Rewriting diabetes: PGI study shows remission achievable

Indian Express

2 days ago

For decades, Type 2 diabetes has been viewed as a lifelong, irreversible condition, requiring daily medication, strict dietary control, and constant lifestyle management, but new hope is emerging from India's Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, where a clinical study has shown that remission may be possible through a carefully designed and practical strategy.
Type 2 diabetes, which affects millions globally and has become a growing health concern in India, has long been seen as a chronic disease without a cure. Patients are often told they must manage it for life, with pills and blood sugar logs becoming permanent companions, but what if there is a chance to hit reset? Remission is the term scientists are now using, meaning a return to normal blood sugar levels with HbA1c of 6.5% without any diabetes medication for at least three months.
However, a made-in-India approach with global promise led by Dr Rama Walia, a team of researchers at PGIMER, launched the DiaRem-1 study, aiming to explore whether tight blood sugar control using modern medicines, combined with lifestyle changes, could push the disease into remission. What makes their work stand out is that it does not rely on extreme weight loss diets or costly surgeries, which are often impractical for many patients.
They selected adults diagnosed with Type 2 diabetes in the past five years, whose blood sugar was still reasonably controlled. For three months, these participants were placed on a combination of proven diabetes medications and guided through diet and physical activity. After that, all medications were stopped, and for the following three months, researchers monitored whether their blood sugar levels could remain in the normal range, drug-free.
What happened?
The results were eye-opening: about one in three participants (31%) achieved diabetes remission, meeting the internationally defined benchmark of maintaining HbA1c below 6.5% without medication for at least three months. Surprisingly, both treatment groups, one using newer medications like liraglutide and dapagliflozin, and the other using more commonly available medicines like glimepiride and vildagliptin, saw similar remission rates.
Weight loss helped, but wasn't everything
The average weight loss was modest, 4.7 kg in the intervention group and 3 kg in controls. MRI scans in select participants showed dramatic declines in internal fat stores, a 51% drop in liver fat and 48% in pancreatic fat, which are crucial contributors to insulin resistance and worsening diabetes.
The science behind the strategy
Doctors now understand that two major culprits drive diabetes progression: glucotoxicity (too much sugar damaging beta cells) and lipotoxicity (fat accumulation impairing insulin action). By reversing these with medication and lifestyle therapy, the pancreas gets a much-needed break and, in some cases, begins to function more normally again. Those who achieved remission also had better beta-cell function (as measured by a 'disposition index') and lower levels of insulin resistance (HOMA-IR) compared to those who didn't. Importantly, no single patient characteristic, age, weight, or the duration of diabetes could predict who would succeed, making this approach potentially applicable to a wide range of patients in early stages of diabetes.
Side effects and safety: Well-tolerated treatment
Minor side effects like nausea were seen, especially in those taking liraglutide, but there were no serious health risks noted. Notably, no patients in the intervention group experienced low blood sugar, a common concern with diabetes medications.
A moment of change, not a cure
Experts caution that remission is not the same as being cured. Blood sugar levels can rise again without ongoing lifestyle commitment, but the fact that normal levels can be sustained without medication, even temporarily, is a major breakthrough.
What's Next?
PGIMER's team is continuing research to test how long this remission lasts and whether longer treatment duration might improve outcomes further. But even now, this small but powerful trial offers a cost-effective and scalable strategy that can work in outpatient clinics across India and the world. 'With early, intensive treatment and continued support, many patients may no longer need diabetes medication. That's a powerful message of hope,' said Dr Walia, the lead investigator of the study. 'If you or someone you care about was recently diagnosed with Type 2 diabetes, this study brings an encouraging message: your condition may not be permanent. With early action, close follow-up, and guided treatment, remission is possible, and potentially within reach for many.'