Diabetes Remission: Missed Opportunities

In BMJ, Louise McCombie and colleagues are stirring up an important dialogue. They note that medical records seldom document diabetes remission. Why, they ask? To answer their own question, they say this failure reflects a prevailing bias that type 2  diabetes is incurable. That presumption is a missed opportunity for hope and for better health outcomes.

Type 2 Diabetes: Incurable or Treatable?

There’s no debate that type 2 diabetes is a chronic disease. It reflects a pancreas that has lost some of its capacity to regulate blood sugar. That loss of function comes with age and it comes with excess weight.

However, there’s a world of difference between viewing a disease as incurable or as treatable. Casting a chronic disease as incurable gives it a dire spin. For many cancers, we now characterize them as treatable. Breast cancer is a notable example. Remission is the unmistakeable goal following a diagnosis. We surround patients with a team of people united by that goal. It gives patients hope for many years of life to enjoy.

Remissions of Type 2 Diabetes

Remissions of type 2 diabetes are poorly defined, say McCombie, but they are clearly possible. A new study in the New England Journal of Medicine for example, found a remission rate of 51% twelve years after gastric bypass surgery. Remissions are also possible, though less common, with lifestyle and medical obesity care.

McCombie says that a weight loss of more than 10% is necessary in order to maximize the odds for a remission. But this thought represents a supposition, not a certainty.

Hope or Motivation?

We have just one more hair to split on this subject. McCombie talks about the importance of providing a more hopeful outlook for patients. And she believes that better attention to the goal of diabetes remission will help with that.

Others focus on a need to motivate patients with diabetes and obesity to lose weight, primarily through lifestyle changes. For example, endocrinologist Sangeeta Kashyap discussed McCombie’s analysis with Healthline and said:

We physicians often push drugs, but give lip service to lifestyle modification. This is a way to not do lip service. By putting it [remission] in the chart, we’re recognizing patients’ efforts and keeping them motivated to keep it up.

We beg to differ. People living with obesity don’t need more urging, more prompts to keep them motivated to maintain a healthier weight. They need the means to do it. Motivation fades when the means to reach a goal are simply unavailable.

Successful obesity care requires access to the full range of evidence-based options. Sometimes intensive lifestyle change is enough. But often, a person needs more. Lifestyle, medicine, and surgery all have a place in evidence-based obesity care. As Healthline notes, diabetes remissions are rare with lifestyle therapy alone for obesity.

If we surround patients with a team dedicated to providing good obesity care for people with diabetes and obesity, remissions are possible. It’s a worthy goal.

Click here for the article in BMJ and here for more from Healthline.

Missing Summer, photograph © Marina Xi (GlenXi Estates) / flickr

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October 4, 2017