Anthony Wilson nearly died of type 2 diabetes, before he even was diagnosed.
His wife Sheila noticed dark circles under her eyes, and that his skin was gray. Sheila went to work one morning in 2012. He was clearly not well and she knew that he needed to be taken to hospital right away. He recalls that he resisted but she persevered and won.
“She walked me down the stairs at home, and the next thing I remember was when I woke up in the ICU,” says Wilson, now 54, who lives in Virginia Beach. Tests revealed Wilson’s blood sugar was multiple times higher than the threshold needed to diagnose Type 2 diabetes, a chronic condition where the body doesn’t use insulin properly, allowing blood sugar to rise unchecked.
So intense was the strain on Wilson’s body that his organs were failing. Wilson says that doctors discussed placing him on dialysis for kidney disease. Wilson also said that they had twice to shock Wilson’s heart to restore rhythm. Wilson believes his diabetes was causing an increase in his risk of developing a heart attack.
Wilson received stabilization and was told by a doctor that he would have to be on insulin the rest of their lives. He was not only able to get off insulin in the months that followed his diagnosis but he is now able keep his blood sugar levels normal and healthy without any diabetes medications.
After losing 60 lb. in 2020—thanks to diet changes and regular exercise—Wilson, who’s an EMS operations manager and volunteer for the American Diabetes Association (ADA), achieved what’s considered the holy grail in Type 2 diabetes management by bringing it into “remission.”
“I’m the type of person who wants to be in control of my health,” says Wilson, who continues to be vigilant about monitoring his blood sugar. “I share my story with anybody who will listen, in hopes that it can make a difference.”
Diabetes ‘reversal’ by another name
The concept of Type 2 diabetes remission, which is getting increasing attention from researchers and doctors, also goes by other names, including diabetes “reversal,” “resolution,” and even “cure.” But a consensus of experts led by the ADA last year agreed on the term remission as being most accurate.
“The reason we use the word remission is because if someone were to think that they were cured or reversed, the challenge is they may then not feel like they need to have anything checked,” says Dr. Robert Gabbay, ADA’s chief science and medical officer.
Simply put, Type 2 diabetes recovery is defined by the panel as having a blood sugar level that’s below the diabetes threshold and not taking any diabetes medications. That would be below, for example, 6.5% A1c, for the blood test that’s used to get a three-month average of blood sugar.
But a lot still remains unclear—like how long remission generally lasts, because it varies. And experts stress that continued follow-up with health care providers—not only to monitor blood glucose but also to check for diabetes complications—is important because the impact of diabetes remission (fleeting or long-lasting) on things like heart health and death rate isn’t yet well understood.
You want to be a success?
Type 2 diabetes treatment advances may make it possible for people who are newly diagnosed to remission. “The most common place we see [diabetes remission] is with bariatric surgery where there’s significant weight loss,” Gabbay says.
He says that in addition to losing weight, there is likely to be hormone secretion after the surgical reconfiguration. This makes it more probable that remission will occur. Some research suggests that after gastric-bypass surgery is performed, certain gut hormones stimulate the production of insulin in the body, including what’s called glucagon-like peptide-1 (GLP-1) and peptide tyrosine-tyrosine (PYY), which drive down blood-sugar levels.
But although remission is strongly associated with bariatric surgery, prominent research shows that significant weight loss alone—without surgery—can be enough to put Type 2 diabetes into remission. A closer look reveals that weight loss can cut fat levels inside the liver and pancreas, letting those organs function normally and allowing them to better regulate blood–glucose levels.
And remission isn’t accessible just to a select few.
DiRECT Trial published in Lancet in 2018 found that nearly half (46%) of 149 participants studied—who had been diagnosed with Type 2 diabetes within six years and who weren’t on insulin—were able to achieve remission through an evidence-based weight-loss program. The research was carried out in primary-care practices—not specialized weight-loss centers-—over a period of a year. These who had lost 33 lb or more were most likely to remission. Remission was more likely for those who have lost at least 33 pounds.
Following-up research published in The Lancet Diabetes & EndocrinologyIn 2019, one third of the participants were still in remission after two years. Maintaining remission is linked with weight loss.
The biggest factor in whether a person can lower blood sugar below diabetic levels and keep it there without medication is the amount of time that has passed since diagnosis, according to Dr. Roy Taylor, professor of medicine and metabolism at Translational and Clinical Research Institute at Newcastle University upon Tyne in the U.K. Taylor was the co–chief investigator and co–senior author of the DiRECT trial.
There’s growing acceptance that remission is possible for a wider group of patients than previously thought, Taylor says, and that’s supported by research. But he expressed frustration that many doctors still don’t approach it this way with patients—at least giving them the option to pursue this goal, should they choose to do so.
Many doctors believe it’s difficult to maintain such weight loss, despite the positive results of studies like the DiRECT study. They stress that diabetes control—not remission—remains a primary goal.
It’s very challenging for people to lose the amount of weight necessary to achieve remission, says Dr. Jill Crandall, professor of medicine and chief of endocrinology at Albert Einstein College of Medicine and Montefiore Health System in the Bronx. “It may be that we’re overlooking an opportunity to really motivate patients for that weight loss by introducing the notion of remission. But I think it’s not first in the mind of most clinicians who are treating people with diabetes.”
Other people believe that it should.
“I used to feel like I was handing out a life sentence when I diagnosed a patient with diabetes. I now work with my patients to reverse their disease,” says Dr. Stephenie Lucas, an endocrinologist at Beaumont Health, which is based in the Detroit area. “Many patients with Type 2 diabetes can go into remission and not require medication to maintain normal glucose levels.”
One thing that’s more universally accepted: regardless of whether a patient is in remission, continued vigilance is key.
“There is no permanent cure for diabetes, because the cells that produce insulin have been damaged and the underlying genetic factors remain,” Lucas says. “The patient does maintain an increased susceptibility to recurrence of diabetes, so lifestyle interventions must be continued.”
Give patients the opportunity to choose
Doctors stress that patients should be supported in making diabetes management a priority—however they choose to do so—regardless of whether the aim is remission.
The majority of patients don’t achieve remission, but the goal is to keep their blood sugar under good control, says Dr. Gwendolyne Jack, endocrinologist and clinician-educator at Weill Cornell Medicine in New York City. She says that some patients may need to continue taking insulin and lifelong medications in order to achieve this. “That’s OK. That is not a failure on their part,” Jack says.
But the impact of a diagnosis on patients—and the desire many patients have to control blood sugar without medication or insulin—shouldn’t be ignored, Taylor and others emphasize. Results of the survey were published in Diabetic MedicineIn February 2018, this was the most common type of diabetes. 1 question patients want researchers to answer about the disease: “Can Type 2 diabetes be cured or reversed, what is the best way to achieve this, and is there a point beyond which the condition can’t be reversed?”
Taylor acknowledges that many people with the chronic condition see it as something the doctor will deal with; patients often get help with controlling blood sugar, but their goal isn’t remission. “However, at least 40% of people with Type 2 diabetes hate their condition and would go to lengths to get rid of it,” he says. “They describe the moment of diagnosis as a hammer blow. Many doctors do not understand that.”
Taylor offers some suggestions for those looking to get remission.
- Keep track of your motivations so that you are able to refer back later.
- Talk about your plans and share them with people who live and work nearby. This will help you gain support.
- Once you’re ready, decide when to start—and prepare meticulously. “This is not a crash diet,” Taylor says.
- Understand that your chances of remission are best the closer you are to diagnosis, but it’s still possible even up to 10 years after diagnosis. It’s less common beyond that; waiting makes the goal harder to attain.
- Remission is possible through weight loss, activity, diet and adherence.
Whether your aim is remission or to improve blood-sugar control through lifestyle changes in addition to taking diabetes medication or using insulin, you’ll want to make it clear to your endocrinologist. And together, carefully parse out a dietary approach in advance of implementing changes to what you eat to ensure it’s safe and that you’re getting all the nutrients you need.
Wilson stressed that it was vital for him see a doctor who shares his dedication to diabetes.
Other conditions could be aggravated by his Type 2 Diabetes, like supraventricular Tachycardia or high blood pressure. He also has risk factors—like a family history of kidney disease—that diabetes could exacerbate. So Wilson wants to make sure his A1c remains well under 6.5% and has worked hard to ensure it’s easily within the normal, healthy range.
The longtime medic wasn’t messing around when he decided to try to reverse his Type 2 diabetes in 2020. So he went to his endocrinologist, who put him on a strict 1,200-calorie-per-day diet, which Wilson followed closely. Wilson ate lean protein, consumed lots of water, reduced carbs, reduced sugar and kept active. He lost 60 pounds by following these steps. Although there’s no single diet that’s recommended to achieve remission, low-calorie and low-carb plans have been found to help with weight loss, and shedding significant pounds can increase one’s chances of achieving remission.
Wilson is grateful to his wife Sheila, who supported him during his Type 2 diabetes journey. Sheila exercises alongside him and supports him in maintaining a healthy diet. “We still have to hold each other accountable,” says Wilson, adding that he uses the ADA as a resource and volunteers with the organization to support others. “I feel pretty good knowing that with hard work, you can accomplish a goal, and I’ve done that with the help of my family.”
He’s also careful not to grow complacent. That’s something experts say is critical to not only achieve but—more important—maintain Type 2 diabetes remission.
Wilson says he is ready to keep working hard. “I didn’t work this hard to lose the weight to go back to the way it was,” he says.
Here are more must-read stories from TIME