Australia's peak authority on diabetes recently acknowledged the possibility that adults with type 2 diabetes could put the disease into remission through weight loss achieved by "intensive dietary changes", or bariatric surgery.
In its first position statement on the issue, Diabetes Australia conceded that while type 2 diabetes was previously understood to be a progressive condition, several recent studies had challenged that view.
"We now understand that, in some cases, progression can be stopped or slowed," the statement says.
HbA1c - also known as the hemoglobin A1C test - is a simple blood test that measures average blood sugar levels over three months.
"New research has shown it is possible for some people with type 2 diabetes to reduce their average glucose level to achieve an HbA1c of under 6.5 per cent and sustain them at that level for a prolonged period of time - at least three months - without the need for glucose -lowering medication," Diabetes Australia says.
"This is referred to as type 2 diabetes 'remission'. Remission is the best term to use - it does not mean that type 2 diabetes is cured or reversed. The underlying glucose intolerance may persist, an increased cardiovascular health risk may persist and, over time, glucose levels may return to levels indicating type 2 diabetes."
Remission of type 2 diabetes was more likely in people with a shorter duration of diabetes - less than five years, a lower HbA1c when attempting remission, and those not requiring insulin therapy.
Diabetes Australia says for people who are overweight or obese, remission of type 2 diabetes usually requires "substantial" weight loss.
"While any amount of weight loss is usually beneficial, people are more likely to achieve remission if they lose around 10-to-15 per cent of their body weight. Weight loss may be achieved through intensive dietary change - such as a very low energy diet, other healthy behaviour modification, or bariatric surgery."
The organisation says type 2 diabetes remission is "not realistic for everyone".
"Nor is it desirable for some people to stop taking certain glucose-lowering medications, as they have benefits beyond the management of blood glucose levels," Diabetes Australia says.
People with type 2 diabetes who want to attempt diabetes remission were advised to do so in "close consultation with their diabetes healthcare team", as intensive dietary and weight changes required careful management, monitoring and support.
"People who do not achieve or sustain remission should not feel that they have 'failed'," Diabetes Australia says. "The health benefits of weight loss and a reduction in HbA1c are significant even if remission does not occur."
