RRR -Reversal, Relapse and Remission

Example R1

Mr X had parked his car into a narrow parking area near his house yesterday. Today, he started the car and switched the vehicle into reverse gear. After the successful reversal of his car, he drove to his office.

Example R2

Mr Y was diagnosed to have Type 2 Diabetes in 2016. His doctor advised a weight loss diet, exercise, stress reduction and medication. As his lifestyle changes began to take effect, his doctor stopped medications, but asked him to regularly monitor his blood glucose. After a few months of maintaining good glucose control, he stopped going to the doctor. Over the next two years the blood glucose levels remained normal. However, in 2019, his Diabetes was back and he regained the weight that he had lost. Indeed, his friends told him that he had a relapse of Type 2 Diabetes, and advised him to go back to his doctor. Simply put, the word relapse meant a return of illness after a temporary pause.

Example R3

Mr Z had been diagnosed to have a cancer of the thyroid gland in the neck, which had spread to several nearby areas of his body. After surgery and radioactive iodine treatment, scans showed the disease was no longer detectable. His doctor told him that his cancer had gone into remission

The word remission, the doctor carefully mentioned, meant that the disease had got better temporarily – but that it could come back later and might have to be treated again. The word remission was a better word than reversal, said the doctor and added that the term remission would send a subtle signal to both the patient as well as healthcare providers about the need for long term surveillance and close monitoring to see if the disease returns.

Friends, RRR was one of most successful Indian movies of all time, and had some glorious scenes. In the movie, which I enjoyed tremendously (yes, I did see it!) RRR stood for the Rise Roar Revolt! In contrast, my Diabetes version of RRR is a less flamboyant, yet equally important one– and stands for Reversal, Relapse and Remission, as explained above.

Putting a car into reverse gear is of course, simpler than trying to reverse Diabetes.Nevertheless, our internet and newspapers are always abuzz with stories of what they call “reversal of Diabetes”. Not all of them are true, and not all of them are false.Firstly, let us get the facts right. Most of these stories pertain to Type 2 Diabetes, the commoner form of Diabetes in the world.Type 1 Diabetes, which occurs due to permanent destruction of insulin-producing beta cells, cannot for the time being be cured or reversed by any means and requires insulin treatment for blood glucose control.

It is true that many people with Type 2 Diabetes are able to stop medications by diet control and other lifestyle changes, and still maintain good glucose control. It is false that this control of glucose is always permanent in every person. Many patients, after successfully controlling their blood glucose, are lulled into a fall sense of security. They feel that they have “reversed” their Diabetes. However, slowly, either because such restrictive lifestyle changes are not sustainable, or because the disease biology has progressed (worsening of beta cell death or increasing ineffectiveness of insulin), eventually, Type 2 Diabetes makes a comeback. They soon go back to their doctors because of rising blood glucose levels.

In order to acknowledge the possibility that people with Type 2 Diabetes can achieve good glucose control via purely lifestyle measures, but at the same time, to prevent them from going into a sense of complacence provided by words like “reversal”, experts now suggest the word “remission”.

The word remission of Type 2 Diabetes, while imparting a sense of positivity by acknowledging that the problem has gone away, continues to emphasize the need to focus on lifestyle modifications and monitoring, because the disease could make a comeback.

The best clinical trials of achieving a remission of Type 2 Diabetes come from studies led by Prof Roy Taylor and his colleagues from the United Kingdom. His studies show the importance of nutritional interventions in achieving a remission of Type 2 Diabetes, and clarify that this remission could be successfully sustained over a period of time in primary healthcare settings in the United Kingdom. Weight loss and a personal fat threshold – i.e. the concept of a very individualized fat loss plan seem to be good predictors of achieving success in remission, according to these studies.

In this issue of Diabetes Health, we thus explain the term “remission of Type 2 Diabetes” and also discuss ways and means to achieve this with purely lifestyle measures. It is important, however, for people with Diabetes to remember that the goal of Diabetes treatment is not to escape medicines or injections; a better goal of Diabetes treatment is to control blood glucose levels.

Just as there are different paths to single goal, there may be various approaches to achieving a glucose control in Diabetes. Before you choose a path, do look into the sustainability of the path and seek help of an expert healthcare provider, so that you can find the path that is suitable for you.

We at Diabetes Health also try to chip in by trying to provide you with the best and most reliable information.

Happy Reading!

Dr Unnikrishnan AG

Editor