Interpretation of Reversal and Remission
The essence of diabetes reversal is the recovery of the function of islet B-cells and insulin sensitivity in patients, which is manifested as the ability to maintain good blood sugar control for a period of time even after the intensity of blood sugar-lowering treatment is reduced.
For newly diagnosed or patients with a short disease course of type 2 diabetes, reversal is to be free from oral hypoglycemic drugs, that is, drug-free remission. Given that the Chinese diabetic population is more common with postprandial blood sugar increase, the “Expert Consensus on Reversing Type 2 Diabetes with Short-term Intensive Insulin Therapy” has proposed a stratified definition of the reversal state.
The consensus emphasizes that clinical remission belongs to a higher level of reversal; although patients who have achieved diabetes remission can be free from hypoglycemic drugs and other medical interventions, it does not mean “cure.” Even if drug-free remission has been achieved, diabetic patients still need to continue lifestyle management and regular monitoring to detect and intervene hyperglycemia as early as possible.
Why can short-term intensive insulin therapy reverse type 2 diabetes?
The goal of short-term intensive insulin therapy is to improve the function of islet B-cells and increase the sensitivity of insulin.
Comprehensive clinical evidence shows that short-term intensive insulin therapy can significantly improve acute insulin response, that is, the first-phase secretion, early-phase insulin secretion, and can also improve the ratio of insulin area under the curve to glucose area under the curve in the oral glucose tolerance test, C-peptide response, insulin secretion sensitivity index-2 and other B-cell function indicators, and significantly improve the insulin resistance index, thereby enhancing the body’s glucose disposal capacity.
Which groups are suitable for intensive treatment?
The “Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition)” suggests that intensive treatment can be implemented when newly diagnosed type 2 diabetic patients have a glycated hemoglobin ≥9.0% or fasting blood sugar ≥11.1 mmol/L, accompanied
