Sunday, January 29, 2023

Getting rid of diabetes does not mean a cure

This transcript has been edited for clarity.

Whenever I meet a new patient with type 2 diabetes who is usually on metformin, the first question they ask me is, “Can I stop my medication?” It seems that everyone who has diabetes wishes they didn’t have diabetes.

So, what does this really mean? What does this mean for me as a physician? And what does this mean for my patients? The American Diabetes Association recently came up with a consensus statement that defines and explains the definition of remission in people with type 2 diabetes. Basically, if the A1c is less than 6.5% without diabetes medications for at least 3 months, it is considered remission.

There are other considerations, such as metabolic surgery, that can lead to remission. But again, they want you to be on and off diabetes medication and lifestyle for at least 3 months after surgery. They believe that remission actually occurs within about 6 months of lifestyle intervention and then diabetes medication is stopped for at least 3 months.

This makes me wonder: what is a discount? Remission really means a temporary recovery, so it doesn’t mean a cure. Now, I am not against diabetes treatment. In fact, I’m all for it. But when someone gets diabetes — and honestly, it doesn’t matter whether it’s type 1 or type 2 — the first thing I think of, and I think the first thing that’s taught to my patients is, That is how important it is to have a healthy lifestyle. This healthy lifestyle isn’t just for people with diabetes; This primarily means the healthy lifestyle we should all follow, one where we eat fewer simple carbs, less processed food, more vegetables, more lean protein and meat – all things we know we have to do. needed. And all the things that keep us healthy. In part, I don’t think you can ever get “remission” from diabetes, because if the person with diabetes points to a healthier lifestyle, I think that’s great.

I think people should exercise more. When it comes to treating diabetes, exercise is important. When you think about obesity, we want to help people who are overweight or obese lose weight to treat diabetes. And that doesn’t go away either.

So, no, people who have been diagnosed with diabetes don’t really go into remission if they keep their same old habits and don’t lose weight and exercise. But many people with diabetes can get away with medication if they do.

However, this isn’t true for everyone, and I don’t want people to have unrealistic expectations because I think there are about a thousand different subtypes of type 2 diabetes. And I’ve certainly seen people who are lean with type 2 diabetes who don’t respond as well to lifestyle interventions, or people who are more insulin deficient, who also need medication.

I think it’s really important to frame the expectation that if remission means going back to the way it was before, when they didn’t have to think about what they ate or exercised or not, that’s not going to happen. I think diabetes should really be a wake-up call that people need to be healthy in terms of their lifestyle habits.

The issue of medicine is really an individual one, and I think we need to help patients see what’s best for the individual, what their goals are, what their goals are. But we also have to think that diabetes is not just about glucose.

So in the context of the ADA definition the relaxation looks at glucose, but I look at glucose as more. You have to look at lipids and blood pressure. And as I mentioned earlier, you have to look at whether a person already has heart disease or there is a presence of microvascular complications that need to be investigated and treated.

I really think that, in some ways, a diagnosis of diabetes is helpful simply because it helps lead people down a better path to health. I don’t want people to think that remission means they can go back into unhealthy habits. I really encourage all people to live a healthy lifestyle, and if this leads to an improvement in glucose levels and the drug is stopped, I think that’s wonderful and a worthy goal. But remember, health and meeting your goals are important in treating type 2 diabetes. Thanks.

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