Obesity and the Elusive Goal of Diabetes Remission

The 144,000 Chosen and the Angels Holding Back the WindsSeeking remission from type 2 diabetes is an elusive goal for people who are facing this diagnosis. The very human wish is to banish this disease forever, but that’s not what remission really is. In fact, remission means a respite from an illness – not the promise of a cure. Physician Anne Peters describes the feelings her patients have:

“Whenever I get a new patient with type 2 diabetes who is generally on metformin, one of the very first questions they ask me is, ‘Can I get off my medication?’ Everybody, it seems, who gets diabetes wants to not have diabetes.”

For remission of type 2 diabetes if a person has any degree of obesity, the best odds come from bariatric surgery. The odds are even better if the diagnosis is recent.

Right now, though, the non-surgical treatment of obesity is getting better at a rapid pace. New drugs are delivering effectiveness for some people that matches what they can get from bariatric surgery.

So what does this mean for people with both obesity and diabetes who are looking for a remission of their diabetes?

Defining Diabetes Remission

To answer that question, we have to go to the definition for remission in type 2 diabetes. Multiple organizations came together with a consensus statement for this very purpose. Their definition is quite detailed, though ultimately very simple. Remission is the word to use when a person has sustained metabolic improvement in type-2 diabetes with an HbA1c value of less than 6.5 percent. Sustained means that  these improvements are present at least three months after an intervention like surgery and after the withdrawal of glucose lowering meds.

Advantage: Surgery

But these new anti-obesity meds are something that a person has to keep taking to maintain a lower weight. So by definition, new and improved anti-obesity meds can’t deliver a remission. These are all drugs that both lower weight and blood sugar.

Thus even with newer and better obesity meds, it will still be true that bariatric surgery gives a person with type 2 diabetes the best odds of remission for type-2 diabetes. A new study in Diabetes Care once again tells us that the odds of diabetes remission are much higher for patients who have bariatric surgery compared to patients who receive intensive medical and lifestyle therapy.

The Wish for a Cure

Under the effort that goes into pursuing diabetes remission is the simple human wish that Peters describes. People with type 2 diabetes wish they did not have it. They wish their doctors could cure it. They don’t like continuing to take meds for it. But in the absence of a cure, the best goal to reach for is remission. And the best odds for that come with bariatric surgery.

This fact is unlikely to change anytime soon.

Click here for the consensus definition for remission and here for the most recent study of medical and surgical care for achieving it.

The 144,000 Chosen and the Angels Holding Back the Winds, painting by Facundus / WikiArt

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June 20, 2022

3 Responses to “Obesity and the Elusive Goal of Diabetes Remission”

  1. June 20, 2022 at 6:58 am, Mary-Jo said:

    People with prediabetes who could be prevented from becoming diabetic in the first place, WITH the use of meds that will more effectively help them to lose adipose tissue, manage metabolic and hormonal irregularities associated with carrying excess fat tissue, thus, not even have to get to the point of the struggle to hopelessly wish for a ‘cure’ are denied meds UNLESS they prove they HAVE full-blown diabetes. I just don’t get it. Sometimes I feel like I’m being punished for working hard at living a healthy lifestyle.

    • June 20, 2022 at 9:08 am, Ted said:

      You are right, Mary Jo. Embedded in all this is the bias that the underlying physiology of obesity is not a health issue that merits treatment. So health systems make it hard to get good care.

  2. June 20, 2022 at 12:59 pm, Angela Golden said:

    Thank you for this post. It is a good reminder that we need to target the best treatment to the goals for the patient, but also a good reminder of the difference of remission and cure!