{"url":"https://whatshealthyandwhy.com/type-2-diabetes/can-type-2-diabetes-be-reversed-naturally","path":"/type-2-diabetes/can-type-2-diabetes-be-reversed-naturally","alternates":{"json":"https://whatshealthyandwhy.com/api/articles/type-2-diabetes/can-type-2-diabetes-be-reversed-naturally.json","markdown":"https://whatshealthyandwhy.com/type-2-diabetes/can-type-2-diabetes-be-reversed-naturally.md"},"topic":{"slug":"type-2-diabetes","name":"Type 2 Diabetes","url":"https://whatshealthyandwhy.com/type-2-diabetes"},"slug":"can-type-2-diabetes-be-reversed-naturally","order":1,"title":"Type 2 Diabetes: Diet, Exercise, and Remission","question":"Can type 2 diabetes be reversed or put into remission naturally?","answer":"It probably can, mainly early on: intensive weight loss put nearly half or more of trial participants in remission at one year, but many relapse.","description":"What weight loss, exercise, low-carb eating, fasting and supplements can do for type 2 diabetes, how often remission occurs, and how long it lasts.","confidence":4,"confidenceNote":"Randomised trials show remission after intensive weight loss, and a meta-analysis supports low-carbohydrate diets at six months, but remission often fades and no trial shows fewer heart attacks.","evidenceSummary":{"rctCount":5,"observationalCount":1,"metaAnalysisCount":3,"totalParticipants":"8,500+","replicated":true,"newestStudyYear":2024},"category":{"categoryTitle":"Your Body","categorySlug":"your-body","subcategoryName":"Body Systems","subcategorySlug":"systems","url":"https://whatshealthyandwhy.com/explore/your-body/systems"},"actions":["Ask your care team about a supervised weight-loss plan, especially if diabetes is recent: in DiRECT, remission rose with weight lost, reaching 86% in those who lost 15+ kg [1].","Build up to 150+ weekly minutes of aerobic or resistance exercise: pooled trials found HbA1c (average blood sugar) fell 0.67 points, and 0.89 beyond 150 minutes [8].","Choose an eating pattern you can keep, such as Mediterranean-style eating: in newly diagnosed adults, 44% needed medicine after 4 years versus 70% on a low-fat diet [7]."],"cautions":["Never stop or cut diabetes or blood pressure medicines alone: in DiRECT, clinicians withdrew them within a supervised programme [1], and a fasting trial reduced low-sugar-risk medicines first [9].","On insulin or sulfonylureas? Low-calorie, low-carb or fasting plans can swing blood sugar: 35% of users had low or high glucose events in a fasting trial's first two weeks [9].","Taking an SGLT2 inhibitor (names ending in -gliflozin)? Low-carbohydrate diets, fasting, dehydration and heavy drinking can trigger ketoacidosis even when glucose looks normal, so ask your doctor first [12]."],"simpleText":"It can, especially in the first years after diagnosis. In the DiRECT trial, a supervised programme of low-calorie formula diet and gradual food reintroduction put 46% of people into remission after one year, against 4% with usual care [1]. Remission tracked weight lost, but it often fades: 13% of those followed with continued support were still in remission at five years [2]. Gentler lifestyle programmes work less often [3]. Medicines still matter; never stop them without your care team.","mediumText":"How it works\n\nWhat remission means. An expert group convened by the American Diabetes Association defined remission as an HbA1c (a blood test of average sugar over about three months) below 6.5% (48 mmol/mol), measured at least 3 months after stopping glucose-lowering medicine. It is not a cure, and they advise continuing to observe people in remission [4].\n\nWeight is the main lever. In DiRECT (306 adults diagnosed within the past 6 years, not on insulin), remission rose with weight lost: none of the 76 people who gained weight, 7% of those who lost up to 5 kg, 34% at 5 to 10 kg, 57% at 10 to 15 kg and 86% at 15 kg or more. The programme withdrew diabetes and blood pressure medicines, used a formula diet of 825 to 853 kcal a day for 3 to 5 months, then reintroduced food and offered long-term support [1]. A trial in Qatar in adults aged 18 to 50 with diabetes for 3 years or less found remission in 61% versus 12% with usual care at 12 months [5].\n\nKeeping it off is harder. At two years, 36% of the DiRECT group were in remission; at five years, 11 of 85 people (13%) who received continued support were [2]. A standard behavioural programme with counselling, calorie reduction and activity (4,503 US adults) produced partial or complete remission in 11.5% in year 1 and 7.3% by year 4, versus 2.0% with usual education [3].\n\nFood patterns. Low-carbohydrate diets (under 130 g of carbohydrate a day) raised remission at 6 months (57% versus 31%, with remission defined by HbA1c alone), but the benefit was smaller if remission required being off medicines and was unclear by 12 months [6]. A Mediterranean-style diet delayed the need for medicine in newly diagnosed people [7]. See our Mediterranean diet article.\n\nExercise and fasting. Structured exercise lowers HbA1c on its own [8]. Two non-consecutive days a week of 500 to 600 kcal gave similar HbA1c results to daily calorie restriction over a year [9]. See our insulin resistance guide.\n\nSupplements are minor. In 10 trials, cinnamon lowered fasting glucose by about 25 mg/dL on average but did not significantly change HbA1c [10]; see our cinnamon article.\n\nWhat remission does not prove. A large trial of intensive weight-loss lifestyle changes did not reduce the rate of cardiovascular events [11]. Keep your regular checks.","deepText":"The evidence in detail\n\nDiRECT and DIADEM-I\n\nDiRECT randomised 49 UK primary care practices (306 adults aged 20 to 65, diabetes under 6 years, BMI 27 to 45, no insulin). At 12 months, remission (HbA1c under 6.5% at least 2 months off all diabetes drugs) occurred in 68 of 149 people (46%) versus 6 of 149 (4%) (odds ratio 19.7, 95% CI 7.8 to 49.8). Mean weight fell 10.0 kg versus 1.0 kg. Nine serious adverse events occurred in the intervention group and two in controls; two (biliary colic and abdominal pain) were possibly related [1]. At 24 months, 36% of the intervention group were in remission [2]. The five-year extension followed 85 people who continued support: they lost 6.1 kg on average and 13% were in remission; among all original intervention participants, 27% of visits were in remission versus 4% for controls, and 26% of those in remission at year 2 were still in remission at year 5 [2]. DIADEM-I (158 randomised, 147 analysed) used a similar formula-diet approach with physical activity support: weight fell 11.98 kg versus 3.98 kg, and remission occurred in 61% versus 12% (OR 12.03, 5.17 to 28.03) [5]. Both were open-label, in early diabetes, and used intensive supervised programmes.\n\nLook AHEAD\n\nThe Look AHEAD lifestyle programme (2,241 intensive versus 2,262 education) achieved weight loss of 7.9% more than controls at year 1 and 3.9% more at year 4. Any remission was 11.5% in year 1 and 7.3% at year 4, versus 2.0%; sustained remission for 4 years was 3.5% versus 0.5%. The authors called absolute rates modest [3]. In the main trial (5,145 adults, stopped early for futility at a median 9.6 years), the primary cardiovascular outcome occurred at 1.83 versus 1.92 events per 100 person-years (HR 0.95, 95% CI 0.83 to 1.09) [11].\n\nDiet and exercise trials\n\nA meta-analysis of 23 trials (1,357 people) found low-carbohydrate diets gave 57% (76 of 133) remission at 6 months versus 31% (41 of 131) (risk difference 0.32, 95% CI 0.17 to 0.47; eight studies, 264 people), with smaller non-significant effects when remission meant off medicine, and a marked drop in studies including insulin users. At 12 months data were sparse, and benefits for weight, triglycerides and insulin sensitivity diminished. Certainty was moderate to low [6]. In 215 newly diagnosed overweight adults, 44% on a Mediterranean-style diet versus 70% on a low-fat diet needed drugs by year 4 (HR 0.63, 0.51 to 0.86); investigators starting drugs were not blinded and intake was self-reported [7]. A meta-analysis of 47 trials (8,538 patients) found structured exercise lowered HbA1c by 0.67 points (95% CI 0.49 to 0.84), aerobic by 0.73, resistance by 0.57 and combined by 0.51; more than 150 minutes a week lowered it by 0.89 versus 0.36 for 150 minutes or less; advice alone changed nothing unless paired with diet advice [8].\n\nFasting and supplements\n\nIn 137 adults with type 2 diabetes, two days a week of 500 to 600 kcal and daily restriction of 1,200 to 1,500 kcal produced equivalent HbA1c changes at 12 months (-0.3% versus -0.5%; 90% CI of difference -0.2 to 0.5); 97 completed the trial, and weight loss was not shown to be equivalent. Glucose events affected 35% of those taking sulfonylureas or insulin in the first two weeks [9]. Cinnamon at 120 mg to 6 g a day for 4 to 18 weeks (10 trials, 543 patients) lowered fasting glucose by 24.6 mg/dL (95% CI 8.7 to 40.5) but not HbA1c (-0.16%, -0.39 to 0.02), with high heterogeneity [10].\n\nWhere the evidence disagrees\n\nRemission rates depend on the definition and programme: 46% to 61% with formula diets, about 7% to 12% with standard behavioural programmes, and 57% at six months for low-carbohydrate diets defined by HbA1c alone [1][3][5][6]. Durability is the weak point, with most gains lost by five years without continued support [2]. Remission has not been shown to prevent heart attacks in a randomised trial [11], and the DiRECT-type programmes are not \"natural\" in the sense of unsupervised: they were medically managed [1][5]. SGLT2-inhibitor ketoacidosis can occur with low-carbohydrate diets or fasting [12].\n\nBottom line (confidence 4 of 5). Early type 2 diabetes can go into remission with large, sustained weight loss, and exercise and food-pattern changes help glucose control. It is a supervised, effortful process that often needs ongoing support, and medicines remain central for many people.","deepTruncated":false,"references":[{"id":"1","title":"Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial","authors":"Lean ME, Leslie WS, Barnes AC, et al.","year":2018,"journal":"Lancet","pmid":"29221645","url":"https://pubmed.ncbi.nlm.nih.gov/29221645/"},{"id":"2","title":"5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study","authors":"Lean ME, Leslie WS, Barnes AC, et al.","year":2024,"journal":"Lancet Diabetes Endocrinol","pmid":"38423026","url":"https://pubmed.ncbi.nlm.nih.gov/38423026/"},{"id":"3","title":"Association of an intensive lifestyle intervention with remission of type 2 diabetes","authors":"Gregg EW, Chen H, Wagenknecht LE, et al.","year":2012,"journal":"JAMA","pmid":"23288372","url":"https://pubmed.ncbi.nlm.nih.gov/23288372/"},{"id":"4","title":"Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes","authors":"Riddle MC, Cefalu WT, Evans PH, et al.","year":2021,"journal":"Diabetes Care","pmid":"34462270","url":"https://pubmed.ncbi.nlm.nih.gov/34462270/"},{"id":"5","title":"Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial","authors":"Taheri S, Zaghloul H, Chagoury O, et al.","year":2020,"journal":"Lancet Diabetes Endocrinol","pmid":"32445735","url":"https://pubmed.ncbi.nlm.nih.gov/32445735/"},{"id":"6","title":"Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data","authors":"Goldenberg JZ, Day A, Brinkworth GD, et al.","year":2021,"journal":"BMJ","pmid":"33441384","url":"https://pubmed.ncbi.nlm.nih.gov/33441384/"},{"id":"7","title":"Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial","authors":"Esposito K, Maiorino MI, Ciotola M, et al.","year":2009,"journal":"Ann Intern Med","pmid":"19721018","url":"https://pubmed.ncbi.nlm.nih.gov/19721018/"},{"id":"8","title":"Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis","authors":"Umpierre D, Ribeiro PA, Kramer CK, et al.","year":2011,"journal":"JAMA","pmid":"21540423","url":"https://pubmed.ncbi.nlm.nih.gov/21540423/"},{"id":"9","title":"Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial","authors":"Carter S, Clifton PM, Keogh JB","year":2018,"journal":"JAMA Netw Open","pmid":"30646030","url":"https://pubmed.ncbi.nlm.nih.gov/30646030/"},{"id":"10","title":"Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis","authors":"Allen RW, Schwartzman E, Baker WL, et al.","year":2013,"journal":"Ann Fam Med","pmid":"24019277","url":"https://pubmed.ncbi.nlm.nih.gov/24019277/"},{"id":"11","title":"Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes","authors":"Wing RR, Bolin P, Brancati FL, et al. (Look AHEAD Research Group)","year":2013,"journal":"N Engl J Med","pmid":"23796131","url":"https://pubmed.ncbi.nlm.nih.gov/23796131/"},{"id":"12","title":"SGLT2 Inhibitor-associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis","authors":"Goldenberg RM, Berard LD, Cheng AYY, et al.","year":2016,"journal":"Clin Ther","pmid":"28003053","url":"https://pubmed.ncbi.nlm.nih.gov/28003053/"}],"wordCount":1202,"source":{"path":"src/content/topics/type-2-diabetes/can-type-2-diabetes-be-reversed-naturally.md"},"citeAs":"“Can type 2 diabetes be reversed or put into remission naturally?.” What's Healthy and Why. https://whatshealthyandwhy.com/type-2-diabetes/can-type-2-diabetes-be-reversed-naturally","notice":"General information backed by peer-reviewed research, not medical advice."}