Type 2 Diabetes Remission
When you hear the word, “remission”, what do you think of? I think of something moving back, like waves on a shore retreating back into the ocean. It turns out this may be a very helpful analogy in thinking of what is meant by type 2 diabetes remission.
When someone is diagnosed with type 2 diabetes, it is commonly accepted and treated as a diagnosis of persistence, meaning once you have it, you will always have it. But with the advancements in medicines for diabetes, metabolic surgeries for weight loss, and better understanding of how impactful lifestyle modifications are, the medical community recognizes that high blood sugars can improve significantly down to normal or near-normal levels and the need for medicines declines and even becomes obsolete. Just a couple of days ago, published online in the American Diabetes Association’s premier medical journal, Diabetes Care, an international expert panel set forth an updated definition for ‘diabetes remission’ and how to follow individuals who achieve remission.
One detail I found interesting and important was the consideration they put into the other terms that we have also heard used to signify normalization of blood sugars off diabetes medicines; words such as: resolution, reversal, and cure. Their decision to use the word ‘remission’ was very intentional, as it was important for them to highlight the fact that even when blood sugars normalized off medicines, continued monitoring of the person’s blood sugars in one form or another remains an important part of follow-up as risk of resurgence of high blood sugars remains.
So what is the definition?
Diabetes remission: A hemoglobin A1C of <6.5% and remaining there for at least three months off any medicines for diabetes. I see this as the diabetes wave having retreated back into a calm, still ocean.
Once it has been established that a person is in remission, celebrate!! Yes, this is wonderful! And revel in your success by realizing how you and your medical team worked to get there. It was likely either medicines, metabolic surgery, significant lifestyle changes, or a combination of the three.
But will it come back (a.k.a. relapse)?
Well, that is a possibility. In the months and years that follow, it is important to continue working with your medical team to test your A1C to confirm continued remission. To continue with our maritime analogy, we want to prevent the ocean from becoming turbulent and prompting the diabetes wave from crashing back to shore. So, here are some ways to try to prevent the recurrence of type 2 diabetes:
1) Maintain an intentionally healthy approach to nutrition and physical activity.
- Studies have shown that healthy lifestyle changes beat out medicines in preventing diabetes.
2) Avoid medicines that are notorious for causing weight gain and raising blood sugars
- Steroids
- Certain antipsychotic medications
Also, you should continue to get your usual screening for potential eye, kidney, and foot complications, even when diabetes is in remission.
So once type 2 diabetes remission is achieved, the goal is to keep the ocean calm and at low tide and prevent the return of a choppy ocean with waves crashing in at high tide. Diabetes remission, ahoy!
