“The definition for remission in this study is basically ‘pre-diabetes,’” explained Jennifer Okemah, RD, CDE, a registered dietitian from Kirkland, Washington.
The study classified patients as “in remission” if they had an HbA1c under 6.5 percent and were taking no diabetes-related medications.
HbA1c (or A1c) is a measurement of your average blood sugar levels during the course of the prior three months.
The 6.5 percent translates to a blood sugar of 140 mg/dL, which is above the goal range for a healthy non-diabetic of 70 to 130 mg/dL.
For patients in the study who continued to take the diabetes drug metformin, remission is defined as an HbA1c of less than 6 percent. In other words, even though they were still taking medication to lower blood sugar levels, the study classified their diabetes as “in remission” if their HbA1c was low enough.
“This surgery is not a cure and it’s important that patients understand that,” said Okemah, who has supported many of her patients with type 2 diabetes through weight-loss surgery.
“We have to differentiate between ‘remission’ and a ‘cure,’” Okemah told Healthline. “After this surgery, you will still need to follow the same diabetes nutrition guidelines. You have pre-diabetes and you’ll still need to manage it.”
While many believe that type 2 diabetes is simply the result of weight gain, inactivity, and a poor diet that leads to insulin resistance, it’s actually more complicated.
“Type 2 diabetes is a progressive disease,” said Okemah. “Even if you go into remission, we watch your blood sugars closely so we can get it to progress as slowly as possible.”
Most patients with type 2 diabetes actually struggle to produce adequate amounts of insulin due to the loss of beta-cell function. Beta-cells are produced by the pancreas and play a critical role in the production of insulin, which carries the sugar in your bloodstream to every part of your body to use it for fuel.
Because type 2 diabetes is a progressive disease, Okemah says it’s imperative that patients understand the likelihood of their blood sugars eventually rising — even if they don’t gain back all of the weight — because of continued loss of beta-cell function.
The study was clear, however, that the patients with the least likelihood of achieving remission were those who required injections of insulin to manage their type 2 diabetes — as this is a clear indication of severe loss of beta-cell function.