Reversing Type 2 Diabetes Mellitus

Diabetes mellitus(DM) is a chronic metabolic disease with increasing prevalence all over the world. The disease is classified into 2 main types : Type 1 and Type 2 Diabetes mellitus. According to the International Diabetes Foundationa an estimated 436 million people are currently living with type 2 DM.In 2011 that estimate was 366 million.

The IDF also reports that around 10% of global health expenditure is spent on Diabetes -- a whopping USD 60 billion annually.

The above figures are projected to get much higher over the next decade especially in urban areas. Growing urbanisation and lifestyle habits such as higher calorie intake, increasing consumption of processed foods and sedentary lifestyles are pushing the up figures. "The prevalence of type 2 Diabetes mellitus in urban areas is 10.8% compared to the lower prevalence of 7.2% in rural areas" --IDF.

Type 2 DM is characterized by high blood glucose levels (hyperglycaemia), insulin insensitivity, declining insulin production and eventual failure of pancreatic beta-cells responsible for producing the hormone

Insulin has a range of vital metabolic functions in the human body. The hormone coordinates the movement of excess blood glucose into muscle cells, liver and fat cells, ensuring that blood glucose levels do not remain too high long after the consumption of meals rich in carbohydrates.

Figure 1. Low Insulin production and utilisation in type 2 diabetes mellitus. Credit :: Thermofisher

Insulin induces the conversion of glucose to glycogen in the liver. Glycogen can subsequently be broken down to release glucose later when blood glucose levels become low. Maintaining this balance is crucial. The brain requires a minute-to-minute supply of glucose to function effectively but of course having elevated levels of glucose in the blood for a long period of time causes a truck load of health crisis such as cardiovascular disease, stroke, kidney failure, poor wound healing sometimes resulting in amputations, blindness and loss of pain sensation due to diabetes-induced neuropathy.

RISK FACTORS FOR TYPE 2 DIABETES

Factors such as obesity, overeating, lack of exercise, ageing and stress have all been implicated in type 2 DM. Research has also uncovered a genetic component.

Children of diabetic patients have a much higher risk of developing the disease during their lifetimes than children whose parents are not diabetic.

On a genetic level, things can go wrong in a couple of ways. Genetic defects of the pancreatic beta-cells as well as genetic defects in the action of insulin have been identified by researchers.

Genetic defects of the pancreatic beta-cels impair the secretory function of the cells and lead to early onset of hyperglycaemia, usually before the age of 25. Genetic defects in insulin action result from gene mutations which then cause abnormalities in the structure and function of the insulin receptor according to American Diabetes Association.

Figure 2. Risk factors for Type 2 Diabetes mellitus. Credit :: Diabetes Center

TREATMENT OPTIONS FOR TYPE 2 DIABETES

As scientific understanding of the disease has continued to improve, more useful therapeutic drugs have been introduced to enhance the well-being of people diabetic patients. We will only consider 2 of such drugs here.

• The biguanides

The only drug in this class of anti-diabetic drugs is Metformin, sold under the tradename Glucophage. This drug is generally prescribed as a first-line medication in the treatment of type 2 DM, usually in combination with dietary modifications and exercise. It is especially useful in cases where the latter 2 approaches (diet and exercise) have failed to sufficiently control the high blood glucose levels.

Metformin works primarily by decreasing the production of glucose (gluconeogenesis) by the liver. It also increases the body's sensitivity to insulin, ensuring that more cells can respond properly to insulin and take up a decent amount of the glucose in the blood. Metformin can be taken alone but is sometimes combined with other antidiabetics or even insulin if deemed necessary by health professionals.

• Sulfonylureas

The most famous of them being Glibenclamide, sold under the trade name Glyburide. Glibenclamide increases the secretion of insulin by the beta-cells of the pancreas (through the inhibition of ATP-sensitive potassium channels. This causes depolarisation and subsequent influx of calcium ions into the pancreatic beta-cells, which then trigger the secretion of insulin).

REVERSING TYPE 2 DIABETES : WHAT MODERN RESEARCH SHOWS

Treatment of diabetes can take a huge financial toll over a long period of time, especially for low income sufferers. This has prompted research into cost-effective measures of controlling and maybe even reversing the dreaded disease.

Exercise has long been shown to be a beneficial tool in controlling blood glucose levels. The trick is to figure out an exercise routine that is not only effective but also enjoyable. Exercise improves blood circulation, it enhances the uptake of glucose by cells and improves mood and sleep.

A review paper published in 2019 concluded that bariatric surgery, low calorie diets or carbohydrate restriction proved sufficient to reverse type 2 Diabetes mellitus (Hallberg et al. 2019). Note => bariatric surgery involves making changes to the digestive system through surgical procedures to cause weight loss.

A research study by Professor Roy Taylor at Newcastle University in 2017 showed that type 2 DM could be reversed by low calorie diet. He placed 30 volunteers with type 2 DM on a diet of 600 to 700 calories a day. These participants lost an average of 14 kilogrammes and did not regain weight over the next 6 months. 12 of the participants who had suffered from the disease for up to 10 years had a reversal of the condition and remained diabetes-free 6 months later.

It must be said that it takes tremendous willpower to comply with a low calorie diet for an extended amount of time but the payoff is certainly worth it. More studies have to be conducted with alot more participants to establish a statistically significant correlation between low calorie diet and reversal of type 2 diabetes mellitus.

REFERENCES

1. Worldwide toll of diabetes. International Diabetes Federation. Diabetes Atlas Ninth Edition 2019, Brussels. Available at https://www.diabetesatlas.org. Accessed on 4th Jan, 2021.

2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, Volume 30, 2007. American Diabetes Association. DOI:10.2337/dc07-S042

3. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients, 2019. DOI:10.3390/nu11040766

4. Newcastle University. "Type 2 diabetes is a reversible condition." sciencedaily. Sciencedaily,13 September 2017. www.sciencedaily.com/releases/2017/09/170913084432.htm