Reversible diabetes

In his essay ‘Scotoma: Forgetting and Neglect in Science’, the late Professor Oliver Sacks notes that science and medicine evolve when people ‘confront both anomalies and deeply held ideologies’, with open debate central to progress (Sacks, 1997). In this context, it is perhaps worth considering a mounting evidence base that challenges the idea (ideology?) of type 2 diabetes (T2D) being irreversible. For example, Rasouli (2020) observes: ‘T2D has been considered a chronic, progressive disease with expected worsening of glycemia due to steady decline in -cell function over time. However, recent studies have suggested that T2D diabetes could be a reversible condition in specific settings.’

If so, the potential savings in both human and economic terms could be huge, given that in the UK around one million people have undiagnosed T2D; 57% of people with type 1 diabetes and 42% with T2D do not receive annual health checks; one third of those diagnosed with T2D have a microvascular complication at the time of diagnosis; and the NHS spends at least £10 billion a year on diabetes, equivalent to 10% of its budget, with 80% spent on treating complications (Whicher et al, 2019).