Diabetes Remission: Is It Possible? Next Steps If Achieved.

For a long time, type 2 diabetes has been considered a lifelong disease. However, recent clinical practice has shown that some patients with type 2 diabetes can discontinue hypoglycemic medications and still maintain normal or near-normal blood sugar levels after adopting certain interventions. Most scholars now use the term "remission" to describe this state of sustained metabolic improvement and even normalization in patients with type 2 diabetes.

Case One: Achieving Sustained Remission of Diabetes Through Strong Willpower

Zhang Qiang, an officer who had been decorated for meritorious service multiple times, was wounded in a fight with criminals while leading a team on a mission. Unlike past injuries, his wound did not heal and became infected. After testing by the military health team, Zhang Qiang's blood sugar was found to be as high as 16.8 mmol/L, with urine ketones ++++, and he was immediately referred to a large hospital. The receiving doctor was puzzled because the entry physical examinations for the military and military academies are very strict, and Zhang Qiang had not suffered from any illnesses except for a few injuries since enlistment. After careful inquiry, it was learned that Zhang Qiang had a family history of diabetes, with his grandmother, aunt, and uncle all suffering from the disease. After graduating from the military academy, he was assigned to work at a grassroots squadron, where he followed the same diet and schedule as the soldiers. Later, he was transferred to the brigade headquarters to serve as a training staff officer. His lifestyle and diet changed significantly: firstly, he was sedentary, and secondly, his smoking habit grew stronger. At the same time, he no longer had time to join the soldiers for morning exercises and physical training... As a result, he developed diabetes. After treatment with fluid replacement and ketone elimination, the ketosis disappeared, and he was switched to subcutaneous insulin injections, using intensive therapy, which involved using short-acting insulin before meals during the day and long-acting insulin before bedtime. Although he was admitted to the hospital with diabetic ketoacidosis, after admission, he was still diagnosed with type 2 diabetes through laboratory tests of pancreatic B-cell function and autoantibodies against islet cells. After the blood sugar stabilized, the insulin was gradually reduced, first using once-daily premixed insulin before breakfast and continuing with once-daily long-acting insulin before bedtime. A month later, the blood sugar remained stable, insulin was discontinued, and oral hypoglycemic agents were used instead. The blood sugar remained stable, and by this time, Zhang Qiang had quit smoking and drinking alcohol with strong willpower. He also adhered to a healthy lifestyle and eating habits. A month later, oral medications were stopped; six months later, a follow-up check showed that his blood sugar was within the normal range.

In this case, the diabetic friend developed ketoacidosis due to trauma and infection. With the qualities of a passionate soldier and strong willpower, he meticulously followed the doctor's orders. Although he started with diabetic ketoacidosis (severe damage to islet function), he still smoothly passed the "acute phase" and entered a long-term remission. This proves that the saying "There are two doctors in treating diabetes: one is the clinician, and the other is the diabetic friend himself" is reasonable, and the key to health is in the hands of the diabetic friend.

Case Two: Slacking Off Leads to Total Loss of Previous Efforts

Ms. Hu was diagnosed with type 2 diabetes after a physical examination showed a blood sugar of 12.0 mmol/L, an HbA1c of 9.2%, and trace proteinuria in her urine. Initially, she followed the doctor's advice very seriously, controlling her diet and exercising. Dr. Wu from the endocrinology outpatient clinic of the hospital prescribed her basic insulin intensification therapy. Within less than half a month, Ms. Hu's blood sugar gradually returned to normal, and her glycated albumin was also within the normal range. Dr. Wu then gradually reduced and stopped the insulin over half a month and switched to oral hypoglycemic agents to consolidate and maintain the therapeutic effect. Dr. Wu prescribed two oral medications for Ms. Hu: metformin hydrochloride 0.25 g three times a day after meals; the other was an SGLT-2 inhibitor taken in the morning. Ms. Hu experienced severe urinary tract infection symptoms such as urgency, frequency, and burning sensation during urination within three days of taking the SGLT-2 inhibitor and stopped the medication on her own. Dr. Wu added another oral medication to be taken in the morning, and after nearly a month of taking oral medications, Ms. Hu's blood sugar and other indicators remained stable. Dr. Wu declared Ms. Hu's diabetes condition to be in remission and stopped the oral hypoglycemic agents. Ms. Hu was overjoyed upon hearing this and did not listen to Dr. Wu's subsequent management advice. For a while after that, Dr. Wu did not see Ms. Hu for a follow-up visit. Half a year later, Ms. Hu came to Dr. Wu dejectedly, as she suddenly experienced blurred vision and swelling of the face and lower limbs. She first went to the ophthalmologist, who diagnosed diabetic retinopathy (stage III) and told her that if she had come a little later, she would have missed the precious time for laser treatment... Dr. Wu immediately checked her blood sugar and routine urine test, and was shocked by the results: blood sugar soared to 18.9 mmol/L, and the routine urine test showed +++ proteinuria. Dr. Wu regretfully told Ms. Hu that her diabetes condition had relapsed and that multiple complications had already occurred, namely diabetic retinopathy (stage III) and diabetic nephropathy (clinical nephropathy stage). Dr. Wu asked Ms. Hu what caused the relapse and why she had not come for treatment for so long. Ms. Hu shyly said that she thought the remission meant cure, and with a busy work schedule, she neither went to the hospital for a check-up nor monitored her blood sugar at home. Especially after giving in to the temptation of delicious food (sweets), she began to relax herself gradually... Dr. Wu had no choice but to admit Ms. Hu to the hospital for treatment. After insulin pump treatment, her blood sugar quickly returned to normal. The doctor told Ms. Hu that she would need to use insulin long-term to prevent further development and deterioration of the various complications that had appeared. Ms. Hu felt very remorseful.

In this case, the diabetic friend did not correctly understand and recognize the remission of the condition, mistaking remission for cure. Therefore, she began to relax her self-discipline, stopped monitoring her blood sugar, and made excuses for not going to the hospital for a check-up, resulting in the appearance of multiple complications, with regret coming too late.

Afterward, Dr. Wu, the treating physician, also reflected deeply and summarized three shortcomings: First, at the initial consultation, she did not conduct precise and detailed analysis of the diabetic friend's laboratory test data. For example, when trace proteinuria was found in the routine urine test, it should have been considered that diabetic nephropathy (microalbuminuria stage) had already occurred. At that time, the microalbuminuria should have been retested to further confirm the diagnosis and remind the diabetic friend that early diabetic nephropathy in the microalbuminuria stage is reversible and can be cured through precise treatment. Unfortunately, these measures were not taken. The diabetic friend was switched to oral hypoglycemic agents, metformin hydrochloride, and a new hypoglycemic drug, sodium-glucose cotransporter-2 inhibitor, which was very appropriate for Ms. Hu, who had high blood pressure, cholesterol, and weight. Regrettably, she only took it for a few days and stopped it on her own due to a urinary tract infection, and the attending physician did not dissuade her in time. She should have been told to drink more water, pay attention to genital hygiene, and take urethral anti-inflammatory drugs when necessary to control the symptoms. It should be noted that the new hypoglycemic drug SGLT-2 inhibitor does not depend on blood sugar and insulin to lower blood sugar but directly excretes glucose from the body through the kidneys, with good hypoglycemic efficacy, and also has protective effects on the cardiovascular and renal systems, which may ultimately slow down the adverse outcome of diabetic nephropathy in this diabetic friend. The diabetic friend did not come for a follow-up visit for a long time, and there was no serious investigation. Most importantly, during the treatment period, doctors should repeatedly introduce the connotation of diabetes remission to diabetic friends to avoid misjudgment by them.