New Delhi: Once a diabetic, always a diabetic. Traditional thinking has always affirmed this notion, but scientific evidence over the years suggests that may not necessarily always be the case.
Research shows that in the initial years of the diagnosis, a person can “reverse” their Type 2 diabetes — a long-term medical condition in which your body doesn’t use insulin properly, resulting in unusual blood sugar levels.
Given India’s alarmingly expanding diabetes numbers — a 2023 study by the Indian Council of Medical Research (ICMR) and Madras Diabetes Research Foundation showed that the country had 101 million diabetics — this concept of “diabetes reversal” is an important, and popular, one.
As a result, a number of health-tech startups have latched onto the idea and offer programmes and services to achieve this. Some, though, seem a little far-fetched.
“The problem is that most platforms are not run by doctors but by people who are not qualified and, hence, in their attempt to make quick money they make all sorts of tall claims,” said Chennai-based diabetologist Dr V. Mohan, adding that sometimes the advertising by such platforms can be very enticing.
For instance, a few claim being able to reverse Type 1 diabetes (in which a body cannot produce insulin), or having cured Type 2 diabetes in nearly all their patients. Others entice patients by claiming that their programme will allow them to enjoy their favourite foods and go off diabetes medication completely within weeks.
What is important, said Dr Mohan, is that instead of going for short term measures that promise “diabetes reversal”, it is important to maintain a slow and steady regime to keep blood sugar levels under control.
ThePrint explains and busts myths related to diabetes “reversal”.
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What is diabetes reversal
Speaking to ThePrint, Dr Ambrish Mithal, chairman and head of endocrinology and diabetes at Max-Healthcare, a super-specialty hospital in Delhi, said, “First of all, it is not appropriate to call the process a ‘reversal’ of diabetes. This might sound like it’s permanent, but there may be no guarantee that your diabetes has gone forever.”
The clinical term, he added, that has been approved by the American Diabetes Association (ADA) is “diabetes remission”.
Even the World Health Organization (WHO) has acknowledged this possibility, stating that diabetes remission can be achieved through “weight loss and calorie restrictions”. In this context, explained Dr Chhavi Agarwal, associate consultant, diabetes and endocrinology, with Fortis Escorts Hospital, diabetes remission refers to achieving blood sugar levels within the non-diabetic range without the use of glycaemic control medications for an extended period.
“It is important to clarify that remission does not equate to a cure, as there is always a risk of diabetes recurrence,” she said.
Experts stress that the most important step in diabetes remission is weight loss, especially in the central body area, since fat there causes insulin resistance — the defining characteristic of type 2 diabetes. Also, bringing the overall body mass index (BMI) to below 23 is critical.
“The second pillar of diabetes reversal is improving muscle mass through aerobic activity and enhancing muscle fitness which decreases insulin resistance. Third, managing sleep and stress levels, so that the hormones perpetuating diabetes due to stress and poor sleep also get blunted,” said an endocrinologist with Delhi’s RML Hospital who wished to not be named.
Also, cautioned Dr Agarwal, while initial weight loss can lead to remission, often lasting up to two years, a substantial level of calorie restriction is also necessary to achieve this remission.
Additionally, individuals must maintain these changes to prevent recurrence. “While diabetes remission is possible, it requires significant and sustained lifestyle modifications or bariatric surgery,” the RML endocrinologist said.
For whom does it work
According to Dr V. Mohan, the concept of diabetes remission is dependent on a few factors. He calls them the “A, B, C, D, E mantra.”
‘A’ stands for A1C or HbA1C — the measure of the amount of blood glucose attached to haemoglobin. Those with an HbA1C value of 6.5 percent and beyond are considered diabetic. “It may be easier for patients with HbA1c value between 6.5-9 to reverse it to below the threshold level, but for others, it’s not easy,” he said
The ‘B’, he said, is for ‘body weight’, or BMI. “If your body weight is high, or if you are obese, you may respond to the reversal efforts that you make because you have got body mass to lose,” he said.
However, he added that there are also people who are lean or even underweight but diabetic. “In such cases, there is usually severe insulin deficiency and they will find it difficult to put their diabetes in remission.”
The ‘C’, he said, stands for ‘C-peptide’, an index of insulin secretion. “If your insulin deficiency is not very high, it means you just have a little bit of reduction of insulin level, then your C-peptide will be quite good and you are likely to achieve remission. If your C-peptide is very low, which means your insulin secretion is very low, then reversal will be very difficult because your beta cells (which secrete insulin to facilitate glucose uptake in glucose-recipient organs) are already damaged. So, the better the beta cell function, the better your C-peptide, greater the chances of remission,” Mohan told ThePrint.
The ‘D’ stands for ‘duration of diabetes’. The shorter the duration of diabetes — say, 6 or 8 years, or below 10 years — the easier it is to achieve remission. However, for those who have had diabetes for over a decade, their number of beta cells would have greatly diminished, making them bad candidates for remission. In such cases, he added, diabetes-related complications affecting the eyes, kidney, heart or feet, are likely.
“At that stage, keeping your life going, keeping your sugar under reasonable control and preventing complications is the ideal situation,” he said.
The ‘E’, stands for ‘enthusiasm’, or the level of a patient’ motivation. “Since the efforts for diet control, weight loss and maintaining an exercise regime demands great self-control, only 5 percent people stick to it,” he said.
Treading with caution
Tech-based platforms usually offer a personal coaching session with diabetes counselors and, in some cases, doctors who advise patients on specific diet and exercise regime. This, of course, comes at a cost.
While most of them make it amply clear the kind of patients the programme is likely to work for, others tend to be ambiguous to draw people in.
“I have seen these companies claiming that once you adopt their services, you can have food and sweets of your choice without worrying about blood sugar level, which is misleading,” said the RML Hospital endocrinologist.
The companies, however, insist that they maintain total transparency.
“There are three top groups of diabetes patients who take up our programme,” said Dr Arbinder Singal, co-founder and chief executive, Fitterfly, a health tech platform. “Those with newly diagnosed diabetes who do not want to start medication or have just started therapy, and the second group is those who have had diabetes for more than 10 years and are on multiple medications, but their blood sugar levels are still very high.”
For the second group, the Fitterfly programme acts as a complement to the medicines to help them achieve normal sugar levels. Some medications can be reduced, but complete reversal is difficult in such patients, said Singal.
The third group consists of individuals for whom all oral medications for diabetes have failed and doctors are considering starting insulin injections for control. This group can also benefit from the programme, Singal said.
Various other health tech startups, too, offer customised services to those struggling with insulin resistance and high Hb1AC. Some claim to reverse chronic diabetes too.
Most doctors, however, remain proponents of maintaining good habits.
“A large number of diabetics may never reverse their diabetes, but they are doing well. They do not have any complications as, at the end of the day, what matters is patients live a long and healthy life without any complications,” said Dr Mohan.
(Edited by Zinnia Ray Chaudhuri)
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Once a diabetic, always a diabetic. This so called traditional thinking comes from the modern medical community called “Allopathic community”. As per this, eye power, BP and many more are irreversible. But if practical approach is taken, these are not illness at all. These are just abnormalities surfaced due to unhealthy life style or ageing. If good natural life style is followed, such abnormalities should not appear. Once they appear, just like symptoms, one should maintain healthy life-style to stay normal. But the modern medical community will term you sick and prescribe medicines. They will also say about maintaining good life style, but they stress more on medicines.