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DRUG TRENDS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
82
VOLUME 14 NUMBER 2 • DECEMBER 2017
Can diabetes be cured?
B
eing diagnosed with diabetes
is often overwhelming for a
person. Living with it can be just
as hard.
Hamish van Wyk, registered
dietitian and diabetes educator
from the Centre for Diabetes
and Endocrinology (CDE), says
there is so much misinformation
regarding how best to live with,
or even ‘cure’, diabetes. Van
Wyk says before addressing that point it is
important to unpack the difference between
type 1 diabetes and type 2 diabetes.
Type 1 diabetes affects around five to
10% of people with diabetes and is an
auto-immune condition whereby the body
attacks the insulin-producing beta-cells of
the pancreas. This results in people needing
insulin from the day of diagnosis to ensure
healthy blood glucose levels. At this stage, it
unfortunately cannot be cured.
Type 2 diabetes, on the other hand, affects
the biggest group of people, approximately
90 to 95% of those with diabetes. It is
largely associated with lifestyle factors
including urbanisation, westernisation,
nactivity, being overweight, and unhealthy
patterns of nutrition, which express an
underlying genetic predisposition.
VanWyk says that fat distribution
is particularly important; too much
fat around the waistline (central,
visceral or abdominal obesity)
is both the initial cause and the
continuing driver of an ongoing
vicious circle of dysfunctional
metabolic processes. These result
in declining production of the
blood glucose-lowering hormone
insulin, resistance to the effects
of insulin and deposition of excess toxic
fat in the liver and pancreas. This situation
leads to an increasing need for therapies
to manage diabetes, including eventually,
insulin therapy.
The big question is, can type 2 diabetes
actually be cured? ‘The simple answer is no,’
says van Wyk. ‘The damaged cells in one’s
pancreas will always be damaged. One
can however reduce or even cure insulin
resistance and you can place type 2 diabetes
into remission.’
‘As with cancer, type 2 diabetes can be
placed into remission; medication will no
longer be required and the person’s blood
glucose levels will remain normal.’
Van Wyk says, ‘Despite remission being
possible, it is often not achieved through
conventional moderate calorie-restricted
diets, where only 11.7% of people go into
remission. However, through very low-
calorie diets (< 800 kcal a day) we see a very
different picture; remission can be achieved
within one week! It appears that the key is
the very low-calorie content of the diet.’
The latest published data from 2016
shows that after eight weeks on a very low-
calorie diet, up to 87% of people who had
diabetes for less than four years went into
remission. ‘The length of time one has had
diabetes is very important and unfortunately,
this fact is not coming across in consumer
articles. If you have had diabetes for 10
years or more, you are less likely to go
into remission even if you follow a strict
nutritional regimen. Around 50% of these
patients achieve remission,’ he says.
Nevertheless, even if one can’t go
into remission, the research shows that
by following a very low-calorie diet and
using the ‘break’ to re-establish a new and
healthier relationship with food, you can
still benefit from huge reductions in insulin
and/or oral medication while improving your
weight and blood glucose levels.
To find out more about how to place
diabetes in remission, find the following link
www.cdediabetes.co.zaHamish van Wyk
for diabetes by 85%, eye complications and
renal failure by 60% and amputation rates
by over 80%. The potential cost savings run
into billions of Rands,’ he says.
Distiller says the problem is that diabetes,
despite its prevalence, is both an expensive
and difficult condition to treat. ‘It requires
ongoing, in-depth management, education,
monitoring and constant review and
intensification of medication, with many
patients eventually requiring insulin for
control. And, as complications develop, the
cost of management goes up incrementally
and exponentially. As we know, diabetes is
linked closely to the other well-known risk
factors for heart disease and death, namely
high blood pressure, high cholesterol levels
and obesity.’
Against the backdrop of increasingly
scarce and costly healthcare resourcing,
and escalating, but preventable, costs of
admissions for diabetes and complications of
poor diabetes care, it is imperative that the
healthcare sector urgently seeks integrated
approaches to preventative, community-
based diabetes care.
‘We are clearly lacking critical research
funding and resources to improve healthcare
and treatment and there is an urgent need
for more education and a change in the way
diabetes is managed and funded in South
Africa,’ Distiller says.
‘The real challenge is finding a way
of reducing costs without impacting on
quality of care. We appreciate that medical
schemes are under enormous pressure to
manage their costs, but it is concerning
when the focus moves to cost-saving rather
than greater patient service utilisation and
improved clinical outcomes. We need to
start being far more pro-active in treating
and promoting patient health, particularly
when one considers economic studies from
the US showing that in people with diabetes,
in-patient hospital care accounts for 43% of
the total medical costs of diabetes and that
poor long-term clinical outcomes increase
the cost burden of managing diabetes by up
to 250%.’
Distiller shared that over the last
23 years, CDE diabetes management
programmes have resulted in a significant
overall reduction in all acute diabetes-
related hospital admissions. ‘We have seen
a reduction as high as 40% in all-cause
hospital admissions and a 20% reduction in
the length of hospital stays. This can only be
good for funders who choose to utilise our
services.’
Distiller highlighted that one of the
challenges in the past was that these
programmes were largely confined to
medical scheme members on the top-end
options. ‘We have been working hard to
ensure that CDE programmes of care can
now be customised to ensure that scheme
members on lower-benefit options are not
excluded and that education platforms are
extended.’
‘Thebottom line is that themost important
person in the management of diabetes is
the person living with diabetes. The majority
of diabetes care is self-administered. The
best results are without doubt where there
is co-ordinated and continuous support for
patients by a team of properly skilled doctors
and allied health professionals in a defined
programme of care, concludes Distiller.