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KEEPING WEIGHT DOWN MIGHT REVERSE TYPE 2 DIABETES
luciano Giacaglia, MD, PhD, endocrinologist and Coordinator of T2D and prediabetes at the Brazillian Diabetes Society, in an interview with Medscape’s Portuguese edition spoke on weight Loss potentially Leading to Remission for Type 2 Diabetes.
Recent research exploring calorie restriction and weight loss has sparked discussions about possible type 2 diabetes (T2D) remission. However, medical experts caution that normalized blood glucose and hemoglobin A1c levels don’t necessarily indicate the disease has been reversed.
“Beta-cell function is already reduced by approximately 50% when T2D is diagnosed. Many beta cells undergo apoptosis and cannot be recovered,” explained Dr. Luciano Giacaglia, endocrinologist and T2D/prediabetes coordinator at the Brazilian Diabetes Society, speaking to Medscape’s Portuguese edition.
Dr. Giacaglia emphasized, “When addressing remission, we must distinguish between temporary glycemic control and genuine disease reversal.”
DEFINING REMISSION
In scientific literature, the word “remission” remains contentious. Giacaglia suggests this terminology may create unrealistic expectations similar to cancer treatment outcomes. “The clinical definition of remission—maintaining hemoglobin A1c below 6.5% without medications—doesn’t mean patients have escaped metabolic complications. Ongoing pancreatic dysfunction and insulin resistance remain significant challenges.”
While progression of type 2 diabetes can be delayed, complete reversal remains elusive. Certain medications, including SGLT2 inhibitors and GLP-1 receptor agonists, can slow disease advancement and delay insulin dependence, but as Giacaglia points out, none provide a definitive cure or prevent the disease’s progression.
Furthermore, weight reduction alone doesn’t guarantee restored pancreatic function.
“Human pancreatic regenerative capacity is limited. Unlike some species such as rats, humans lack pancreatic islet germ cells capable of developing into new beta cells,” Giacaglia explained. Consequently, despite effective strategies for reducing insulin resistance, type 2 diabetes typically continues its progression in most patients.
CLINICAL EVIDENCE
The UK-based DiRECT clinical trial assessed a severely calorie-restricted diet (825-853 kcal daily) administered for up to 5 months, with subsequent food reintroduction and ongoing weight maintenance support.
Results showed that after one year, 46% of intervention participants achieved remission versus just 4% in the control group. However, long-term follow-up revealed only 26% maintained medication-free remission at the 5-year mark.
Dr. Wellington Santana da Silva Júnior, director of the Department of Diabetes Mellitus at the Brazilian Society of Endocrinology and Metabolism, highlighted weight reduction as crucial for better glucose control.
The data demonstrated striking differences based on weight loss magnitude: patients losing over 15 kg experienced an 86% remission rate, while those losing 5-10 kg achieved 34% remission. Nevertheless, Dr. Santana noted that longitudinal data indicates most patients find maintaining these outcomes challenging over time.
A Chinese clinical investigation evaluating dapagliflozin (an SGLT2 inhibitor) combined with caloric restriction enrolled 328 participants and reported remission rates of 44% in the treatment arm compared to 28% in the placebo group.
Dr. Giacaglia advised interpreting these outcomes carefully: “Type 2 diabetes pathophysiology varies significantly between Eastern and Western populations—we’re essentially discussing different diseases. Furthermore, this research only measured blood glucose without evaluating pancreatic function. When glucose levels serve as the sole criterion, virtually any therapeutic class could achieve similar results.”
He further highlighted the practical challenges of translating research findings to everyday clinical care: “These investigations feature highly controlled environments with stringent monitoring and persistent support systems. In real-world clinical settings, patients face significant hurdles maintaining such restrictive dietary protocols.”
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