Type 2 diabetes reversible
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Reversibility of Type 2 Diabetes: Current Evidence and Mechanisms
Introduction to Type 2 Diabetes Reversal
Type 2 diabetes (T2D) has traditionally been viewed as a chronic, progressive disease. However, recent research suggests that T2D can be reversed through various interventions, including bariatric surgery, low-calorie diets (LCD), and carbohydrate restriction (LC) 1. This article synthesizes the current evidence on the reversibility of T2D and the underlying mechanisms.
Bariatric Surgery and Type 2 Diabetes Reversal
Bariatric surgery has been shown to be an effective method for reversing T2D. This surgical intervention leads to significant weight loss, which in turn reduces fat accumulation in the liver and pancreas, improving insulin sensitivity and beta-cell function 14. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have recognized bariatric surgery as a treatment option for T2D since 2016 1.
Low-Calorie Diets (LCD) and Carbohydrate Restriction (LC)
Low-calorie diets and carbohydrate restriction are also effective in reversing T2D. These dietary interventions lead to substantial weight loss, which reduces fat in the liver and pancreas, normalizing insulin sensitivity and beta-cell function 137. The Diabetes Remission Clinical Trial (DiRECT) demonstrated that 46% of participants achieved remission at 12 months, and 36% maintained remission at 24 months through weight loss 3.
Mechanisms of Reversal: Fat Reduction in Liver and Pancreas
Excess fat in the liver and pancreas is a primary cause of insulin resistance and beta-cell dysfunction in T2D. Substantial weight loss through dietary interventions or bariatric surgery reduces this fat, restoring normal insulin sensitivity and beta-cell function 347. Within a week of starting a low-calorie diet, fasting plasma glucose levels can normalize, and over eight weeks, insulin secretion rates improve significantly 47.
Beta-Cell Function and Insulin Sensitivity
Beta-cell dysfunction in T2D is often reversible, especially in the early stages of the disease. Weight loss can restore first-phase insulin secretion and reduce intrapancreatic triglyceride content, leading to improved beta-cell function 26. However, in cases where T2D has persisted for more than ten years, these cellular changes may become irreversible 2.
Emerging Therapeutic Targets
Recent studies have identified new molecular targets that could potentially reverse beta-cell failure. For instance, inhibiting the transcription factor BACH2 has been shown to restore normal beta-cell function and insulin secretion in diabetic models 9. These findings open new avenues for pharmacological interventions aimed at reversing T2D.
Conclusion
The evidence strongly supports the notion that T2D is a reversible condition, particularly through significant weight loss achieved via bariatric surgery, low-calorie diets, and carbohydrate restriction. These interventions reduce fat in the liver and pancreas, restoring insulin sensitivity and beta-cell function. Early intervention is crucial, as the reversibility of beta-cell dysfunction diminishes with the duration of the disease. Emerging research on molecular targets like BACH2 offers promising new strategies for reversing T2D. Healthcare providers should be informed about these options to better counsel patients seeking to reverse their condition.
Sources and full results
Most relevant research papers on this topic
Reversing Type 2 Diabetes: A Narrative Review of the Evidence
Type 2 diabetes reversal is achievable using bariatric surgery, low-calorie diets, or carbohydrate restriction, and healthcare providers should be educated on these options to counsel patients.
Systematic Review
Very Rigorous Journal
Highly CitedType 2 Diabetes: The Pathologic Basis of Reversible β-Cell Dysfunction
Early type 2 diabetes is a reversible -cell response to chronic positive calorie balance, with weight loss restoring insulin secretion and triglyceride levels.
Very Rigorous JournalHighly CitedUnderstanding the mechanisms of reversal of type 2 diabetes.
Weight loss can reverse type 2 diabetes by reducing excess fat accumulation in the liver and pancreas, leading to normal blood glucose levels and remission in 46% of individuals after 12 months and 36% after 24 months.
Highly CitedType 2 Diabetes
Type 2 diabetes can be halted with restoration of normal carbohydrate and fat metabolism, making it a potentially reversible metabolic state caused by chronic excess intraorgan fat.
Very Rigorous JournalHighly CitedPutting insulin resistance into context by dietary reversal of type 2 diabetes
Type 2 diabetes can be reversed by dietary changes, revealing that insulin resistance and pancreatic islet beta cell loss are not the sole causes of the condition.
Population response to information on reversibility of Type 2 diabetes
Public interest in reversing Type 2 diabetes using a very low energy diet led to a website with general information and personal experiences from motivated individuals.
Rigorous JournalReversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol
Dietary energy restriction can reverse beta cell dysfunction and insulin resistance in type 2 diabetes, with normalized blood sugar levels and decreased pancreatic and liver triacylglycerol.
Non-RCTRigorous JournalHighly CitedEmerging Targets in Type 2 Diabetes and Diabetic Complications
Novel targets in type 2 diabetes may lead to novel therapies for treating or preventing the disorder and its complications.
Highly CitedBACH2 inhibition reverses β cell failure in type 2 diabetes models.
BACH2 inhibition can reverse type 2 diabetes-specific cell failure, restoring insulin secretion and lowering glycemia in diabetic mice and human islets.
Non-RCT
Animal StudyRigorous JournalInduction of Long-Term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients by Transient Intensive Insulin Treatment
Short-term intensive insulin treatment can effectively establish responsiveness in newly diagnosed type 2 diabetic patients, allowing long-term glycemic control without medication.
Non-RCTHighly Cited