A possible remission of type 2 diabetes

People with type 2 diabetes are not doomed to suffer from this disease all their lives and to take medication to control their blood sugar. Remission may be possible by changing lifestyle habits. At the Research Institute of the McGill University Health Center (MUHC) and the Montreal Heart Institute, randomized trials are being conducted to demonstrate this.

The concept of “remission” in type 2 diabetes is gaining ground in the medical community. As of November 2022, Diabetes Canada has indicated in its guidelines that remission of the disease is possible and may even be a treatment goal for some patients. Reversing the disease, however, is “more likely” in people with type 2 diabetes for less than six years, overweight or obese and not taking insulin, says the organization. A weight loss of at least 15 kilos increases the chances of remission.

“It was already known that with bariatric surgery, you could have a remission of type 2 diabetes,” says Dr.^D Kaberi Dasgupta, professor at McGill University and researcher at the Research Institute of the MUHC, who sits on various Diabetes Canada expert committees.

A growing number of researchers now believe that changing lifestyle habits can also lead to remission (i.e., glycated hemoglobin of less than 6.5% for at least three months, without the use of sugar-lowering drugs, according to Diabetes Canada).

In collaboration with the University of Leicester in England, the D^D Dasgupta is conducting a randomized study — called RESET and funded by the Canadian Institutes of Health Research — of around 100 people aged 18 to 45 who have had type 2 diabetes for less than six years and do not take insulin. .

For three months, half of the participants will be on a low-calorie diet (900 calories, compared to the usual 2000), consisting of meal replacements such as nutritional bars as well as a little food. They will exercise three times a week under the supervision of a kinesiologist. They will then have to maintain their weight through a “normal” diet. They will not take blood sugar control medication unless the sugar level is found to be abnormal.

So far, about fifteen patients have completed the program. “To date, we have been successful,” says the D^D Dasgupta, adding that the study is far from over, however. His team is also recruiting participants in Montreal and Edmonton.

Thanks to this study, the D^D Dasgupta hopes to be able to demonstrate the value of this approach, so that governments in Canada put in place programs aimed at the remission of type 2 diabetes.

This is what England did following a UK study conducted in 2017 and funded by Diabetes UK. Research has shown that a low-calorie diet for three months can lead to remission of type 2 diabetes in overweight people.

“After a year, 45% of people who had type 2 diabetes and followed this diet no longer had the disease,” says Dr.^D Dasgupta. The low-calorie diet program is now offered to type 2 diabetics in half of England and will be everywhere within the next 12 months, the Duty the National Health Service (NHS).

Studies at the Heart Institute

At the Montreal Heart Institute (MHI), a diabetes prevention and remission clinic was set up in 2019. It offers prediabetic and type 2 diabetic patients suffering from cardiovascular disease the opportunity to participate in a program intensive nine-month course to reverse this disease.

“It consists of intensive physical training [trois fois par semaine]intervals for example, and in a personalized food approach, but which aims for a significant calorie reduction and a significant weight loss”, explains the D^r Philippe L.-L’Allier, director of prevention at the ICM. The diet is based on the Mediterranean diet, which includes an emphasis on whole grain cereal products, colorful fruits and vegetables, legumes and fish.

According to the ICM, 12% of type 2 diabetic patients who have taken part in the clinical program so far are in remission. Prediabetes was also reversed in 20% of patients with this condition. The institution now wants to demonstrate the effectiveness of its approach through randomized trials. Two studies, with 36 participants each, began a year ago and will end in May.

Stéphane Mailloux participated in the intensive program of the ICM. In August 2021, he suffered a heart attack at age 41. A shock for this father who kept in shape. “I had a third of the heart blocked at 95%,” he says.

Stéphane Mailloux underwent angioplasty (insertion of an endoprosthesis — or stent — to widen an artery). Following blood tests, he learned that he had type 2 prediabetes. According to him, the ICM’s diet and exercise program “helped him a lot” from the first months. He is now in “remission”.

“We don’t have to change our eating habits that much,” he insists. In particular, he had to reduce the amount of pasta, bread and soft drinks he consumed. He also stopped his traditional yogurt with granola and fruit in the morning. He exercises three times a week.

According to the D^r L.-L’Allier, this “global” approach makes it possible to treat type 2 diabetes, but also to prevent the cardiovascular complications associated with it. “We do not say that the drugs [diminuant ou contrôlant la glycémie] are not good, he said. But from a prevention perspective, we think that aiming for diabetes remission would be more promising. »

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