New Study Focuses on Type 2 Diabetes Treatment

Type 2 diabetes can be reversed with intensive medical treatment using oral medications, insulin and lifestyle therapies, according to a new study.

The research has been published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Individuals with type 2 diabetes often need to use a healthy diet, exercise and an increasingly complex combination of medications to manage the condition.

“By using a combination of oral medications, insulin and lifestyle therapies to treat patients intensively for two to four months, we found that up to 40 percent of participants were able to stay in remission three months after stopping diabetes medications,” Natalia McInnes MD, MSc, FRCPC, one of the study’s main authors asserted.

McInnes is resident at the McMaster University and Hamilton Health Sciences, in Hamilton, Ontario, Canada.

“The findings support the notion that type 2 diabetes can be reversed, at least in the short term–not only with bariatric surgery, but with medical approaches,” McInnes concluded.

One in 10 American adults has type 2 diabetes, according to the Society’s Endocrine Facts and Figures report.

To study ways to put type 2 diabetes into remission, the researchers randomly divided 83 individuals with the condition into three study groups.

Two of the groups received an intensive metabolic intervention where they were provided with a personalised exercise plan and a suggested meal plan that reduced their daily calorie intake by 500 to 750 calories a day.

These study participants met regularly with a nurse and dietitian to track their progress and received oral medications and insulin at bedtime to tightly manage their blood glucose levels. One group underwent the intervention for eight weeks, while the other was treated intensively for 16 weeks.

After the intervention, individuals in both groups stopped taking diabetes medications and were encouraged to continue with lifestyle changes.

The two intervention groups were compared to a control group of individuals with type 2 diabetes.

Participants in this group received standard blood sugar management advice from their usual healthcare provider for the duration of the trial, and they received standard lifestyle advice.

And participants in all three groups received usual diabetes care if they experienced a diabetes relapse.

Study participants had their average blood glucose levels from the past two to three months measured using a HbA1C blood test at eight, 20, 28 and 52 weeks to gauge how well their blood sugar was controlled.

Three months after the intervention was completed, 11 out of 27 individuals in the 16-week intervention group met HbA1C criteria for complete or partial diabetes remission, compared to four out of 28 individuals in the control group.

Three months after finishing the eight-week intervention, six out of 28 individuals in that group met the same criteria for complete or partial diabetes remission.

“The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for any signs of relapse,” the aforementioned McInnes commented. “The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes and to achieve normal glucose levels with the help of medications. This likely gives pancreas a rest and decreases fat stores in the body, which in turn improves insulin production and effectiveness.”

The senior investigator on the trial, Hertzel C. Gerstein, MD, MSc, FRCPC, of McMaster University and Hamilton Health Sciences, believes the study could be very informative for future treatment.

“We chose to use metformin, acarbose and basal insulin glargine in this trial as these medications have all been shown to slow or prevent the development of type 2 diabetes. However, other drug combinations could lead to higher remission rates and need to be systematically studied with regard to this outcome.”

Commenting on the research, Emily Burns, Research Communications Manager of Diabetes UK, suggested that more evidence was required to support this interesting study.

“We know that diet, exercise and medications can help people with Type 2 diabetes to manage their condition. We’re starting to see mounting evidence that putting Type 2 diabetes into remission is feasible as well. This is really interesting research, but we need longer trials in larger numbers of people to see if their approach works for the long-term.”

Burns also outlined activities of Diabetes UK intended to improve the situation.

“Research in this area is looking incredibly promising. That’s why we’re funding a large clinical trial, called DiRECT, to see if a low calorie diet can put Type 2 diabetes into remission for the long-term. We’re looking forward to seeing the results in 2018. In the meantime, we encourage people with Type 2 diabetes to follow a healthy diet that is low in sugar, saturated fats and salt.”

 

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