Reverse type two diabetes, eliminate medication

A woman checks her blood sugar level. FILE PHOTO | NMG

What you need to know:

  • Experts note that the condition is rising due to a sedentary lifestyle and unhealthy diets, which predispose many Kenyans to obesity.
  • Despite their significance, the diabetes treatment journey is not a walk in the park and usually requires people to adjust in life.

Type two diabetes is among the leading contributors to non-communicable diseases in Kenya.

Experts note that the condition is rising due to a sedentary lifestyle and unhealthy diets, which predispose many Kenyans to obesity.

Among these individuals, fat accumulation in the stomach usually prevents insulin (the hormone that regulates body sugar) from working effectively, hence causing Type 2 diabetes.

The condition predisposes people to serious conditions like kidney failure, hypertension, vision loss, nerve damage and leg amputation.

To avert these complications, prompt diagnosis and treatment are required. Type two diabetes is usually managed through appropriate medication or insulin that is injected.

Despite their significance, the diabetes treatment journey is not a walk in the park and usually requires people to adjust in life.

This includes enduring the discomfort of injecting insulin daily and side effects such as weight gain, low blood sugar and anxiety or depression.

Tablets used to manage diabetes can also expose people to nausea, abdominal pain, bone fractures, congestive heart failures and cancer.

Even though the benefits of the treatments outweigh the risks, these challenges are a burden.

And if many were given a choice, they would love to get rid of the disease and go back to when their bodies could naturally regulate blood sugar levels.

“I usually tell people that they should try as much as possible to lead healthy lives that prevent type 2 diabetes because this is a condition that no one is born with. We mostly bring it to ourselves as a result of our lifestyles,” says 45-year-old Martin that has been battling the condition for three years now.

All hope is not lost for people like him. New research indicates that incorporating targeted weight-loss interventions into the treatment plan for type two diabetes patients can help reverse the disease.

A new study published in the Lancet Journal indicates that a weight loss of 15 percent should become a central focus of managing type two diabetes since it has the potential to slow the progress of the disease, reduce complications and reverse the condition.

The proposed strategy was presented at the recently concluded Annual Meeting of the European Association for the Study of Diabetes (EASD).

“We propose that for most patients with type 2 diabetes who do not have cardiovascular disease, the main treatment focus should be managing the key underlying abnormality and driver of the disease, which is obesity,” stated Dr Ildiko Lingvay, an author of the study from the University of Texas Southwestern Medical Centre.

He notes that the new approach would have added benefits of addressing not just high blood sugar but other obesity-related complications such as fatty liver, obstructive sleep apnoea, osteoarthritis, high blood pressure and elevated fat levels in the blood.

Blood sugar

“This will have a much greater impact on the person’s overall health than just managing blood sugar alone,” said Dr Lingvay.

“Treatment of obesity to achieve a sustained loss of 15 percent body weight has been shown to have a major impact on type 2 diabetes progression and even result in diabetes remission in some patients,” stated Dr Priya Sumithran, another author of the study from the University of Melbourne.

The new study drew its evidence from a research trial (known as DiRECT) that assessed the impact of an intensive lifestyle intervention among overweight or obese patients with the disease.

The results of this research trial showed that type 2 diabetes remission occurred — at two years — among 70 percent of the individuals who lost 15 kilos or more of their body weight. The average weight of these people before the intervention was 100 kilos.

Studies have also shown that weight-loss surgery also reduces the need for glucose-lowering drugs among diabetics within days of the surgery, thus improving multiple indicators of health in the long term.

Weight management

The new Lancet study also offers insights into various drug treatment options for weight management. Exercise and appropriate diets also come in handy but they require strict discipline.

According to the researchers, most patients (between 40 and 70 percent) have type 2 diabetes that is driven by increasing body fat.

Dr Lingvay notes that key features that identify such people are central adiposity (fat around the waist), increased waist circumference, multiple skin tags, high blood pressure and fatty liver disease.

“In this population, we propose a treatment goal of total weight loss of at least 15 percent, with the intention of not merely improving blood sugar control, but rather changing the course of the disease in the long term and preventing its associated complications.”

Based on the promising findings of the new study, the authors recommend the updating of treatment guidelines to include substantial, sustained weight loss as a primary treatment target for patients with type 2 diabetes.

“The time is right to consider the addition of substantial weight loss as a principal target for the treatment of many patients with type two diabetes.”

The researchers further note that health systems should focus on the upstream benefits of reducing obesity in preventing or controlling the disease, rather than the higher costs of treating advancing type 2 diabetes.

He notes that healthcare providers, especially those managing people with diabetes, should be trained and become experienced in all aspects of obesity management.

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