Defining diabetes “reversal”

Because type 2 diabetes is diagnosed based on elevated blood sugar, if your blood sugar remains normal without the use of diabetes-specific medications and you no longer meet the diagnostic criteria, you have successfully reversed your type 2 diabetes.

There are three forms of treatment for type 2 diabetes that have been demonstrated to reverse this disease. Bariatric surgery can sometimes reverse type 2 diabetes, but it is expensive, can have major side effects including death, and often loses its effectiveness after a few years. Very low calorie diets (also called semi-starvation diets) can lead to rapid weight loss and diabetes reversal, but can only be followed for a few months, after which weight maintenance and continued diabetes control are difficult. The third treatment is a well-formulated ketogenic diet, which is nutritionally complete and can be followed for years. The diet sets up a state of nutritional ketosis in the body in which fat becomes the primary fuel instead of carbohydrates.

The terms “reversed” and “cured” mean very different things. Type 2 diabetes can be “reversed” but not “cured” because the disease will come back if long-term behavior change is not successfully maintained. There are still several points of debate around the term “reversal”—in particular, how long HbA1c and medication reduction success have to last for the diabetes to be considered reversed. Since diabetes reversal is a relatively new term, there is no universally accepted definition by the scientific community or agencies like the American Diabetes Association or American Medical Association. Thus many medical professionals are still unaware that reversal is even possible.