Not so long ago I was in a debate with a prominent endocrinologist who specializes in the treatment of diabetes. She did not have many patients who had lost weight, let alone changed their lifestyle, so she didn’t believe that “fixing diabetes” was possible because she hadn’t seen it. I pointed out that research published by a weight loss surgeon in the mid 1980’s convincingly showed that diabetes went away with effective weight loss. I also shared the clinical experience that I had, using lifestyle to fix diabetes. She agreed to debate what the correct terminology should be to describe someone whose diabetes went away after weight loss (by whatever means, lifestyle, medicine, or surgery).
Consider the case of someone who has high blood sugar levels and is on several medications to treat diabetes, but now has lost so much weight that there was no evidence of diabetes – no high blood sugar, no kidney, nerve, or eye damage. If one were not told that this person once had diabetes, you would not be able to find any evidence or trace of it. Because her diabetes had gone away, this person was no longer at risk for the long-term problems related to diabetes. I said that we could say this person has been cured. Like curing an infection or appendicitis, this person did not have diabetes anymore. Take it off the medical chart and insurance policy applications!
My colleague’s response was to say, “No, the diabetes is never cured–it is just put into remission. It will come back if the weight comes back.” However, wouldn’t an infection come back if there was exposure again? Yet we use the term “cured” when a disease goes away. I suppose the language “in remission” may be a motivator to a person that diabetes can come back if eating changes are not sustained. The literature is starting to use the language “diabetes in remission” if blood sugar levels are normal for one year. I prefer using the term “cure” to motivate people to make the change. The main point is that diabetes does not have to be permanent, or have an inexorable downhill course.