Can type 2 diabetes be reversed and how can this best be achieved? James Lind Alliance research priority number one

The James Lind Alliance, in association with Diabetes UK, conducted a survey of people with Type 2 diabetes to establish their priorities for research. The number one research priority was found to be ‘Can Type 2 diabetes be cured or reversed, what is the best way to achieve this, and is there a point beyond which the condition cannot be reversed?’. The present review summarizes the current understanding of weight loss‐induced reversal of Type 2 diabetes. It considers the diagnostic criteria for remission and describes the clinical features of post‐diabetes. It is of great importance to recognize these, as post‐diabetes differs considerably from the high cardiovascular risk state of prediabetes. Current data demonstrate long‐term stable β‐cell function, providing weight regain is prevented. If an individual, having previously demonstrated susceptibility to Type 2 diabetes, returns to their previous weight then recurrence of the condition is certain. Appropriate use of the terms ‘reversal’ and ‘remission’ is discussed, with emphasis that the word ‘cure’ is inappropriate. Evidence‐based means of achieving and maintaining remission of Type 2 diabetes are described, together with a summary of the information on the steadily diminishing chance of achieving reversal with increasing duration of Type 2 diabetes. What's new? It is established that short‐duration Type 2 diabetes can be returned to non‐diabetic blood glucose control by substantial weight loss. The importance of recognizing post‐diabetes is described, with details of the prognostic implications, which differ markedly from the high risk state of prediabetes. Evidence‐based approaches to long‐term avoidance of weight regain are considered. The terms ‘reversal’ and ‘remission’ are defined, with emphasis on avoiding the word ‘cure’. At the time of diagnosis of Type 2 diabetes it is recommended that all are offered the opportunity of returning to a state of post‐diabetes.