The science behind type 2 diabetes reversal

Type 2 diabetes is popularly known as a chronic progressive disease that gets worse over time and often leads to complications and eventual death. It is believed that people living with type 2 diabetes have to be on lifelong medication. This used to be true until now. In this essay, I will be showing you that type 2 diabetes is a reversible condition and that people can go off medications.

I’ll start by helping you understand what type 2 diabetes really is. Type 2 diabetes is characterized by a high amount of glucose in the blood. It is commonly thought to occur either because cells in the body are not responding to insulin (insulin resistance) or because there is a reduction in the amount of insulin produced by the beta cells of the pancreas or a combination of both.

Insulin is a hormone produced by beta cells in the pancreas. It has many functions, like allowing the glucose in the blood to go into cells thereby reducing the amount of glucose in the blood or inhibiting protein breakdown in muscle cells, and fat breakdown in fat cells. In this essay, I’ll be focusing on its effect on glucose.

Understanding insulin resistance

Understanding beta-cell failure

Introducing type 2 diabetes reversal

An image showing the metabolic health spectrum

The American Diabetes Association defines type 2 diabetes reversal as a return of HbA1c to less than 6.5% that occurs spontaneously or following an intervention and that persists for at least three months in the absence of usual glucose-lowering pharmacotherapy

How to reverse type 2 diabetes

Bariatric surgery

Very low calorie diets

Low carbohydrate diets

I think it is important to inform patients that reversal or remission doesn’t mean “cure”. If they return to their previous unhealthy habits the disease might come back. Patients should also be advised to see their doctors regularly for ongoing support and to prevent a relapse. David Sackett, the father of evidence-based medicine once famously said:” half of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half — so the most important thing to learn is how to learn on your own.” This is why it is important to keep up with research. The knowledge and treatment of type 2 diabetes have improved in the last 10 years. It is important to embrace these changes so that we can offer the best treatments to our patients.

This essay was written by Joseph Anya, founder of Sustain, an online clinic that reverses chronic metabolic diseases without the side effects or risks of medication or surgery. If you have questions for me, please leave a comment here or tweet at me on Twitter.


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  2. Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–1131. doi:10.1001/2012.jama.11164
  3. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344–355. doi:10.1016/S2213–8587(19)30068–3
  4. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489–2496. doi:10.1001/jama.2012.67929
  5. Adams RN, Athinarayanan SJ, McKenzie AL, et al. Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction. J Behav Med. 2022;45(3):416–427. doi:10.1007/s10865–021–00272–4



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Sustain is an online specialty clinic that reverses chronic metabolic diseases without the use of medication or surgery