New Approaches Offer Diabetes Patients Hope
Dr. Jay Shubrook Highlights New Treatments that Offer Avenues to Diabetes Remission and Hope for Type 2 Patients
While Type 2 diabetes requires lifelong management and medication to control blood sugar levels, recent research has shown that achieving remission is not only possible but also achievable, according to Dr. Jay Shubrook, a leading expert in the field of diabetes and professor at the Department of Clinical Science and Community Health at Touro University California (TUC) in the College of Osteopathic Medicine.
Diabetes remission is not a cure, however.
“By the time you have Type 2 diabetes, clinically the insulin producing beta cells in the pancreas have been damaged to the point that you can't go back to zero risk, but you can dramatically change the course with one of the remission protocols,” warns Shubrook.
According to Shubrook, recent clinical studies have shown that intensive lifestyle intervention, Metabolic surgery, and intensive insulin treatments can significantly improve the lives of Type 2 patients.
The Intensive Lifestyle Intervention involves primary care clinicians coaching patients through an 800 calorie per day shake diet for about 12 to 20 weeks. Physician supervision is critical to ensure patients don’t experience nutrient deficiency or muscle loss, but Shubrook says that those who get through the regimen lose an average of 33 pounds (15 kg).
“Sticking to 800 calories a day in shakes is hard, but if patients can do this three-to-four-month program of a very restricted diet while staying active, they see positive results” says Shubrook. “In a UK study, patients that completed the program had substantial one-to two-year diabetes remission outcomes.”
The second therapy is metabolic surgery or weight reduction surgery. Shubrook says that most patients who have the surgery, usually Roux-en-Y or gastric sleeve, lose on average 33 pounds (15 kg) and experience Type 2 diabetes remission for up to 10 years.
Shubrook says the third concept is an intensive insulin treatment based on the Diabetes Control and Complications Trial (DCCT) of the 1980s and 1990s. The study demonstrated that multiple injections of insulin in Type 1 patients reduced the risk of diabetes-related complications, but Shubrook notes that the 12-week intensive insulin treatment on Type 2 patients can create remission up to a year.
“We used to think that beta cells, which produce insulin in the pancreas, died when patients experienced frequent hyperglycemia,” says Shubrook. “The cells don’t die, they just become less metabolically active, and intensive insulin treatment helps the pancreas produce insulin again. By normalizing patient physiology with insulin, we induce diabetes remission.”
Shubrook says that it’s critical to understand what remission means, and why it doesn’t last a lifetime. When a Type 2 patient reaches sub-diabetes level HbA1c below 6.5% A1C and sustains these levels without the use of medications for a minimum of three months, they are in remission. For comparison, people without diabetes have an A1C level that is usually below 5.7%.
“The message people should hear is that if you are willing to intervene early in the disease you have multiple ways you can achieve diabetes control without long term medication use. However, the longer you wait to start the less likely these interventions will work”
The A1C test, or glycated hemoglobin test, measures the average percentage of blood sugar concentration in an individual’s blood over the course of several months. Standard fasting blood sugar shows glucose levels at one point in time, but an A1C test provides a wider measure of overall blood sugar. Both tests are important tools in managing diabetes effectively, but A1C tests are used to monitor blood sugar levels in people with diabetes or at risk for Type 1 or Type 2 diabetes.