Can Type 2 Diabetes be cured?

Can Type 2 Diabetes Be Cured?

Type 2 diabetes cannot be completely cured, but it can be put into remission through significant weight loss achieved via metabolic surgery, intensive lifestyle modifications, or certain medications that promote substantial weight reduction. 1, 2, 3

Remission vs. Cure

While a true "cure" for type 2 diabetes does not exist, remission (defined as normalization of blood glucose levels without diabetes medications) is possible for some patients through several approaches:

Metabolic Surgery

• Metabolic surgery should be recommended for appropriate surgical candidates with:
  • BMI ≥40 kg/m² (≥37.5 kg/m² in Asian Americans), regardless of glycemic control
  • BMI 35.0-39.9 kg/m² (27.5-32.4 kg/m² in Asian Americans) with inadequately controlled hyperglycemia despite lifestyle and optimal medical therapy
  • Consider for BMI 30.0-34.9 kg/m² (27.5-32.4 kg/m² in Asian Americans) with inadequately controlled hyperglycemia despite optimal medical control 4

Intensive Lifestyle Interventions

• Comprehensive lifestyle modifications can lead to significant improvements and potential remission:
  • Weight loss of 7-10% of body weight
  • At least 150 minutes per week of moderate-intensity aerobic activity
  • Healthy eating patterns with nutrient-dense foods and reduced calorie-dense, nutrient-poor foods
  • Reduced sedentary behavior 1

Pharmacologic Approaches

• High-potency GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists can result in weight loss >5% in most individuals, sometimes exceeding 10%, which may contribute to remission in some patients 2
• These medications should be considered alongside lifestyle modifications for patients with BMI ≥27 kg/m² 4

Ongoing Management

Even during remission, type 2 diabetes requires ongoing monitoring and management:

• Regular HbA1c monitoring (every 3-6 months)
• Continued lifestyle modifications
• Screening for complications
• Prompt reintroduction of therapy if hyperglycemia returns 1

Pathophysiological Considerations

Type 2 diabetes involves progressive loss of insulin secretion from pancreatic β-cells in the setting of insulin resistance 2, 3. This progressive nature means that:

• Early intervention is critical for the best chance of remission
• The underlying pathophysiological abnormalities may persist even during clinical remission
• Without continued management, hyperglycemia typically returns over time

Key Caveats

1. Weight regain risk: Following very-low-calorie diets, weight regain is common unless a comprehensive weight loss maintenance program is provided 4

2. Medication discontinuation: If weight loss medications produce <5% weight loss after 3 months or cause safety/tolerability issues, they should be discontinued and alternatives considered 4

3. Specialized care: Metabolic surgery should be performed in high-volume centers with multidisciplinary teams experienced in diabetes management and gastrointestinal surgery 4

4. Long-term monitoring: Even after achieving remission, patients require ongoing monitoring for recurrence of hyperglycemia and development of complications

While type 2 diabetes cannot be permanently cured, the focus on achieving remission through weight management, lifestyle changes, and appropriate medical or surgical interventions offers patients the possibility of living without medications and with normalized blood glucose levels for extended periods.