The first line of treatment is to improve lifestyle habits (diet and exercise). In most cases, drug treatment must also be started. Over time, the dose and number of drugs may have to be increased to maintain optimal blood sugar control. This is due to the premature and accelerated aging of the pancreas. The pancreas is the organ that produces insulin, the key that allows sugar to enter cells. By the time type 2 diabetes is diagnosed, the pancreas has already lost an average of 50% of its ability to produce insulin, and this ability continues to decline over time.
A new approach is to treat type 2 diabetes early, intensively, but briefly, as soon as a diagnosis is made. This involves taking insulin for four to 12 weeks, while adopting healthy lifestyle habits. Animal studies suggest that by doing this some of the cells that produce insulin can get back to work and the abnormalities in insulin secretion may be partly reversible. The goal of this approach is therefore to induce a remission by intervening early in the disease and giving the pancreas a rest.
Studies have compared this new approach with current treatments. The results so far seem promising. A meta-analysis has shown that two years after stopping insulin, 40% of patients had not resumed the medication and maintained near-normal blood glucose levels.
Why is it called a remission and not a cure?
Remission refers to achieving good glycemic (blood glucose) control over an extended period of time without drug treatment. For the moment, no treatment can guarantee the complete disappearance of the disease.
What is the status of the recommendations?
No recommendations have been made to date for this new approach, as further studies are still needed to verify its efficacy, determine the most effective treatment and which patients could benefit the most.
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Research and writing : Diabetes Québec team of health care professionals
December 2017 (updated in July 2018)
Adapted of : Naomi Latendresse Desruisseaux, Katherine Desjardins, Corinne Suppère, Chantal Blais et Rémi Rabasa-Lhoret (Printemps 2017). Le diabète de type 2 : est-ce que la rémission est possible? Plein Soleil, Diabète Québec, p.14 à 16
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References :
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60762-X/fulltext
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70006-8/fulltext