Remission in type 2 diabetes has been regarded as elusive and impractical by clinicians for as long as we’ve been identifying and treating diabetes. Unlike other conditions where treatment can result in a reversal or return to normal levels within the body, type 2 diabetes treatments have not progressed to offer remission as an achievable target for people living with diabetes. When Diabetes Canada announced they were including a chapter on diabetes remission in their clinical practice guidelines (CPGs), there was considerable buzz around the diabetes circles on what that looked like and what the science says.

 

As seen above, an A1c <6.0mmol/L for 3 months or more without pharmaceutical treatment is considered diabetes remission. Source: Diabetes Canada https://guidelines.diabetes.ca/cpg/special-article-remission-of-type-2-diabetes

 

Why Was Diabetes Remission Previously Unachievable?

In order to discuss why diabetes remission was previously thought to be an unachievable physiological state, it’s important for us to review some of the basics of human physiology so that we can link what we know about the causes of diabetes to possible opportunities for remission.

 

The Physiology of Digestion in a Non-Diabetes State

 

The graphic above taken from our Diabetes Manager University (DMU) training program summarizes several systems within the body that are constantly working to balance our physiology and to keep us in homeostasis (balance). When there is no food in the stomach or we’re in a fasting state, the pancreas releases a hormone called glucagon. Glucagon signals the body to release stored glucose/sugar from the muscle and the liver (storage form of sugar is called glycogen). The release of glycogen provides glucose in the blood to fuel body activities such as pumping your heart, or your brain thinking or reading this page. This process keeps our blood sugars usually between 4-6 mmol/L when we’re not eating.

When we eat food or drink beverages several body systems kick in to help us with digestion, absorption and processing of those nutrients. The foods we eat break down into one of three nutrients: carbohydrates, protein, or fat. Carbohydrates have the biggest effects on the rise of blood sugars. When carbohydrates reach the small intestine, incretins are released, and then signal their effects within several body systems. Incretins are gut hormones that have been shown to have a significant impact on human physiology. There are several identified incretins and their role in physiology is outlined in the Obesity Canada Guidelines. If any of these systems are not working well, blood sugars will begin to rise, and the individual will develop prediabetes and eventually type 2 diabetes.

In our next blog post, we will build upon this understanding and review the common causes of hyperglycemia (high blood sugar) leading to prediabetes and diabetes. Once we understand how the body system failure can lead to hyperglycemia and type 2 diabetes, we can then link that dysfunction to the current proposed methods of diabetes remission according to the Diabetes Canada Clinical Practice Guidelines.

Or if you just can’t wait and want to read up on diabetes remission yourself, you can find information in the Diabetes Canada Remission of Type 2 Diabetes Chapter and also in the article Ricci M, Mancebo-Sevilla JJ, et al. Remission of type 2 diabetes: A critical appraisal. Front Endocrinol (Lausanne). 2023 Apr 3;14:1125961. doi: 10.3389/fendo.2023.1125961. PMID: 37077356; PMCID: PMC10107406 which you can access here.

Questions and discuss about this and other Canadian diabetes related practice questions are always welcomed in our Facebook group, the Canadian Diabetes Educators Community of Learning.

Thanks for reading.

Michelle Archer, RD, CDE
Certified Diabetes Educator
Diabetes Training 101 Inc.