insights

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Many functional and integrative clinicians have had patients with 2 diabetes (T2D) who have lost that diagnosis as a result of sustained lifestyle modifications. Yet up until now, there was little recognition in the wider medical community that such change was possible and no established language to describe this phenomenon. In a sudden reversal of this longstanding trend, late last year, the American Diabetes Association convened an international expert group to officially recognize that such change was possible and propose new terminology to describe it. The result was a consensus report outlining the definition and clinical details of what the group termed diabetes remission.1 The report also recognizes the importance of lifestyle change as a primary cause of T2D remission and its publication is at least in part the result of many years of ongoing clinical successes by functional medicine clinicians and others who focus on lifestyle change as the primary treatment for T2D. 

To summarize the consensus statement, the authors suggest: 

• The term remission be used to describe sustained return to normoglycemia, which should be defined by an HbA1c of <6.5% that occurs spontaneously or following an intervention and that persists for at least three months in the absence of usual glucose-lowering pharmacotherapy.  
• When HbA1c cannot be reliably used, a fasting plasma glucose of FPG <126 mg/dL or eA1C <6.5% calculated from CGM values can be used as alternate criteria.  
• Further testing should be done at least once per year to determine long-term maintenance along with continued routine testing for potential complications of diabetes (e.g., retinopathy, neuropathy). 
• Further research is needed to determine the frequency, duration, and effects on short- and long-term outcomes of T2D remission.1 

It is encouraging to see recognition of the potential for T2D remission among the leading diabetes organizations and at least some measure of understanding that lifestyle is important in achieving this goal. Functional medicine clinicians, with their primary focus on sustainable lifestyle change to prevent and treat T2D and other dysfunction, are leading the way in helping patients achieve remission. Future research will tell us more about how lifestyle change may impact the ongoing risks of those in remission.  

IFM members can can read a longer version of this news article with additional commentary on the findings in the September 2022 issue of Connections, IFM’s monthly email member newsletter.

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References 

1. Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44(10):2438-2444. doi:10.2337/dci21-0034