Diabetes Reversal

Jun 16, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Kevin Tabin was trying to educate me about football. He was explaining how the left side of the offensive line was called "the blind side". A few days later my son Eric wandered out of his room at about 6:30 am. He said, "You know Dad. When you sell things on Ebay, you have to declare them as income so your income tax can be assessed properly." This early morning declaration definitely came from my blind side. What other almost 12-year-old cares what income tax is? Why is Eric worrying about the tax implications of having an online garage sale? I've bought a few things on Ebay, but I've never sold anything. Why was Eric developing a well-researched master plan in online sales? What stuff of mine was he planning to sell? I'm not sure if I'm raising a future accountant or a hustler.

"Can Type 2 Diabetes be reversed?" This blind side question surprised me almost as much as a12 year old learning income tax tips from YouTube videos. But recently, Canadian researchers from McMaster University say they might be on to something.

What is diabetes? Diabetes is when your body has trouble using sugar. There are 2 main types of diabetes: Type 1, and Type 2. Type 1 diabetes is when your pancreas doesn't produce insulin. You must inject insulin or you will die. Type 1 diabetes accounts for about 10% of diabetics. Type 2 diabetes accounts for about 90% of diabetics and is a little different. Let's start with a person without diabetes. They eat something. The carbohydrates in their food get broken down into sugar. That sugar goes into the blood. The pancreas produces insulin in response to the sugar. The insulin is a signal to all the cells in the body. I think of insulin as a key. It goes into locks in the cells. When the insulin key goes into the lock, little doors open in the cell. These open doors let the sugar leave the blood and get into the cell. The cell then burns the sugar to produce energy.

In Type 1 diabetes, the body can't produce any insulin keys. There is no way to open the doors in the cells. The sugar stays in the blood stream. That means the blood sugar level stays high, but the cells have no energy to use. In Type 2 diabetes the pancreas produces insulin. It may even produce higher than normal amounts of insulin. The problem seems to be with the little locks on the sugar doors in the cells. The little locks seem to have gotten rusty. Even if insulin keys go into the locks, the keys can't turn and the doors won't open. We call this insulin resistance, and we think this is the main problem in Type 2 diabetes. If insulin resistance goes on for enough years, we think the pancreas gets tired out and decreases or stops producing insulin.

Why do should we care if we get Type 2 diabetes? With treatment people with Type 2 diabetes can live long productive lives, but there are four main complications of diabetes we worry about. People with diabetes are more likely to go blind, have their kidney stop working, need to have a foot amputated or have a heart attack than people without diabetes.

A team of researchers from McMaster University in Hamilton says it has reversed Type 2 diabetes in some patients. That is an incredible claim. It was a small study of 83 patients. Natalia McInnes et al. published a pilot project in the March 2017 Journal of Clinical Endocrinology and Metabolism. The researchers then broke the 83 participants into 3 groups of about 28 people each. The control group had no changes to their lifestyle and medications. Group 2 and Group 3 got intensive therapy. Group 2 got intensive therapy for 8 weeks. Group 3 got intensive therapy for 16 weeks.

Intensive therapy is really what it sounds like. First a dietician had them slash 500 to 750 calories per day off their diet. If you assume the average Canadian eats 3000 to 3500 calories per day, that is reducing your daily calories by up to 25%. Then an exercise specialist got these diabetics off the couch. They aimed for more than 150 mminutes from exercise er week. That is more than 20 minutes of exercise per day. For all you FitBit types out there, the exercise specialist also told them to aim for 10,000 steps per day. The goal was for the participants to achieve and maintain a >5% weight loss by week 28. Now come the drugs. The intensive group were giving long acting insulin at bedtime. It was lantus or glargine insulin which was increased until the participant's fasting blood sugar was between 4 and 5.3 mmol/L. They usually ended up taking about 25 U of glargine insulin. There were also given metformin 1000 mg twice a day and acarbose 50 mg three times a day.

The idea behind these drugs is interesting. The long acting insulin was to help make the blood sugar go down, but also to allow the patient's pancreas to "rest" or not have to work as hard. The metformin was to reduce insulin resistance, so the insulin present would work better. The acarbose was to stop some of the carbohydrates the person ate from getting broken down in the gut and absorbed. That meant less sugar was getting absorbed from the food the participants ate.

What happened? Well, the results from the small trial were a little under whelming. Twelve weeks after treatment, the group that had intensive therapy for 8 weeks had a couple more reductions of diabetes than the control group, but no more likely than could happen by chance. The intensive therapy for 16 weeks group did a little better. The researchers defined complete diabetes remission as HbA1C <6.0%, partial remission as HbA1C <6.5% and regression as HbA1C<7.0%. And these HbA1C numbers are all if the participant was on no diabetes medications. The 16 week group had more complete remissions than the control group, but again it could have just been chance. But if you added up the partial and complete remissions, there were 11 in the 16 week group and only 4 in the control group. And if you added up all the regressions and remissions, there were 13 in the 16 week group and still only 4 in the control group. Those results were statistically significant.

It is interesting that almost half the people (48.2%) in the 16 week intensive group still had a HbA1C less than 7% 12 weeks after they stopped all their diabetes meds. But this was a really small trial. And these were newly diagnosed diabetics. What would happen if you did intensive therapy on someone who had been diagnosed with Type 2 diabetes for 10 years? We don't know. Will this intensive therapy mean someone will never need diabetes pills again? We don't know. But I think a good take home message is something we've been saying for a long time. If you are diabetic, watch your diet, exercise, and take your medications.

Emily came home from a school trip from Quebec with a t-shirt that had the silhouettes of crossed hockey sticks and a puck in between them. The text on the shirt said, "I don't give a puck". That was a little surprising. However, she is a 15 year old who likes driving her mom round the bend, so not shocking. My almost 12 year old son discussing income tax implications before 7 am and Canadian researchers looking at ways to get Type 2 diabetics off all their meds, those blindsided me.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.

CTV News Article on Diabetes Reversal - http://www.ctvnews.ca/health/type-2-diabetes-can-be-reversed-say-canadian-researchers-1.3399207

Journal of Clinical Endocrinology and Metabolism article - https://academic.oup.com/jcem/article-abstract/doi/10.1210/jc.2016-3373/3070517/Piloting-a-Remission-Strategy-in-Type-2-Diabetes?redirectedFrom=fulltext


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