Dr Mohammad Arif Shahar
First published: 17 December 2020
Last updated: 31 August 2021
“Cure” – brings a connotation of ‘complete amelioration and subsequently absence of – not only symptoms – but the disease itself.’
“Reversal” – brings about an understanding of ‘the return of the original state in which the illness is absent.’
“Remission” – is a medical term used to describe the absence of symptoms of a disease without referring to complete resolution of the underlying core pathology of the disease itself. The usage of the term “remission” necessitates the presence of its antonym, a state that is called “relapse”.
Diabetes – for sure – is a state where “remission” and “relapse” could occur with fluctuation of weight and change in lifestyle. Thus, using the word “remission” for diabetes is medically accurate.
A paper published in the Lancet in 2018 described that more than 50% of patients with diabetes is able to achieved “remission” with meal replacement & lifestyle modification in the primary care setting[i]. The DIRECT trial which described “remission” of diabetes showed that a third of diabetes patient remained in “remission” from diabetes after 2 year.[ii]
The idea of “remission” in diabetes has been talked about more in recent years among the medical professionals and research community. However, major diabetes organisations are sending signals to exercise caution with the use of the term “remission” for diabetes. In addition to that, the definition of “remission” for diabetes is still a debate. A suggested criteria used was (1) absence of glucose-lowering therapy; (2) normoglycaemia – most defined as glycated haemoglobin (HbA1C) less than 6.0%; and (3) for duration of at least 1 year.[iii]
The recent consensus statement by the American Diabetic Association (ADA) suggests a more lenient definitions of diabetes “remission”. “Remission” was defined as a return of HbA1C to <6.5% that occurs spontaneously or following an intervention and that persists for at least 3 months in the absence of usual glucose-lowering agent.[iv]
While the term “remission” of diabetes is absolutely appropriate among the medical fraternity; this term is alien to the lay speaking community.
In simple English, “cure” from diabetes or “reversal” of diabetes is much more intuitive. Apart from not having to deal with medical jargons, the word “cure” and “reversal” brings about a positive outlook for patients with diabetes. However, the word must be qualified with an explanation that “remissions” and “relapses” may occur with fluctuation in weight and change in lifestyle.
“Cure” and “reversal” motivates patients to work on lifestyle modifications that would help their diabetes.
The more exigent question is:
While patients are working frantically on dealing with their diabetes, should health care professionals be debating on whether the word “cure”, “reversal” or “remission” be used?
This is a call to action, not to question – support your patients. supportedlifestylemodification.com.
(Disclaimer: This article is the author’s opinion on the rhetorical question of whether diabetes is “curable” or “reversible”. The author does not endorse the use of any commercially available meal replacement or any form of specific dietary regime).
[i] Lean et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. VOLUME 391, ISSUE 10120, P541-551, FEBRUARY 10, 2018. https://doi.org/10.1016/S0140-6736(17)33102-1
[ii] Lean et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. . https://dx.doi.org/10.1016/S2213-8587(19)30068-3
[iii] Captieux et al. Defining remission of type 2 diabetes in research studies: A systematic scoping review. PLOS Medicine. 2020. https://doi.org/10.1371/journal.pmed.1003396
[iv] Matthew C. et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes Diabetes Care 2021 Aug; https://doi.org/10.2337/dci21-0034