Reversibility of diabetes mellitus: Narrative review of the evidence

Abstract

The global disease burden of diabetes mellitus is high. It is well-established that prediabetes is reversible but it is unclear whether diabetes is reversible once it has been diagnosed. The objective of this narrative review is to review the evidence of reversibility of diabetes mellitus and stimulate interest in prolonged remission as a treatment target. The current evidence for bariatric surgery is stronger than intensive medical management and the evidence is stronger for type 2 diabetes patients compared with type 1 diabetes patients. It is also unclear whether non obese diabetes patients would benefit from such interventions and the duration of diabetes before diabetes become irreversible. Further research is needed in this area especially with regards to the subgroup of diabetes patient who will benefit from these interventions and the long term safety and efficacy remains unknown especially with intensive medical management.

Keywords: Diabetes; Reversibility; Remission; Bariatric surgery; Obesity

Core tip: Diabetes mellitus is potentially reversible especially with bariatric surgery. Intensive medical management is promising but the evidence is weaker. The subgroup that is likely to go into prolonged remission is those with insulin resistance, short duration of diabetes and obesity. Further research is needed to identify those that can go into remission and how to use intensive medical management to achieve this.