Hitting type 2 diabetes hard and fast is the key to achieving remission, according to the new diabetes handbook.
The new diabetes handbook dedicates a whole section on how people with type 2 diabetes can sustain lower HbA1c levels without needing medication.
The RACGP, in conjunction with Diabetes Australia, released their latest set of evidence-based guidelines last week in the form of the Management of type 2 diabetes: A handbook for general practice guidelines, affectionately referred to as the “Diabetes Handbook”.
One of the newly added sections in the handbook focused the remission of type 2 diabetes, where Hb1Ac levels remain below 6.5% (48mmol/mol) for at least three months while the patient is not taking glucose-lowering medications.
Dr Gary Deed, chair of the RACGP’s diabetes specific interest group, was excited by the addition of the new section on diabetes remission.
“Research has shown some people with type 2 diabetes, particularly when it’s diagnosed early, can reduce their average glucose level to achieve an HbA1c of under 6.5% and sustain it there, without glucose-lowering medication,” the Queensland-based GP told media.
“It’s a best-case scenario, and the new section will help GPs and patients achieve it where possible.”
The handbook recommends that intensive lifestyle changes, including weight loss (ideally 10-15% of their body weight) can help achieve remission from type 2 diabetes.
Recommended changes include low-calorie (800-850kcal or 3344-3553kJ per day) diets for three to five months followed by a gradual and structured reintroduction of food and increased physical activity for non-pregnant adults diagnosed in the last five years with a BMI of 27-45, a HbA1c under 12% and no insulin use.
The handbook also recommends that bariatric surgery should be considered in non-pregnant adults with a BMI of 35 or more as another method of inducing remission.
Remission rates are higher in people who had been diagnosed with type 2 diabetes in the past five years, who had lower HbA1c levels when attempting remission and in those who do not require insulin therapy – so basically the sooner remission is attempted, the better the chances.
If remission is achieved, HbA1C levels should be retested every six months (at a minimum) to determine whether remission is being sustained or a relapse has occurred.
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The guidelines stressed that while remission was the goal, it was not a complete cure-all. Research out of the UK suggests that less than 50% of type 2 diabetics who attempt to achieve remission with intensive dietary changes meet that goal within 12 months, and only one in three people will be able to sustain it for a further 12 months.
“Remission from diabetes does not mean that type 2 diabetes is cured or reversed,” the new guidelines read.
“The underlying glucose intolerance may continue, an increased cardiovascular health risk may continue and, over time, glucose levels may return to levels indicative of type 2 diabetes requiring further intervention.”
Diabetes Australia Group CEO Justine Cain said the new guidelines represented a major advance that will support people with diabetes to achieve better health outcomes.
“Diabetes can lead to severe complications including heart attack, kidney disease, limb amputation, and vision loss, so it’s critical that people get up-to-date advice from their GP early-on in their journey,” Ms Cain said in a statement.
Other new sections to feature in the updated guidelines include weight management interventions for type 2 diabetes, sleep and diabetes and a section on disability, dementia, cognitive decline and hearing impairment in diabetic patients.
Several existing sections have also received significant updates, including the medical management of glycaemia (focusing on newer therapeutic agents like the GIP and GLP1-RA drugs) and the complications associated with diabetes (namely the addition of the updated cardiovascular disease risk assessment tool).
Over a million Australians are affected by type 2 diabetes, a figure that has been steadily increasing in line with rates of overweight and obesity.
