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Cases of reversed type 2 diabetes must be highlighted

Experts say losing weight can reverse diabetes but is rarely recorded

Adrian O'Dowd

Thursday, 14 September 2017

Patients can reverse their type 2 diabetes with sustained weight loss of around 15kg despite widely held views that the condition is progressive and incurable, according to experts writing an analysis* piece published today in The BMJ.

Louise McCombie from the human nutrition section at the University of Glasgow’s School of Medicine and colleagues argued that patients and doctors might not realise that type 2 diabetes can be reversed and called for greater awareness, documentation, and surveillance of remissions to improve health outcomes and reduce healthcare costs.

Type 2 diabetes now affects about 3.2 million people in the UK and the NHS currently spends almost £1 billion a year (£22 million a day) on anti-diabetes drugs, while costs are rising worldwide as diabetes rates and drug prices escalate.

Current guidelines advise reducing blood sugar levels and cardiovascular risks, primarily with drugs and general lifestyle advice, but many patients still develop complications and life expectancy remains up to six years shorter than in people without diabetes, said the authors.

They argued that consistent evidence showed weight loss was associated with extended life expectancy for people with diabetes, and that weight loss of around 15kg often produced total remission of type 2 diabetes.

Achieving remission had obvious health benefits as well as producing a strong sense of personal achievement and empowerment, removed stigma, and could even reduce insurance premiums.

However, cases of remission were rarely recorded, they said, such as in one US study which found remissions in only 0.14% of 120,000 patients followed for seven years, while the Scottish Care Information Diabetes database, which includes every patient in Scotland, showed that less than 0.1% of those with type 2 diabetes were coded as being in remission.

They suggested that lack of agreed criteria and guidance over recoding may have led to hesitation in coding remission, but the main reason for the low recording was probably that few patients were attempting or achieving remission.

“It is in everybody’s interest to reclassify people with type 2 diabetes when they become non-diabetic,” said the authors. “Official guidelines and international consensus for recording diabetes in remission are needed.”

They concluded: “Appropriate coding will make it possible to monitor progress in achieving remission of type 2 diabetes nationally and internationally and to improve predictions of long-term health outcomes for patients with a known duration of remission.”

* McCombie L, et al. Analysis: Beating type 2 diabetes into remission. BMJ 2017;358:j4030. DOI:10.1136/bmj.j4030.

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