Type 2 Diabetes Remission: Turning 20% into 100%

…Diabetes remission becomes the norm and remission and hope become mutually reinforcing dance partners in a more metabolically healthy society...

Medication-free remission from Type 2 Diabetes is possible and sustainable, and there’s no question about it.

Well, that’s not entirely true.

We know it’s possible and sustainable, but what are the key ingredients for long-term success?

What does a person need to go from having out of control blood sugar and metabolic dysfunction to getting their blood sugar under control, their metabolic health in order, and off medications?

That’s the core question to which we will build in this letter, after reviewing important data published on a 5-year study from Virta Health assessing diabetes remission among 120 incredible humans.

Without further a-dough-nut, let’s delve into it.

*There’s now a video associated with this newsletter, for those who prefer to watch*

Diabetes Remission: What Is It?

Diabetes remission is having an HbA1c, a marker of average blood sugar, of <6.5% while off blood-sugar lowering medications. For obvious reasons, diabetes remission is thought to confer protection against the ravages of the disease.

It does not mean that, at some point, you can go back to eating endless breadsticks at the Olive Garden or Munching on Munchkins at Dunkin Donuts. You do not develop metabolically gifted adipocytes or a superhero pancreas.

But provided you’re happy to stick with the lifestyle that brought you to remission—in this case, a low-carb ketogenic diet—then your organs and overall health are thought to be protected against the devastations of a disease that can otherwise lead to amputations, nephropathy, neuropathy, retinopathy, heart disease, dementia and a multitude of other disastrous consequences.

What is the Virta Health Model?

The Virta Health model, at a high level, is a continuous remote care app that can be now accessed commercially through direct payment or insurance coverage.

There is a telemedicine care team that advises participants on nutrition therapy and manages diabetes medication.

The dietary therapy includes advising patients to consume < 30 g carbohydrates per day, 1.5 g protein per kg body weight, and fat intake to satiety.

Otherwise, the diet plan is individually tailored—be your personal preference a tomahawk in tallow or tarragon tofu. I don’t know if that’s actually a thing, but I like alliteration, and I have ChatGPT. So, this is what you get.

Anyway, Virta has previously published the results of its prior controlled trial comparing the Virta (CCI) vs Usual Care, with Virta yielding far superior results in terms of blood sugar control, including large drops in HbA1c, fasting blood glucose and fasting insulin as compared to usual care.

Table 2 from prior controlled trial. The three different between group differences refer to per protocol unadjusted, per protocol adjusted for baseline, and intention-to-treat analyses. Irrespective of the analysis, Virta performed superior to usual care.

5 Year Study Results

But in this recent study, researchers reported on 120 people who consented to an extension and completed 5 years of monitoring.

• 20% of these 5-year completers, 24 people, achieved diabetes remission.

• Of these, 8 were in complete remission from pre-diabetes and diabetes, with HbA1c <5.7% and off medication.

• 32.5% (one-third) achieved HbA1c in the non-diabetic range with no diabetic medication or only metformin.

How should you think about these numbers?

I’m sure there are some of you who impressed, but others who may be underwhelmed. Maybe you were expecting a majority to achieve complete remission?

But consider these 3 facts:

1. First, at baseline these people were very poorly off. Average weight was 117 kg (258 lbs) with 8 years since diabetes diagnosis.

2. Second, these are free living humans dealing with all the complexities and challenges that come with living in the modern food environment and social ecosystem, with constant sugar pushing and dietary booby traps galore.

3. Third, diabetes is often presented to patients as a chronic, progressive disease. The status quo assumes remission can’t be achieved or that it’s too hard. Despite that, through an app and telemedicine, 20% of those who stuck through did achieve remission, with some even achieving complete remission after 5 years with HbA1c levels in the 5% range and off all medications.

The point: It’s possible. These data prove it’s possible. These data provide hope.

I’ll also point out that even among those who didn’t achieve remission, the vast majority exhibited improvements in health, including increased HDL-C, decreased insulin resistance scores, weight loss, and decreased inflammation.

The majority of patients on the diabetes medications with harshest side effect profiles, like sulfonylureas and insulin, also come off those medications entirely.

Health isn’t an all or nothing and even among those who didn’t achieve remission, they made tremendous progress.

Remission: Secret Sauce and Scalability

But now, the question that’s of greatest interest to me: what is the secret sauce of those who achieved remission, and how can we – as a biomedical community – scale that proportion from 20% to 100%?

Well, first, it’s important to note that those with higher ketone levels in this study tended to show better results.

This is proof in the pudding – sorry, in this cheese platter? – that adherence to lower carb, “more ketogenic,” diets yields better results in terms of blood sugar control.

Of course, in a free-living environment, there are challenges and adherence isn’t always easy. But for those who can find ways to adhere more strictly to very low-carb diets, they’re more likely to achieve remission and improvements in health.

So, my “success formula” for diabetes remission, were I to create one, includes all tools to empower people to happily adhere to an optimized low-carb diet. This includes:

• Metabolic Health Education … Translation: Click Subscribe ;)

• Support communities

• Biofeedback tools like continuous glucose monitors (get yours HERE)

• And, more broadly placing patients’ data – your data, in your own hands (see more below).

That’s individual empowerment!

Final Ingredient to Metabolic Health Success

The final ingredient in the formula to diabetes remission and metabolic health success is, in my opinion, stimulating broad social change.

Yes, your health journey is personal—but it’s also communal. We construct and shift social norms together. If you adopt lifestyle changes and become a case study in reclaiming your health, your family and friends may follow, and these positive behaviors can spread like hot butter on toast.

… ugh, sorry, I did it again—I mean spread like hot butter on steak.

So, what I love about these data from Virta is not that 20% remission is good enough. But that Virta is pioneering in a place and time where normal is inevitable disease progression. They’re proving what’s possible, and in that way shifting culture until a – to paraphrase the late great Sarah Hallberg – a “critical mass” of individuals is reached such that diabetes remission becomes the norm and remission and hope become mutually reinforcing dance partners in a more metabolically healthy society.

…Diabetes remission becomes the norm and remission and hope become mutually reinforcing dance partners in a more metabolically healthy society...

Your Data in Your Hands (Relevant Promotion)

For those interested in getting at home lab testing kits to test the effects of a lifestyle change of your choosing on 17 different biomarkers, SiPhox is offering my audience 50% off two lab testing kits. Click HERE to learn more.