In 1980, 4.7% of the world’s population suffered from type 2 diabetes. This figure, linked to obesity and ageing, reached 8.5% in 2014 and 9.3% in 2019. And it continues to grow, mainly in low- and middle-income countries. Until recently, this disease, which increases the risk of heart disease or cancer, seemed like a degenerative process that always got worse and eventually required insulin and other drugs. However, this view has changed in recent years. In 2017, the magazine the Lancet published the Direc study, a study which demonstrated that if a significant weight loss was achieved, it was possible to reverse the disease and get rid of the drugs. A barrier to that knowledge changing the course of the disease was that the nutritionists and personal trainers who helped the patients in this study were not within reach of public health.
Since the publication of that study, various techniques are being tested to achieve weight loss that reverses diabetes. Today Magazine Journal of Clinical Endocrinology and Metabolism Publishes a paper showing how an intermittent fasting intervention can improve the health status of people with the disease, reduce the need for medication and even lead to disease remission completely can end with. The authors, researchers from Hunan Agricultural University (China), applied a type of diet, baptized as Chinese medicine nutrition therapy, which involved five days of fasting, with a controlled timed intake of 840 kilocalories per day. After this, 10 kcal was consumed. ate normally.
Ninety percent of 36 volunteers with diabetes, including those on drugs to lower blood sugar and insulin levels, were able to reduce their medication, and 55% saw their disease subside and maintain their health for at least a year. Was able to stop taking the drug. Among trial participants, the average weight loss was about 12 pounds, compared to a 200-gram drop in a comparison group eating a normal diet. Study author Dongbo Liu affirms that “diabetes is not a lifelong disease,” but “it can go away if patients lose weight by changing their diet and exercise habits.”
Cristóbal Morales, an endocrinologist at Vithas Hospital and Virgen Macarena University of Seville, cautions that the study is “with few volunteers and with populations such as the Chinese in which patients with diabetes are different from those found in Spain”. Because of his low body mass index. However, consider that intermittent fasting may be another means of losing weight. “There are studies that show us that losing between 5 and 10% of body weight has a huge metabolic benefit. Intermittent fasting can be appealing to many people and the important thing is to lose weight and keep it off.” put away, and it seems like it doesn’t matter how you do it,” he explains.
According to Morales, the idea of creating a Diabetes Remit is a new one, but they now aspire to achieve it through different methods to reduce weight. In a recent guideline published by the Diabetes Canada Association, it is noted that “a weight loss of approximately 15 kg is associated with the highest likelihood of type 2 diabetes remission.” This goal would be a possibility for patients with mental illness or severe eating disorders, heart disease, heart failure or chronic kidney disease.
surgery and medications
As with many other illnesses, even when you know what to do, it’s not always easy to do. Andrea Azcarate, head of the endocrinology service at Madrid’s Sanitas la Moraleja University Hospital, explains that after losing weight, “the most difficult and essential thing is to maintain that loss long-term.” “It’s about offering a personalized treatment that may be more useful for each patient. Fasting has been practiced for many years, although it has now become fashionable. It may be useful for patients not to fast kill them let them rest [al aparato digestivo] and to improve insulin sensitivity. But you should never be too categorical”, he added. “Not all diabetics are the same, some take too many medications and medication should be adjusted or monitored for a tendency to dehydration, which can lead to kidney problems”, he continues.
The reference intervention for very significant weight loss and against which other methods are compared is bariatric surgery. However, according to Azcarate, it is necessary to have a body mass index of more than 35 to meet the criteria (a man of 1.75 m must weigh more than 104 kg). The method, proven in direct studies with diet and exercise and very close follow-up by professionals, achieved remission of diabetes in approximately 50% of participants. However, this requires very expensive resources. Therefore, experts and patients look with hope to new drugs for obesity such as semaglutide or tirgepatide. These drugs mimic incretins, hormones our bodies produce when we eat that reduce appetite and increase resting energy expenditure. Semaglutide has shown that it can reduce, on average, 15% of the weight of those taking it, and tirzepeptide up to 22.5%, figures that would be similar to bariatric surgery.
Despite the fact that the demonstration that weight loss can reverse diabetes offers hope for patients and that there are new ways to achieve it, the path to reducing fat content and maintaining it long-term remains complex. It is made up. New drugs or strategies like intermittent fasting are tools that open the door to a solution.
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