Diabetes doesn’t have to be a life sentence. Although the disease isn’t considered curable because it can return after several years, it can go into remission with appropriate medication and a change of diet and lifestyle.
More than one million adults in the UAE — or about 17 per cent of the population — have type 2 diabetes, according to the International Diabetes Federation.
“Contributing factors in the UAE include a sedentary lifestyle, stress and an unhealthy diet,” explains Dr Naveed Rauf, Specialist Cardiologist at Emirates Hospital Day Surgery and Medical Centre in Dubai Motor City.
Diabetes mellitus is a set of metabolic disorders characterised by high blood glucose levels. By far the most common is type 2 diabetes, a lifestyle disease triggered by factors such as obesity and age, as well as by ethnicity and family background. It accounts for 90 per cent of all cases and occurs when the body can’t produce enough insulin, or when insulin doesn’t regulate blood glucose levels properly.
“Type 2 diabetes has been proved to go into remission for some period of time,” says Dr Kishore Kumar Katam, Specialist — Endocrinology at Thumbay University Hospital, Ajman. He points to the DiRECT open-label study that tracked 280 participants in the UK over 24 months to assess whether lifestyle changes can trigger remission. Two years later, more than a third of participants remained in remission. “Younger people with new onset diabetes in whom insulin is started as initial therapy sometimes see diabetes go into remission,” says Dr Katam. “But [overall], weight loss due to a well-planned diet and exercise or bariatric surgery can cause remission of diabetes.”
The UAE has already clocked a reduction in overall levels of type 2 diabetes. In March, the Ministry of Health and Prevention announced that diabetes among adults dropped by over a third between 2010 and 2019, while adult obesity decreased by about a quarter.
GN Focus asks doctors across the nation to illustrate how type 2 diabetes goes into remission with case studies from their practice. For privacy reasons, the patients’ names have been left out.
Take a combined approach
Dr Katam cites the case of an overweight South Asian man aged 35 years, who visited the clinic with new onset diabetes and HbA1C levels above 10 per cent in February 2018. HbA1C is a blood pigment bound to glucose, tests for which indicate how well diabetes is being controlled. Normal levels are under 6 per cent. He’d had symptoms of increased urination and thirst for over two months. “He was frightened because he’d developed diabetes at a younger age,” says Dr Katam. “We counselled him to follow a low-calorie and high-fibre diet, with regular exercise. He was advised to take insulin as the sugars were very high, above 250 mg/dL. He was started on premix insulin; two weeks later, his sugars were well controlled. Insulin was slowly brought down to the lowest possible dose, before being stopped entirely.”
Several follow-ups later, through to July, the patient has been able to maintain blood sugar levels without insulin in the target range, but by keeping a careful watch on his diet and exercise.
“The period of remission depends on diet, exercise and genetic background.”
Drugs combined with lifestyle changes delivered quick results for an Arab patient too.
“On February 2, a 34-year-old male who was obese at 115kg with high fasting glucose, elevated blood pressure and high cholesterol levels was counselled about his condition and offered a treatment of lifestyle modification and metformin for three months,” explains Dr Rauf.
“He came back seven months later after losing 14kg. We repeated the blood tests and all was within normal limits. He’d taken metformin for three months only and did the rest with lifestyle modification. This included diet control, calorie reduction and reduced carbohydrate intake, as well as exercise of least half an hour five times per week and giving up smoking.
“There’s so much we still don’t know about how long remission lasts or complications in the future, but lowering your blood sugar, blood pressure and cholesterol definitely reduces the risk of complications.”
Involve the family
Dr Sarla Kumari, Specialist Physician Diabetologist, Canadian Specialist Hospital, tells of a 35-year-old Egyptian man who weighed 140kg and had a BMI of over 40. “He came to me in May 2018, feeling weak and tired. He complained of repeated throat infections, had a family history of diabetes and his HbA1c levels were 9 per cent.
“We then involved his wife to help change his diet and prescribed one hour’s brisk walk aimed at weight reduction and started him on oral hypoglycaemic medication Janumet two times a day. We explained diabetes can be reversed with weight loss, gave him diet charts and referred him to a dietician.” The patient stopped eating rice and bread, opting instead for soups, salads, grilled fish and chicken, vegetables and fruit.
“Over a year, he has lost 40kg and now weighs 100kg. The good news is that his last HbA1c was 5.4 per cent, well within normal limits this June, and he remains committed to losing 10kg more. I credit his success to his willpower and strong determination to reverse his diabetes along with his wife’s support, and his commitment to regular check-ups so as to monitor his blood sugar levels.”
Add a surgical intervention
Dr Shaimaa Mashal, Specialist — Internal Medicine at Bareen International Hospital, MBZ City, Abu Dhabi, describes the case of a 38-year-old obese Arab woman: “She had type 2 diabetes for four years on (uncontrolled) oral hypoglycaemic medication and presented with hyperglycaemia (400-500mg/dL) and all the basic symptoms of diabetes. Her HbA1C was 12.5 per cent.
“We changed all diabetic treatment to a diabetic diet, basal insulin combined with glycogens such as a peptide agent, short-acting insulin and combined metformin with sodium glucose transporter inhibitor.”
The patient responded quickly and within two months, her HbA1C levels dropped to 8 per cent. Nevertheless, Dr Mashal felt bariatric surgery would help her further. “Two weeks after surgery, her HbA1C was down to 7 per cent. On self-monitoring, her blood glucose is 100-120 mg/dL, so we reduced the insulin to a third of the total dose. There was an improvement in protein and lipid profiles as well. Overall, she has now a better quality of life and is on her way to remission.”