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Advances in Type 2 Diabetes—What's Ahead?

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Adult-onset diabetes (Type 2) is the health risk constantly in the news, but our awareness doesn't seem to be helping much. 

American Diabetes Assn predicted there would be a 165% growth in the number of people with diabetes from 2000 to 2050. We're on track to prove that prediction correct. Even more worrisome, it is estimated that 90% of the people who are pre-diabetic right now don't know it.

The hot question in the medical field right now is whether Type 2 diabetes can be cured.

Most doctors say, no. That includes mainstream opinion from WebMD to the American Diabetes Association.  

But other equally respected sources say there's hope and a cure may be possible.

The Lancet, published in England, is the most respected medical journal in the world. In December 2017, Lancet published results of the DiRECT study on 306 people in Scotland and England with Type 2 diabetes. The news was good.

All the patients in the study had been diagnosed with Type 2 diabetes within the past six years. All of them had a body mass index of 27 (decidedly overweight) or higher. The team put half the recruits on a strict diet and took them off all their oral anti-diabetic and anti-hypertension medicines at the outset. That was a precaution because sudden calorie restriction can send blood pressure down too rapidly. If needed, the blood pressure drugs were reintroduced... but they usually were not needed!

Scientists are shy about making bold statements. At least until an idea has been proved many times over. That's what makes the DiRECT conclusion so unusual and so promising. To quote:

“Our findings confirm that type 2 diabetes of up to 6 years' duration is not necessarily a permanent, lifelong condition. Weight loss sufficient to achieve remission can be attained in many individuals by use of an evidence-based structured weight management programme delivered in a non-specialty community setting by routine primary care staff”.... almost half had remission of diabetes, off diabetic medicine.

In short, losing enough weight can put type 2 diabetes into remission. Caught early enough, that could amount to a cure.

To make the proof even more convincing, the DiRECT results were highly consistent from person to person. There was a clear, systematic relationship between how much weight patients lost and how well they did. For patients who met the goal of losing 15 kg (33 pounds), 86% saw their diabetes go into remission. Not one of the patients in the study who gained weight saw their diabetes improve.

That makes losing weight the first thing you should consider if you are pre-diabetic or have type 2 diabetes already.  It also has the beauty of being one of the safest things you could try. But coordinate with your doctor before and during your mission to be sure your medications are correct and all is well. 

The DiRECT finding is consistent with more drastic means of weight loss, such as bariatric surgery, that has helped some patients manage their diabetes.

Cleveland Clinic is doing substantial work in that area. It has said that for some patients with more recent and milder symptoms, gastric bypass surgery has even led to “complete resolution of diabetes mellitus.” Overall, in a study on 80,000 patients who had a gastric bypass, 84% “experienced a complete reversal of their type 2 diabetes.”

There's also the possibility of zapping diabetes into submission.

GE and DARPA (Defense Advanced Research Project Agency) are now conducting a $2.9 million study on neuromodulation for type 2 diabetes. Essentially the idea is that electrical stimulation of the right nerves might accomplish the same things as drugs—without the side effects and with much greater precision. Neuromodulation is often used for pain management, so this treatment is an expansion on a practice with considerable success behind it.

A fourth avenue that might pay off is stem cell therapy. This is still in very early exploration. So far, studies using stem cells haven't been helpful for type 2 diabetes, but there are hints that experiments using pancreatic stem cells to treat type 1 diabetes may work. And if that approach works, it may help type 2 patients as well. 

Meanwhile, if you are diabetic or pre-diabetic, the information we have today says that diet is your first line of defense. And the sooner you shed pounds the better.

Second, if you are thinking about bariatric surgery, you should know that it is no longer a rare or extreme measure, and it has been extremely successful. Bariatric surgery is now considered to be safer than gall-bladder removal or a hip replacement. The risks are certainly lower than living with active diabetes. Type 2 diabetics who have a gastric bypass may get positive results within hours to days after surgery, including ditching insulin.

Until DARPA can zap you into good health our options are limited, but they're good.


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