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Can Diabetic Nephropathy Be Reversed?

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Diabetic nephropathy is considered irreversible and is a chronic complication of diabetes that cannot be cured. The survival period varies for each patient, with some living around 10 years and others up to 20 years. This largely depends on the progression of diabetic nephropathy in each individual. Some diabetes patients may already have diabetic nephropathy or reach a stage of renal insufficiency. However, with good control of blood sugar and blood pressure, along with regular medication, the kidney disease may stabilize and not progress further. In such cases, the life expectancy of these patients may reach around 20 years.

For diabetes patients with concurrent kidney diseases, such as renal insufficiency, poor control of blood pressure and blood sugar, inadequate treatment, and a continuous rise in creatinine levels leading to uremia, prompt dialysis treatment is required. The life expectancy for these patients is relatively short, possibly around 10 years, with more severe cases facing a survival period of around 5 years.

The Definition Of Diabetes Reversal: Reversal ≠ Cure

The ability to maintain blood sugar at normal levels without medication is referred to as the “reversal” of diabetes. On August 30, 2021, the International Diabetes Experts drafted the “Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes.” In this consensus, the term “reversal” of diabetes is also referred to as “remission.”

From the literal meaning of “remission,” we can understand that the reversal of diabetes is essentially a form of relief of the condition, reaching a state that is relatively mild, manageable, and does not require medication.

This is currently the most authoritative and professional explanation. Therefore, we can conclude that the reversal of diabetes is not a cure, but it is indeed an ideal state for diabetes patients.

The Diagnostic Criteria For The Reversal Of Diabetes

The diagnostic criteria for the reversal of diabetes in the domestic medical community currently include:

Cessation of Antidiabetic Medications: The patient should stop antidiabetic medications for a minimum of 3 months.

Hemoglobin A1c Level: The hemoglobin A1c (HbA1c) level should be less than 6.5%.

These criteria serve as the gold standard for any diabetes reversal service. Meeting these conditions indicates a state where a patient has successfully achieved diabetes reversal, characterized by stable blood sugar levels without the need for antidiabetic medications for a specified duration, coupled with a HbA1c level below the defined threshold.

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Considerations For Diagnosing Diabetes Reversal

When diagnosing the reversal of diabetes, it’s important to consider the following:

1.Monitoring Hemoglobin A1c Levels

It is recommended to have blood drawn and tested at a hospital to monitor hemoglobin A1c levels accurately.

Alternatively, specialized instruments and devices can be used for testing.

Estimating hemoglobin A1c levels can also be done by assessing fasting blood sugar levels.

2.Timing of Diabetes Reversal Diagnosis

If diabetes is treated through surgery, self-assessment for diabetes reversal should be done at least 3 months after the procedure.

For those using lifestyle interventions, self-assessment for diabetes reversal should be carried out at least 6 months after the intervention. Additionally, all blood glucose-lowering medications should be discontinued for at least 3 months before evaluation.

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Who Can Reverse Diabetes

As evident, diabetes reversal, while not a cure, significantly improves the quality of life for patients by effectively managing the condition and eliminating the hassle of injections and medications. Many diabetes patients are enthusiastic about the prospect of achieving reversal. However, it’s essential to note that there are limitations to reversal, and not all diabetes patients can attain it. A thorough and scientifically rigorous assessment is necessary to determine eligibility. In general, only individuals in the prediabetic stage and some with type 2 diabetes can potentially achieve reversal.

A comprehensive assessment across four dimensions includes:

(1)Exclusion of Autoimmune Diabetes

Negative results in diabetes autoimmune antibody tests, including glutamic acid decarboxylase antibodies and other islet-related antibodies, help rule out autoimmune diabetes.

(2)Overweight or Obesity

Presence of overweight or obesity, indicated by a Body Mass Index (BMI) ≥ 25 kg/m2 or a waist circumference exceeding 90cm for males and 85cm for females.

(3)Preservation of Pancreatic Beta-Cell Function

Presence of preserved pancreatic beta-cell function, as indicated by fasting C-peptide levels ≥ 1.1 ng/ml and postprandial 2-hour C-peptide levels ≥ 2.51 ng/ml.

(4)Short Disease Duration

A short duration of diabetes, with the condition having been present for less than 5 years.

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1.Diabetes Patients with Preserved Pancreatic Function

The pancreatic function serves as the control switch for blood sugar, playing a crucial role in determining its levels. When diabetes is diagnosed, the remaining pancreatic function is typically in the range of 30% to 50%. Between 50% and 70%, pancreatic function may be dormant or deceased. During this stage, where pancreatic function damage is not extensive, there is a significant opportunity to awaken dormant pancreatic cells.

For diabetes patients with a short duration of the disease, studies abroad suggest that the shorter the duration, the greater the chance of reversal. Ideally, taking action to address diabetes as soon as abnormal blood sugar is detected can be pivotal. The summary is as follows:

Diabetes for 2 years: Approximately 80% have the potential for reversal.

Diabetes for 5-10 years: About 60% have a chance of reversal.

Diabetes for 10 years: Approximately 20% have a chance of reversal.

2.Obese Diabetes Patients

Many cases of diabetes are linked to obesity, and weight loss proves to be a highly effective method for glycemic control. Scientific weight loss can transform about 80% of diabetes patients into “healthy” individuals.

Note: The normal range for BMI is 18.5-23.9. For male diabetes patients, the waist circumference should not exceed 90 centimeters, and for female diabetes patients, it should be controlled within 85 centimeters. For obese diabetes patients, reducing waist circumference by 10 centimeters can be a highly effective means of reactivating pancreatic function. However, it’s important to emphasize that for diabetes patients, being too thin is not necessarily better. Maintaining weight within the standard range is optimal.

3.Diabetes Patients with a Short Duration and No Other Complications

The presence of complications such as diabetic neuropathy, ischemic heart disease, and high blood pressure also serves as relevant indicators for assessing the potential for reversal. Diabetes itself may not be inherently threatening; what is concerning are the complications that gradually develop, often likened to the proverbial frog in gradually heating water. Antioxidant stress and anti-inflammatory measures play a crucial role in the prevention and improvement of diabetes-related complications.

Contrary to common belief, diabetes is not solely about impaired blood sugar. Elevated blood sugar marks the beginning of the diabetic journey, and many patients already experience organ damage at the time of diagnosis. Therefore, chronic complications resulting from organ damage and vascular complications caused by high blood sugar require careful attention.

Diabetes complications are diverse, including but not limited to retinal changes, kidney failure, cardiovascular events, and amputations. These complications pose significant threats to the overall health of the individual.

01. Retinal Changes

Due to prolonged elevated blood sugar levels in diabetes patients, the blood vessel walls become damaged. Components from within the blood vessels may leak outside, leading to ischemia and hypoxia in the retina, resulting in retinal changes.

Once the retina undergoes pathological changes, it can adversely impact a person’s vision. In severe cases, retinal changes can lead to blindness.

02. Kidney Failure

The increasing prevalence of type 2 diabetes over the past few decades is a major contributing factor to the global rise in end-stage renal disease. Currently, it is estimated that over 3 million people worldwide are undergoing treatment for kidney failure, and this number is projected to exceed 5 million by 2035.

Diabetic nephropathy affects up to 40% of diabetes patients and stands as an independent risk factor for cardiovascular diseases, hypertension, retinal disorders, and premature death. Furthermore, as many as 45% of diabetes patients progress to end-stage renal disease.

In reality, diabetes is preventable and manageable. While complete cure might be challenging, timely medication, a healthy lifestyle, and proper management can prevent significant damage to the body.

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What Methods Can Relieve Diabetes?

Three Approaches to Achieve Remission

1.Dietary and Exercise Control

Strengthening lifestyle interventions forms the fundamental approach to achieving remission in type 2 diabetes, focusing on both dietary nutrition and physical activity.

Patients with type 2 diabetes and obesity can opt for energy-restricted diets (e.g., energy-restricted Mediterranean diet) and short-term, specialized diets (such as low-carbohydrate diets, very low-carbohydrate diets, ketogenic diets) alongside incorporating exercise.

Developing a Dietary Plan

DASH Diet (Recommended): The Mediterranean Diet encompasses the eating habits of Southern European countries such as Greece and Southern Italy, located along the Mediterranean coast. It primarily emphasizes plant-based foods with a low glycemic index, including vegetables, fruits, and whole grains. Additionally, it incorporates moderate amounts of fish or poultry, dairy products, limited red meat, and a diet pattern that includes olive oil. It involves controlling the overall energy intake.

There are three main types of energy restriction within this diet:

Reducing calorie intake by 30% to 50% based on the intake calorie target.

Daily reduction of approximately 500 calories from the intake calorie target.

Daily intake of 1000 to 1500 calories.

It is recommended to consider this plan as the fundamental dietary approach for alleviating type 2 diabetes.

DASH diet

Short-Term Specialized Diets

Low-Carbohydrate Diet: This diet involves consuming carbohydrates below 130 grams per day or less than 520 calories per day, while ensuring the intake of essential elements such as protein, vitamins, minerals, dietary fiber, and water. For those consuming 20 to 50 grams of carbohydrates per day or having carbohydrate energy intake below 200 calories, it falls into the category of a very low-carbohydrate diet.

Ketogenic Diet: This diet is characterized by a high proportion of fat intake (70%-75%), moderate protein intake (20%-27%), and an extremely low carbohydrate intake (3%-5%).

These types of dietary plans are nutritionally unbalanced and may lead to adverse reactions such as non-fat weight loss, increased risk of gout, and electrolyte imbalances. They should only be implemented for a short duration, typically 4 to 12 weeks, and require guidance from professional physicians and nutritionists. Additionally, it’s important to note that patients should not take SGLT2 inhibitors while following these diets.

2.Developing an Exercise Plan

Activities: The exercise plan should include both aerobic and resistance training. Aerobic exercises involve continuous and repeated body movements, primarily relying on aerobic metabolism. Examples include jogging, brisk walking, swimming, cycling, and various sports. Resistance training, also known as muscle strength training, involves active movements of muscles against external resistance. Examples include dumbbell exercises, weightlifting, sit-ups, push-ups, and more.

Intensity: Aim for at least 30 minutes of moderate-intensity aerobic exercise daily. If maintaining this frequency and duration is challenging, break it into 10-minute sessions, three times a day. Additionally, incorporate resistance training at least twice a week, with each session lasting for 30 minutes.

Considerations: Patients with conditions such as high blood pressure, coronary heart disease, or other health issues affecting exercise should assess their own exercise capabilities. It is important to consult with healthcare professionals to evaluate suitability and safety for engaging in physical activities.

It is crucial to emphasize that after diabetes “reversal,” one should not relax this lifestyle just because blood sugar levels are normal. Only through the long-term commitment to healthy dietary and exercise habits, along with regular monitoring of blood sugar levels, can one better maintain the alleviated state of diabetes.

3.Pharmacological Intervention

Three Types of Medications:

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

These medications not only lower blood sugar levels but also improve pancreatic function, aid in weight reduction, and have protective effects on the cardiovascular system and kidneys. In patients with type 2 diabetes who are also obese, it is possible to achieve diabetes alleviation through the use of these drugs.

Short-Term Intensive Insulin Therapy

There is a common misconception among diabetes patients that once insulin is initiated, it becomes a lifelong commitment. However, for certain type 2 diabetes patients, especially those who are lean, short-term (2 weeks) intensive insulin therapy can be employed to alleviate the toxic effects of high glucose, improve beta-cell function, and, in some cases, achieve “reversal” of diabetes.

Finerenone

Finerenone is a nonsteroidal MRA indicated for reducing the risk of chronic kidney disease (stages 3 and 4 with albuminuria) progression, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adults with type 2 diabetes (T2D)-related chronic kidney disease.

In February 2023, Bayer announced the European Commission’s approval to expand the indication of Finerenone tablets in the EU. The expanded indication covers the early stages of chronic kidney disease associated with type 2 diabetes.

4.Metabolic Surgical Intervention

For individuals with a body mass index (BMI) ≥32.5 kg/m² who have type 2 diabetes and find that lifestyle interventions and medication treatments fail to improve weight or achieve diabetes relief, and if severe complications have already emerged, metabolic surgery (laparoscopic gastric bypass surgery or laparoscopic sleeve gastrectomy) may be considered.

It is essential to emphasize that not all diabetes patients can achieve blood sugar reversal through surgical means. Additionally, surgery may entail early complications (such as postoperative anastomotic bleeding, stenosis, fistula formation) and medium-to-long-term complications (such as malnutrition, incisional hernia, anastomotic ulcer).

Type 2 diabetes is a complex condition. Early and proactive treatment can help more patients regain health and improve their quality of life. It’s crucial to remember that establishing a healthy and scientific lifestyle can bring lifelong benefits.

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