Reversal of T2DM – A New Concept of Management by Dr. Banshi Saboo

CASE OVERVIEW

Diabetes is known as an irreversible and progressive disease. The DiRECT study (2017) concluded that remission of type 2 diabetes is a practical target for individuals with type 2 diabetes from less than 6 years, BMI >25kg/m2, not on insulin at the enrollment, and those who are well motivated for lifestyle modifications. Dr. Banshi Saboo had a real-world experience of diabetes reversal when a 45-year-old female patient with type 2 diabetes for the last 4 years and hypertension since the last 5 years visited him. She also complained of tiredness with a weight gain of about 5 Kg in the last 6 months. Her height was 166 cm with a weight of 90 Kg leading to a BMI of 32.6 Kg/m2. She was on Metformin 2g with Glimepiride 3g.

Reversal of Diabetes is defined in following stages:-

• Stage of Diabetes – Control Reversal , Target HbA1c – <7.0,  Medications – Any
• Stage of Diabetes – Reversal stage 1 , Target HbA1c – <6.5, Medications – IS, GE, GR.
• Stage of Diabetes – Reversal stage 2 , Target HbA1c – <6.5, Medications – IS.
• Stage of Diabetes – Reversal stage 3 , Target HbA1c – <6.5, Medications – No.
• Stage of Diabetes – Remission , Target HbA1c – <5.7, Medications – No

DIAGNOSIS

Her HbA1c was 9.2% on the first visit. She had also complained of intermittent snacking with weight gain, maybe due to in between low sugar.

RESULTS

Consistent weight reduction and improved HbA1c was recorded on her follow up visits. After 12 months of follow-up, she had a total weight loss of 25 Kg with a BMI of 23.5 Kg/m2, and HbA1c was 6.3%. Her HbA1c was further reduced to 5.6% with BMI being 23 Kg/m2 at 18 months follow-up. She was already in a reversal of stage 1 at this period. At 24 months follow-up, her HbA1c was 5.7% & she was now in reversal stage 2.

TREATMENT

She was started on inj. Dulaglutide 0.75 mg once a week. Along with that T. Metformin 1 gm, Pioglitazone 7.5 mg, Dapagliflozin 10 mg were started. From the 2nd week onwards, she was started on 1.5 mg dulaglutide. This treatment was continued for the next 7 to 8 months. Aggressive diet & lifestyle modification was encouraged. After 12 months follow up, inj. Dulaglutide. & pioglitazone was stopped. Now she was on T. Metformin 2 gm, Dapagliflozin 10 mg. At 18 months follow-up, dapagliflozin was stopped and metformin was continued. At 24 months follow up, she was only on metformin 2 gm.
She is being continued with metformin 1 gm simply to keep her motivated for adherence to diet & lifestyle modification. In the next 2 years, they might even stop metformin.