Many of us often encountered the question of 'Is my Diabetes curable?' especially young individuals who think it is impossible to continue the medications for a lifetime. Still, the answer is there is no cure for diabetes. We can prevent or delay the onset of diabetes in high-risk individuals.
Who are high-risk individuals?
- People with prediabetes
- Overweight or obese
- Strong family history
- Gestational Diabetes
- Low birth weight
How to prevent diabetes?
- Identifying individuals with risk factors for diabetes
- Educating regarding Lifestyle changes which include dietary modification and physical activity
The strongest evidence for the prevention of diabetes came from a Diabetes prevention programme, intensive lifestyle modification(LSM) can prevent the onset of diabetes by 50% at the end of 3 years. Two important lifestyle modification goals for the prevention of diabetes in prediabetes individuals being
- Achieve and maintain a weight loss of atleast 7%.
- Moderate intensity exercise of 150 minutes/week.
Diabetes onset can be prevented by 40% by moderate physical activity alone despite the absence of weight loss.
What is remission?
- Remission of Diabetes may be sometimes mistaken as a cure for diabetes.
- In some individuals, after initiation of treatment for diabetes, there will be an improvement in insulin resistance after starting metformin and lifestyle modification leading to normal glucose values for a short period before progression of diabetes, and this shouldn't be confused with a cure.
- The remission period may vary from a few months to a few years, depending on the individual's beta-cell reserve and strict lifestyle changes.
- In type 1 diabetes, in very few patients, there will be complete remission varying from few months to years after initiation of treatment with insulin, as there is an acute decrease in glucotoxicity and improvement of beta-cell function leading to the normal production of insulin, this period is called Honeymoon phase.
Nutrition therapy
- The dietary modification includes reduced consumption of carbohydrates and fats.
- Following the Mediterranean diet and DASH diet – increasing the consumption of whole grains, legumes, fruits, vegetables and nuts and less processed food decrease the incidence of diabetes.
Physical activity
- Atleast 150 minutes of brisk walking improves insulin resistance, decreases abdominal fat, and delays the onset of diabetes.
- 75 minutes of strength training as add on to moderate exercise is helpful in the prevention of diabetes.
- Avoiding long sedentary hours also plays a role in delaying the diabetes onset.
Pharmacotherapy
- Metformin is effective in prediabetes individuals with overweight or obesity and age <60years.
- Metformin alone was less effective than LSM.
- Other drugs for Diabetes like Alpha-glucosidase inhibitors, Liraglutide may have a role in the prevention of diabetes.
- Weight loss drugs like orlistat and phentermine-topiramate also have a role in the prevention of diabetes.
There is no cure for diabetes. Prevention or delaying the onset of diabetes in high-risk individuals can be achieved by strict lifestyle modification along with drugs if necessary.