It is usually not possible to permanently reverse diabetes. However, if you have type 2 diabetes, it is possible to have your diabetes go into ‘remission’.

Sometimes patients are able to use a combination of diet and exercise to reverse many of the metabolic changes that occur with diabetes. When someone’s blood sugars return to normal and we are able to stop all diabetes medications, the patient is in what we call ‘diabetes remission’.

We have found that the most important change leading to diabetes remission is weight loss in patients who are obese. It is hard to predict who can achieve diabetes remission but the main factors seem to be younger age (at the onset of disease), a shorter duration of diabetes and the extent of weight loss.

The patients in our clinic who lose weight and enter remission are still at high risk of having their diabetes return. About one in two individuals in remission need to start back on diabetes medications after five years.

Blood glucose fluctuates throughout the day depending on an individual’s diet and activity levels, so we choose different assessments depending on the situation.

A “random” glucose test can be taken by individuals presenting with symptoms suggestive of uncontrolled diabetes mellitus, such as increased thirst, passing large volumes of urine and weight loss. A glucose level of 11.1 mmol/l or above in symptomatic patients confirms the diagnosis and removes the need for measuring fasting plasma glucose or an oral glucose tolerance test.

Other screening tests include fasting plasma glucose, which can be done after an eight-hour fast. It is reproducible and measurements of 7.0 mmol/l and above on two separate occasions indicate diabetes mellitus. This can also be followed by a 75g oral glucose load test, where samples are taken before and after 120 minutes to complete an oral glucose tolerance test. In this instance, a plasma glucose of 11.1 mmol/l or above at 120 mins confirms the diagnosis. Please note that the diagnostic criteria differ for gestational diabetes mellitus.

The HbA1c gives an indication of the average blood glucose over the past three months and is independent of food or activity that day. However, HbA1c levels are impacted if the patient has anaemia or a haemoglobinopathy. A HbA1c reading of 6.5 per cent or more confirms diabetes mellitus and the test is used to assess glycaemic control at future clinic visits.

A fasting plasma glucose test or an oral glucose tolerance test must be scheduled while a HbA1c test can be taken at any time. Those with symptoms can be initially screened with a random plasma glucose. Health systems and clinicians must consider labour costs, differing laboratory costs (HbA1c is a more expensive test), patient factors and convenience when planning diabetes screening.

Clinical Assistant Professor David Carmody
Senior Consultant, Department of Endocrinology, Singapore General Hospital
SingHealth Duke-NUS Medicine Academic Clinical Programme