Metabolic surgery is the most efficacious, with a maximum remission rate of approximately 70–80% at 1–2 years after surgery [ 3 , 4 ], followed by lifestyle interventions with caloric restriction, with a 40–80% average remission rate at 1 year after intervention [ 5 ], and intensive insulin therapy, which can also provide remission in 30–70% of patients with T2DM [ 6 , 7 ]. The most commonly used oral hypoglycemic agents for the treatment of T2DM have been understudied to date.…”