Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose. Hyperglycaemia, also called raised blood glucose or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.
In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. Another 460 000 kidney disease deaths were caused by diabetes, and raised blood glucose causes around 20% of cardiovascular deaths (1).
By contrast, the probability of dying from any one of the four main noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between the ages of 30 and 70 decreased by 22% globally between 2000 and 2019.
Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. In 2017 there were 9 million people with type 1 diabetes; the majority of them live in high-income countries. Neither its cause nor the means to prevent it are known.
Symptoms of type 2 diabetes can be mild. They may take several years to be noticed. Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen.
More than 95% of people with diabetes have type 2 diabetes. Type 2 diabetes was formerly called non-insulin dependent, or adult onset. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.
Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future.
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.
WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low- and middle-income countries. To this end, WHO:
In April 2021 WHO launched the Global Diabetes Compact, a global initiative aiming for sustained improvements in diabetes prevention and care, with a particular focus on supporting low- and middle-income countries.
In May 2021, the World Health Assembly agreed a Resolution on strengthening prevention and control of diabetes. In May 2022 the World Health Assembly endorsed five global diabetes coverage and treatment targets to be achieved by 2030.
Although there's no cure for type 2 diabetes, studies show it's possible for some people to reverse it. Through diet changes and weight loss, you may be able to reach and hold normal blood sugar levels without medication.
This doesn't mean you're completely cured. Type 2 diabetes is an ongoing disease. Even if you're in remission, which means you aren't taking medication and your blood sugar levels stay in a healthy range, there's always a chance that symptoms will return. But it's possible for some people to go years without trouble controlling their glucose and the health concerns that come with diabetes.
So how can you reverse diabetes? The key seems to be weight loss. Not only can shedding pounds help you manage your diabetes, sometimes losing enough weight could help you live diabetes-free -- especially if you've only had the disease for a few years and haven't needed insulin.
Several studies in England have looked at the effects of a very low-calorie diet on overweight people with diabetes. Two had people follow a mostly liquid diet of 625-850 calories a day for 2-5 months, followed by a less restricted diet designed to help them keep off the weight they lost. Both studies found that nearly half the people who took part reversed their diabetes and kept their blood glucose near the normal range for at least 6 months to a year.
Most of the people who reversed their type 2 diabetes lost 30 pounds or more. They also hadn't had diabetes as long as those who weren't as successful. So it's important to get started on a weight loss plan as soon as possible after you're diagnosed.
When you have type 2 diabetes, cells that help your body control your blood sugar stop working right. Doctors used to think they were shut down for good, but research shows that certain cells may come back. People who lost weight had lower levels of fat in their liver and pancreas, and for some of them, that helped the beta cells in their pancreas that release insulin and control blood sugar start working again.
More physical activity is a way to improve diabetes, but it may be tough to lose enough weight to go into remission with workouts alone. When combined with changes to your eating, though, exercise helps. A modest, lower-calorie diet plus a big step up in burning calories could put you on the path to remission.
This type of surgery helps you lose weight by changing your stomach and digestive system to limit how much you can eat. Aside from helping you lose weight, it may help reverse diabetes in other ways, although scientists don't yet know exactly why. One theory is that it affects the hormones in your gut to help your body control blood glucose.
Researchers estimate that upwards of three-quarters of people see their diabetes reversed after bariatric surgery. Gastric bypass and gastric sleeve (also called sleeve gastrectomy) surgery have better long-term results than gastric banding.
Bariatric surgery is generally an option when your BMI is at least 35 if you have a weight-related health problem such as diabetes. It works best for people who've had the disease for 5 years or less and don't use insulin.
A very small study found therapeutic fasting -- going without food and drink with calories for a set amount of time -- can help reverse type 2 diabetes. Three people with diabetes followed a diet program of three 24-hour fasts each week for several months. They would eat only dinner on days they fasted, and lunch and dinner on days they didn't fast, focusing on low-carbohydrate meals.
Two of the people in the study were able to stop taking all diabetes medication, and the third stopped three of their four medications. Within 1-3 weeks, all three of them could stop taking insulin. They lost between 10% and 18% of their body weight, or 20-23 pounds.
Another study showed that eating very few calories (500-600) 2 days a week and a normal diet the other days helped people with type 2 diabetes lose weight and lower their blood sugar levels just as much as limiting calories to 1,200-1,500 every day.
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