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Editorial Diabetes Can Type 2 Diabetes be Reversed? Osama Hamdy Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, US O ver the last few years, the question, “can type 2 diabetes be reversed?” came to the surface after several observations of partial or complete remission from the disease were seen in response to surgical and non-surgical interventions for weight management. This leads us to propose an alternative model for type 2 diabetes management by targeting body weight instead of our current classic model of targeting blood glucose levels by anti-hyperglycemic medications. The proposed alternative model may be successful in the early stages of type 2 diabetes as we currently have several effective tools. Untimely, this model of intervention may reduce cost and improve patients’ quality of life. Keywords Weight management, diabetes, clinical practice, lifestyle intervention, cardiovascular risk Disclosure: Osama Hamdy receives research grants from The National Dairy Council and Metagenics Inc. He is a consultant to Abbott Nutrition and Merck Pharmaceutical and share holder of HealthyMation LLC. This article is a short opinion piece and has not been submitted to external peer reviewers. No funding was received for the publication of this article. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: October 26, 2016 Published Online: December 20, 2016 Citation: US Endocrinology, 2016;12(2):76–7 Corresponding Author: Osama Hamdy, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, US. E: osama.hamdy@joslin.harvard.edu For decades, endocrinologists have been targeting blood glucose levels as their prime focus of type 2 diabetes management. They frequently start their patients on one oral medication and gradually escalate over time up to four or five medications, including insulin. Many of these medications paradoxically contribute to further weight gain, including sulfonylureas, thiazolidinediones and insulin. 1 Increased body weight secondary to these medications may block any attempt for successful weight management or make it extremely difficult. Over time, diabetes control frequently deteriorates and leads to further frustration for many patients. This classical model of type 2 diabetes management has been challenged over the last few years for being directed toward the 'fever' of the problem and neglecting its core cause, which is increased body weight. Over the last few years, several studies have shown that targeting body weight instead of targeting blood glucose as primary goal could lead to reversing type 2 diabetes and/or inducing partial or complete remission. 2 The first proof of this concept came after significant weight loss through bariatric surgery. 3 However, non-surgical intervention also showed a possibility of inducing partial or complete remission, especially early in type 2 diabetes course. 4 For example, weight reduction through a very low-calorie diet showed similar improvement in beta-cell function and insulin sensitivity to gastric bypass surgery. 5 This alternative model of primarily targeting body weight for diabetes management gained more traction after approval of several anti-obesity medications by the US Food and Drug Administration over the last few years. These medications showed marked improvement in blood glucose levels and hemoglobin A 1c during weight loss. 6–8 The overall advantages of this alternative model are that it reduces cost of medications, results in better improvement in A 1c , reduces cardiovascular risk through reducing blood pressure and improving lipid profile, reduces inflammation, and improves patients’ quality of life. Combining strategies that include anti-obesity medications, low-calorie and low-carbohydrate dietary plans, increased physical activity and behavioral modification may be more effective than escalating use of anti-hyperglycemic medications as shown in the classic model of type 2 diabetes management. If this alternative model is applied early enough, the possibility of inducing partial or complete remission from type 2 diabetes is much higher. If needed, several antihyperglycemic medications that help weight reduction including glucagon-like peotide-1 (GLP-1) analogs, sodium- glucose cotransporter 2 (SGLT-2) inhibitors and pramlintide can be added. Combining one or two of these medications with metformin enhances weight reduction and rarely causes hypoglycemia, which frequently slows weight reduction. 9 76 TOUCH ME D ICA L ME D IA