From the Guidelines
Diabetes reversal is possible for many people with type 2 diabetes through lifestyle modifications and medication, with the most effective approach combining weight loss, regular physical activity, and dietary changes, as supported by the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases 1. The key to diabetes reversal lies in a multifaceted approach that includes:
- Weight loss of at least 5% of body weight, with even modest weight loss delaying progression from pre-diabetes to type 2 diabetes, as shown in a meta-analysis of 63 studies 1
- Regular physical activity, such as moderate-to-vigorous exercise for more than 150 minutes per week, which improves insulin sensitivity and reduces the risk of cardiovascular complications 1
- Dietary changes, including a Mediterranean diet supplemented with olive oil and/or nuts, which reduces the incidence of major cardiovascular events 1
- Medication, such as metformin, which remains the first-line treatment for type 2 diabetes and supports reversal efforts by reducing glucose production in the liver 1 Some newer medications, like GLP-1 receptor agonists, can also significantly aid weight loss and improve glucose control, and may be considered as part of a comprehensive treatment plan 1. Regular blood glucose monitoring is essential to track progress, with targets generally below 140 mg/dL after meals and fasting levels below 100 mg/dL, and reversal is considered when blood sugar levels return to normal without medication, though ongoing lifestyle maintenance is required to prevent relapse 1. The benefits of lifestyle modifications and medication are supported by studies such as the Diabetes Prevention Program and the Da Qing Diabetes Prevention Study, which have shown that lifestyle intervention can significantly reduce the development of type 2 diabetes and its vascular complications 1. Overall, a comprehensive approach that combines lifestyle modifications and medication can help many people with type 2 diabetes achieve reversal and improve their quality of life, as supported by the highest quality and most recent evidence 1.
From the Research
Diabetes Reversal Methods
- Bariatric surgery, low-calorie diets (LCD), and carbohydrate restriction (LC) are methods that have shown evidence of achieving type 2 diabetes (T2D) reversal 2
- Lifestyle interventions, including diet-only interventions and diet combined with physical activity interventions, have been found to be effective for achieving diabetes remission, reducing weight, and improving quality of life in patients with T2D 3
- GLP-1 receptor agonists have been found to have a significant effect on blood glucose and weight control in patients with T2D, and are recommended as the preferred first injectable glucose-lowering therapy for T2D 4
Importance of Lifestyle Modifications
- Lifestyle modifications, such as diet and physical activity, play a crucial role in the management of T2D and can help achieve better management of the disease 5
- Weight loss should be the primary goal of treatment for people newly diagnosed with T2D, and nurses have an important role in supporting this 6
- Significant weight loss (>10% of body weight) and duration of the condition (<10 years) are factors that can increase the likelihood of achieving remission of T2D 6
Role of Healthcare Providers
- Healthcare providers need to be educated on T2D reversal options so they can actively engage in counseling patients who may desire this approach to their disease 2
- Nurses have an important role in supporting patients with T2D to achieve and sustain weight loss, which can help achieve remission of the disease 6