Diabetes remission: Relief for countless people — Dr Rajiv Kovil, Diabetologist, Nanavati and Raheja

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Dr Rajiv Kovil, Diabetologist, Nanavati and Raheja, talks about the genuine need to whip up hopes in millions of diabetic sufferers by spreading awareness about the larger concept of remission altogetherDiabetes cases all over the world have been on a steady upswing for a considerable period of time. A lot has been debated upon and written about diabetes in India, the country with the second highest incidence of diabetes in the world. While a diabetic patient encounters physical and physiological challenges, the underpinning thought that, “I cannot get out of it (the disease per se)”, turns out to be all the more debilitating and often catastrophic. But not any more: a consensus statement issued in 2018 by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) points to stronger possibilities of ‘diabetes remission’ in Type 2 diabetic patients.

In Type 2 diabetes, the body develops insulin resistance meaning the body produces insulin but is not being able to use it effectively. A nutrition-rich diet, exercises etc. are recommended at this stage of the disease and most patients are put on anti-diabetic medication simultaneously to pre-empt developing additional complications. In keeping with the trends across the medical field, the focus is now shifting from symptom-led treatment to tailored methods which are seen to reverse the elements that are causing the disease in the first place. Proper portioned food intake (nutrition) and exercise (physical activities) are important catalysts which aid and supplement the process of diabetes remission.
Medically, cure may be defined as restoration to good health, while remission is defined as abatement or disappearance of the signs and symptoms of a disease.

Remission is the state where someone is relieved of diabetes symptoms which also entails that the patient no longer needs to be on targeted medication therapy. However, a disciplined approach to life and expert clinical interference play an important role in the remission process. Medical Nutrition Therapy (MNT) comprises a proven and disciplined nutritional approach underscored by the concepts of calorie restrictions, increased percentage of protein and fibre intake and portion control when it comes to food intake.

In a study (Direct) published in the Lancet in December 2017 an intervention which comprised of withdrawal of anti diabetic and anti hypertensive drugs in a patient with type2 diabetes with less than six years of duration and replacing drugs with a total diet replacement (850 kcal per day formula diet for three to five months), stepped food reintroduction (two to eight weeks) and structured support resulted in 15 kgs weight loss in 1/4 th of participants and half of patients achieved remission to a non diabetic state for 12 months.

In recent years, in patients who have practiced the Medical Nutrition Therapy, it has been observed that glucose remained at standard levels required for the body. This, in turn, has generated a lot of interest among doctors and researchers to devote more time to study and research the idea of diabetes remission. However, remission efforts are sustained only when a patient’s overall lifestyle is consistent and disciplined which minimizes and eradicates chances of a relapse.

In fact, the concept of MNT includes assessment of a patient’s nutrition-related facts, identification and maneuvering of individual goals in the nutrition process, inclusion of well-planned meals, imparting of diabetes self-management education and skills and providing for education material that backs the rationale behind the wholesale implementation of the approach, with an ongoing monitoring practice.
Another important factor – which combines physical activities and exercise regimens – helps lower blood sugar levels as insulin sensitivity spikes, eventually enabling muscle cells to become better equipped to use any available insulin. Also, when the muscles contract during a physical activity, the body cells are able to take up body glucose and use it up for energy even in the absence of insulin. A consistent and thorough exercise routine fused with the effectiveness of MNT can lead to managing blood glucose levels for a longer duration which in turn reduces dependence on medication. However, continuous follow up and regular monitoring under the guidance of a medical practitioner are important elements in the diabetes remission endeavour.

The concept of diabetes remission is still not so known to a majority of the people having to live with the condition. Remission conversations based on detailed research reports and successful testimonials of patients who have succeeded in leaving the disease behind them has been in vogue in recent times.
So, there is a genuine need to whip up hopes in millions of diabetic sufferers by spreading awareness about the larger concept of remission altogether. This would surely go a long way in bolstering efforts to fighting the battle against diabetes, but at the same time setting new benchmarks for diabetic patients driving them eventually to lead healthy and active lives.

Diabetic remission is a relief for countless people on this planet who have spent their entire lives in distress but are now willing to ‘break free’ of disease by way of a disciplined and tailored approach which hinges on a synergy between: Medication, Lifestyle and Nutrition.