Reversal and Remission of T2DM – An Update for Practitioners

Lina Shibib,1 Mo Al-Qaisi,1 Ahmed Ahmed,1 Alexander D Miras,2 David Nott,1 Marc Pelling,1 Stephen E Greenwald,3 Nicola Guess4 1Department of Surgery and Cancer, Imperial College London, London, UK; 2Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; 3Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK; 4School of Life Sciences, Westminster University, London, UKCorrespondence: Mo Al-Qaisi, Imperial Weight Centre, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK, Tel +44 7968 016315, Email mrcgp74@yahoo.co.ukAbstract: Over the past 50 years, many countries around the world have faced an unchecked pandemic of obesity and type 2 diabetes (T2DM). As best practice treatment of T2DM has done very little to check its growth, the pandemic of diabesity now threatens to make health-care systems economically more difficult for governments and individuals to manage within their budgets. The conventional view has been that T2DM is irreversible and progressive. However, in 2016, the World Health Organization (WHO) global report on diabetes added for the first time a section on diabetes reversal and acknowledged that it could be achieved through a number of therapeutic approaches. Many studies indicate that diabetes reversal, and possibly even long-term remission, is achievable, belying the conventional view. However, T2DM reversal is not yet a standardized area of practice and some questions remain about long-term outcomes. Diabetes reversal through diet is not articulated or discussed as a first-line target (or even goal) of treatment by any internationally recognized guidelines, which are mostly silent on the topic beyond encouraging lifestyle interventions in general. This review paper examines all the sustainable, practical, and scalable approaches to T2DM reversal, highlighting the evidence base, and serves as an interim update for practitioners looking to fill the practical knowledge gap on this topic in conventional diabetes guidelines.Keywords: weight loss, very low energy, very low calorie, bariatric surgery, orlistat, electrical muscle stimulation, low carbohydrate, behaviour change, diabetes reversal, diabetes remission