Endocrinologists Recommend Describing Dramatic Reversals of Diabetes Symptoms As

Reversal of symptoms: Cure or remission?

| Nov 14, 2009

How careful should healthcare workers and patients be in describing a total remission of diabetes as a "cure?" That's a question that has taken on increasing urgency in the wake of reports about dramatic reversals of type 2 symptoms after gastric bypass surgery and the cessation of symptoms in people with type 1 diabetes after pancreatic islet replacement. To answer it, a group of endocrinologists met earlier this year to come up with descriptions and definitions that accurately describe what happens when people with diabetes experience a reversal of symptoms.

Their answer, recently published in Diabetes Care, is that caregivers should use the term "remission" rather than "cure" as the preferred word. Their reasoning was based on the difference between what they call "dichotomous" diseases, like cancer, and diseases that exist on a continuum, like diabetes. In other words, with a disease like cancer, you either have it or you don't. With diabetes, which is defined by the level of hyperglycemia, the symptoms can be well controlled day by day even as the underlying cause of the disease remains uncured. At most, then, the disease can be said to be in remission if the hyperglycemia is successfully controlled over a prolonged period.

The endocrinologists agreed on certain definitions for describing remission in type 1 and type 2 patients:

    * "Partial remission" is when hyperglycemia remains below the diagnostic thresholds for diabetes for at least one year without the assistance of drugs or ongoing medical procedures.

    * "Complete remission" is when a patient consistently achieves normal non-diabetic glycemic levels for at least one year without the assistance of drugs or ongoing medical procedures.

    * "Prolonged remission" is a complete remission that lasts at least five years.

Although the endocrinologists reported that prolonged remission could be considered "essentially equivalent to a cure," for now "prolonged remission" is the closest they want to come to using "cure" to describing dramatic, enduring changes in diabetes symptoms. They reasoned that "remission" is more accurate than "cure" because therapies for type 1 and type 2 will probably always leave patients at risk for relapse.

For type 1 diabetes, the endocrinologists described remission as a consequence of immune system modulation or islet replacement that doesn't require continuing immune suppression via drugs. They also said that in people with type 1 who have undergone transplants and require continuing doses of immunosuppressive drugs, the term "remission" should not apply.

Remission in type 2 patients, they said, could follow bariatric/metabolic surgery or changes in diet, exercise and weight that produce a reversal of hyperglycemia. However, in the case of devices such as gastric banding, remission cannot be said to have occurred until the patient no longer requires adjustments to the device and has been living with it problem-free for some time.

The endocrinologists noted that even if treatments given to type 2s result in A1c levels of 6.5 percent or below-levels that some might consider to indicate an absence of diabetes-those levels continue to be a sign of impaired ability to properly produce or use glucose. Thus, the best they can do in describing such lower A1c levels is "partial remission."

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Categories: A1c Test, Diabetes, Diabetes, Health Care, Losing weight, The Cure, Type 1 Issues, Type 2 Issues

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Posted by DAR on 15 November 2009

According to this article, my type 2 diabetes could be considered to be at least in "partial remission" because I have kept my A1c under 6 for over 6 years (the past few without meds of any kind). However, I consider myself to be a "well-controlled type 2" because I know I am only one meal away from a BGL over 200 at any time.

Only by severely limiting my carb intake (20 or fewer net carbs per day) am I able to keep my BGLs where they are. How much I weigh has nothing to do with it. In fact, my BGLs are even pickier after losing 60 lbs to get into the normal weight range for my height, and working out to the point of getting hot and sweaty spikes my BGL instead of lowering it.

I think "remission" and "cure" are both inaccurate as long as my BGL still reacts to a high carb meal with a spike over nondiabetic levels (about 70-100).

Posted by cde on 16 November 2009

"Remission" is a figure of speech not appropriate to talking about DM, which is incurable. Obviously, "cure" is even less appropriate...ever (up till now at least). One piece of cake, as DAR suggests, and you again see full-fledged DM, which did not just develop because of the piece of cake but rather has been there all along.

I think the word long in use ("control" of diabetic hyperglycemia) is still the best choice. It is the word that we use most in Mexico...though of course "controlled" for some is quite different from "controlled" for others.

Dr. Stan De Loach
Mexico, Distrito Federal

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