Diabetes currently has no cure.

If there was a permanent cure for diabetes, physicians would retrieve it from the ends of the earth for their clients, urging governments to mobilise, to seek charitable donations to take it to third world countries.

If there was a magic herb, supplement or probiotic pill that was tested and proved, there would be nothing that physicians would not do to avoid seeing clients lost to follow-up, losing limbs and vision and mobility, from seeing parents wrenched with anxiety to manage their little ones; to avoid the suffering from depression, inability to cope and premature death. Diabetes can be managed successfully, but complications may be dire and life-changing.

There are few persons alive who can say that they do not know someone with diabetes or do not have diabetes themselves; one in eight adults in the North America-Caribbean region are persons with diabetes. The International Diabetes Federation’s predictions of 415 million persons worldwide with diabetes in 2015, with projections to 642 million by 2040 underscore the global emergency that diabetes has become. St. Lucia has a prevalence estimated at 10.9% and ranks #41 in the world by prevalence.

There is currently no cure for diabetes but remission is possible for some persons. Remission is defined as clinical symptoms and clinically detectable diabetes while not taking medications or ongoing surgical/immunosuppression options for at least one year. A cure, however, restores the natural production of insulin and normalises blood glucose levels without any other risks or negative effects.

Remission of type 2 diabetes may occur in certain circumstances:

1. Promotion of insulin sensitivity:

A person who is insulin-resistant needs more insulin to keep blood glucose within normal range. Conversely increasing insulin sensitivity will reduce insulin requirements and can normalise blood glucose levels. That is the rationale behind the use of medications and administering insulin to control blood glucose.

Medications such as metformin and pioglitazone have been proven to increase insulin sensitivity and can prevent the onset of diabetes from a state of pre-diabetes. In addition, certain foods and meal plans improve insulin sensitivity and can reduce blood glucose; even if remission does not occur, the benefits extend beyond diabetes management. Meal plans such as the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet which emphasise meals rich in fruits and vegetables, low in saturated fat and high in nuts and pulses, not only improve insulin sensitivity but consequently reduce the incidence and improve the management of type 2 diabetes, and many other illnesses.

Weight loss by means of these meal plan changes and possibly low calorie diet (Diabetes remission Clinical Trial) may potentially allow remission of diabetes when diagnosed early. Similarly, physical activity – aerobic and resistance exercise – is key to primary and secondary prevention of diabetes, hypertension, obesity, cancer, obesity, osteoporosis, depression, that is, reduces incidence and allows effective management.

Molecular research such as galectin-3 studies are currently being conducted; removing Gal-3, a protein that is involved in inflammatory processes, removed insulin resistance in mouse models. This research has great potential.

2. Avoidance of beta cell destruction such as the proposed vaccine for type 1 diabetes.

3. Promotion of beta cell recovery, regeneration or growth such as stem cell replacement of beta cells and pancreatic transplantation, but both of these methods have had the challenge of being destroyed by the human immune system. If a solution to autoimmune destruction is found, this can lead to a cure.

Diabetes can be managed successfully with lifestyle interventions – improvements to meal plans and physical activity, as well as medications including insulin. Physicians are keeping up to date with the promising research and options for persons with diabetes and other chronic illnesses. Information, methods and medications that reach our clients must be safe, efficacious and proven. Then the discerning physician will individualise management to the challenges, other illnesses, motivation and health literacy of the client so that no person with diabetes ever feels more like a disease than like themselves.