Can you really ‘reverse’ type 2 diabetes? Here’s what the experts say

More than five million people are believed to be living with diabetes, 90 per cent of whom have type 2, according to Diabetes UK.

While type 1 is believed to be an autoimmune disease (occurring because the body’s own immune system has destroyed the pancreas cells that create insulin – the hormone that helps keep our blood sugar/glucose levels in a normal range), type 2 diabetes happens when blood sugar levels become too high due to the body no longer producing enough insulin, or insulin no longer working properly (insulin resistance).

Over time, this can lead to a range of possible complications, including nerve and blood vessel damage affecting the eyes, kidneys and feet, as well as an increased risk of heart attack and stroke.

But, can you really reverse type 2 diabetes?

Diabetes remission

Natasha Marsland, senior clinical advisor at Diabetes UK, says the term ‘remission’ is a more accurate way of looking at this.

“Type 2 diabetes remission is when your long-term blood sugars fall below the diabetes level and stay there for at least three months, without the need for glucose-lowering medication. By bringing your blood sugars into a non-diabetes range long term, the symptoms of diabetes and any new damage it can do to your body are on pause.

“Remission doesn’t mean your diabetes has gone away forever, as your blood sugar levels can rise again – and we don’t call it ‘reversing type 2 diabetes’ because remission isn’t a cure for type 2 diabetes. You still need to attend regular check-ups and get the support you need to treat or manage any existing complications.”

How does diabetes remission work?

“We know from evidence that the key to remission is weight loss. The chances of remission are better the sooner you try after your diagnosis,” says Marsland. “If you are living with obesity, your type 2 diabetes is more likely to go into remission if you lose around 15kg (2 stone 5lbs) of weight as safely as possible.”

Weight is one of a number of risk factors associated with type 2 diabetes, as well as genetics and family history, age and ethnicity (people of south Asian, Chinese, African-Caribbean and black African origin are generally at higher risk). But while it’s a key part of the picture for remission, Marsland also points out: “Weight loss is not a guarantee for putting your type 2 diabetes into remission. However, losing weight if you need to can have a positive impact on your everyday health and wellbeing and long-term health.

“The causes of type 2 diabetes are multiple and complex, but we do know that in many cases it’s caused by a build-up of fat inside the liver and pancreas, stopping them from working properly.”

For some, weight loss surgery or medication (such as Ozempic and Wegovy) might be beneficial. Nutrition and healthy eating are also key.

Type 2 diabetes and nutrition

“The majority of research shows us that weight loss reduces insulin resistance and blood glucose levels. However, we also know that 10% of people diagnosed with type 2 diabetes are a healthy weight,” says diabetes specialist dietitian William Hadfield, who has over 10 years’ experience working within the NHS, as well as being co-founder of WE Nutrition (wenutrition.co.uk).

“People with type 2 not wanting, or unable to lose weight may want to focus on reducing overall carbohydrate intake (e.g. bread, rice, pasta, potato, cereal) and increasing lean proteins (e.g. beans, lentils, eggs, white meats, fish), as well as vegetables and healthy fats (e.g. nuts, seeds, and olive, canola, nut and seed oils and spreads).

“Maintaining hydration with sugar-free fluids (e.g water, sugar-free squash, unsweetened tea or coffee) and only consuming alcohol within recommendations, can help with overall health, managing hunger and avoiding unneeded calories.

“For all people, but especially for people with diabetes, it is important to avoid added sugar as this is linked with obesity and tooth decay. For people with diabetes, it can contribute to higher blood glucose levels. These foods (e.g. sweets, chocolate, highly processed foods and drinks) often have little or no nutritional value so rarely offer health benefits,” he adds.

Make choices that work for you

Hadfield is keen to focus on sustainable changes. “Choose a dietary approach that works for you and your life,” he says. “Consider every aspect of your life, and how food, drink and lifestyle fit into it, and find a way that allows you to live your life the way you want to live it, and also supports you in achieving your health goals.”

He suggests avoiding “overly restrictive and fad diets, unless supervised by a trained and qualified healthcare professional”, and adds: “In such a fast-paced and immediate results-driven world, we can sometimes expect the same to apply to our health. It is important to recognise that sometimes slow and steady changes really do win the race with health and type 2 diabetes.”

What else do you need to know?

Marsland emphasises the importance of continuing to check in with your healthcare team.

“Whether you’re thinking about trying to go into type 2 diabetes remission, already attempting it, or your type 2 diabetes is in remission, it’s incredibly important to have conversations with your healthcare team. You need advice and guidance that is right for you,” she says. “It’s also important to highlight trying for remission isn’t clinically appropriate for everyone. If you do try for remission, you may need to make changes to medication you take, which your healthcare team will be able to advise you on. They may recommend increased monitoring too.

“We know going into remission can be challenging and staying there even more so, at a weight that’s right for you. Which is why we’ve just launched our new remission information and support resources [available on the charity’s website] and are continuing to fund research to understand how to help more people living with type 2 go into remission and stay there longer.”

Hadfield also believes having “a holistic approach is key, as diabetes affects so many parts of life”, he says. “Consider food and drink, but also consider mental health, exercise, sleep, support networks, relaxation – all these parts of the jigsaw come together to make up a person, and it’s important that we see the whole of the puzzle in order to get the best results.”