“I just want to get rid of my diabetes”, is something I frequently hear when people are newly diagnosed with diabetes.
Can people with type 2 get rid of their diabetes? Well, not exactly, but a small percentage of people with type 2 can achieve normoglycemia, especially after metabolic surgery or significant weight loss. However, over time, blood sugars often rise again. That is why diabetes isn’t “cured” or fixed. Keep reading to learn the new standardized term and ongoing screening guidelines.
What is the right term to use when blood sugars normalize, even with type 2 diabetes?
A new consensus statement designed to answer this question was issued by the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK last month.
The 12-member panel recognized that we have no standard term to describe the phenomenon of prolonged normoglycemia in people previously diagnosed with type 2 diabetes, who are not using glucose-lowering medications.
Terms like “reversal”, “resolution”, or “cure”, are frequently used to describe this phenomenon and are sometimes are associated with unsubstantiated claims.
The new standardized term is “remission”.
Diabetes remission defined – A1c< 6.5% for at least 3 months after stopping glucose-lowering pharmacotherapy. This definition holds true whether attained by lifestyle changes, metabolic surgery, or other means,
When A1c is not a reliable marker of glycemic control (due to anemia, hemoglobinopathies, or others), fasting plasma glucose <126 mg/dL or estimated A1C <6.5% calculated from CGM values can be used.
With this standardized definition, researchers will be able to conduct studies and analyze medical records using standard terminology so they can accurately compare factors that help people with type 2 achieve remission and factors that influence remission duration.
A1c Testing still needed if in Remission?
Even if people are experiencing remission, they require continued glucose evaluation because hyperglycemia frequently recurs. People in remission who experience weight gain, are started on steroids or other medications like atypical antipsychotics or meds to treat HIV, may exhibit elevated blood glucose levels. In addition, stress from other forms of illness and the natural decline of beta-cell function over time can all lead to the recurrence of Type 2 diabetes. Testing of A1c or another measure of glycemic levels needs to be performed at least yearly.
Metabolic Memory – people in diabetes remission still experience complications.
Even after a remission, the classic complications of diabetes including retinopathy, nephropathy, neuropathy, and enhanced risk of cardiovascular disease can still occur due to metabolic memory.
Diabetes Care Consensus Report 2021
The metabolic memory or legacy effect is relevant in this setting. If a person with diabetes has a history of hyperglycemia, this metabolic memory can cause persisting harmful effects in various tissues. Even after remission, the classic complications of diabetes including retinopathy, nephropathy, neuropathy, and enhanced risk of cardiovascular disease can still occur. This is why it is important for people in diabetes remission to have regular retinal screening, tests of renal function, foot evaluation, and measurement of blood pressure and weight in addition to ongoing monitoring of A1c.
To read the complete article from Diabetes Care, Aug 2021, Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes.
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What is a Certified Diabetes Care and Education Specialist?
Read More: What is a CDCES? First awarded in 1986, as Certified Diabetes Educator (CDE) credential and in 2020 with a new name: Certified Diabetes Care and Education Specialist (CDCES) to more accurately reflect the specialty. CDCES has become a standard of excellence for the delivery of quality diabetes education. Those who hold this certification are known to possess comprehensive knowledge of and experience in diabetes prevention, management, and prediabetes. “Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM 
Why become a CDCES?
Three Reasons from Coach Beverly
Read More: 3 Reasons to Become a CDCES “The best part of becoming a CDCES is working with my colleagues and people living with diabetes. As diabetes educators, we hear compelling and beautiful life stories. I am astounded by the barriers they face and inspired by their adaptability, problem-solving skills, and resilience.” Reason 1: CDCES is a widely recognized certification by employers and health care professionals throughout the U.S. This credential demonstrates a specialized and in-depth knowledge in the prevention and treatment of individuals living with pre-diabetes and diabetes. Reason 2: Currently, 10% of people in the U.S. have diabetes and another 35% have pre-diabetes which means 45% of Americans are running around with elevated blood glucose levels. Given this epidemic, there will be plenty of future job opportunities. Reason 3: Having my CDCES along with my nursing degree, has opened many doors of opportunity; from working as an inpatient Diabetes Nurse Specialist in a hospital to working as a Manager of Diabetes Education in the outpatient setting to starting my own consulting company.
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