Ask Well: Reversing Diabetes

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Type 2 diabetes can be reversed in some people, at least temporarily, but it may take extreme measures.

Lifestyle changes like weight loss and exercise are most likely to have an effect early in the course of the disease, shortly after a patient moves from prediabetes to diabetes and is still producing some insulin. At that point, “if you can reduce your body’s requirements for insulin by losing weight, you may be able to go back to the prediabetes phase,” said Dr. Judith Fradkin, director of the division of diabetes, endocrinology and metabolic diseases at the National Institute of Diabetes and Digestive and Kidney Diseases.

Studies have shown that both bariatric surgery and extreme low-calorie diets can reverse more established Type 2 diabetes, but “we still need more information on how long the remission is going to last,” Dr. Fradkin said.

Patients with Type 2 diabetes were able to normalize their glucose levels after a week on an extreme diet of 600 calories a day, a small study in 2011 found, but such severe caloric restriction cannot be maintained for long.

Bariatric surgery is a potent tool for reversing Type 2 diabetes: About half of obese patients who undergo bariatric surgery achieve remission, a phenomenon that occurs even before extreme weight loss and seems to persist for several years at least. A recent study reported that 19 of 38 bariatric surgery patients — including 37 percent of those who had gastric bypass surgery and 63 percent of those who had a different procedure called biliopancreatic diversion — were still diabetes-free five years after surgery. But bariatric surgery is only recommended for severely obese people and carries risks of its own, Dr. Fradkin noted.