Hemoglobin A1c: Can Weight Loss Reverse Type 2 Diabetes?

Q: Hemoglobin A1c: Can Weight Loss Reverse Type 2 Diabetes?

Dear Ms. Anonymous： 1. According to the diagnostic criteria for diabetes set by the American Diabetes Association： a. Fasting plasma glucose level ≥ 126 mg/dl after fasting for more than 8 hours, b. Plasma glucose level ≥ 200 mg/dl during a 2-hour oral glucose

Glycated hemoglobin

Doctor, I would like to ask you about my situation.
In September, my hemoglobin A1c was 6.1, and in January of this year, it was 6.5.
Am I diabetic? When I went to the hospital to review my report, the doctor advised me to lose weight.
Is this to manage my diabetes or to potentially cure it? When I visited, the doctor mentioned that my hemoglobin A1c was 6.5 and diagnosed me with type 2 diabetes with complications.
The doctor asked me to return in March to see if losing weight could help lower my hemoglobin A1c to 6.1.
Does this mean they are checking if I can revert to being non-diabetic? Additionally, the doctor did not prescribe any medication, which suggests that I might have the potential to return to a non-diabetic state.
I have been questioning whether I truly have diabetes since I do not experience symptoms like excessive thirst or frequent urination, and I do not feel dizzy if I skip a meal.
My weight is 115 pounds, and my height is 169 cm.
If I lose weight, is there a chance I can revert to being non-diabetic?

Nìngmíng, 10~19 year old female. Ask Date: 2017/02/10

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
Anonymous:
1.
According to the diagnostic criteria for diabetes set by the American Diabetes Association: a.
Fasting plasma glucose level ≥ 126 mg/dl after fasting for more than 8 hours, b.
Plasma glucose level ≥ 200 mg/dl during a 2-hour oral glucose tolerance test, c.
HbA1c ≥ 6.5% (this must be confirmed with a method that meets the international certification standards of NGSP and DCCT, and there should be no disproportionate hyperglycemia), and at least two of the above a, b, or c must be confirmed on separate occasions.
d.
If there are clinical symptoms of diabetes (such as excessive thirst, frequent urination, increased appetite, weight loss, etc.), a plasma glucose level ≥ 200 mg/dl on any occasion is sufficient for diagnosis.
2.
Your weight is 115 kg, height is 169 cm, and your body mass index (BMI) is 40.2 kg/m², which classifies you as severely obese.
Risk factors for developing diabetes include a family history of diabetes, obesity, hypertension, hyperlipidemia, lack of physical activity, overeating, alcohol abuse, certain medications, poor lifestyle habits, and excessive stress.
You may evaluate these factors for yourself.
Obesity can lead to insulin resistance, increasing the risk of type 2 diabetes.
Therefore, moderate weight loss is very important.
Dietary control, regular exercise, and behavioral therapy are non-pharmacological methods for weight loss; dietary control is the fundamental step.
Generally, it is recommended that individuals consume 1500-1200 calories per day to meet nutritional needs.
Clinically, we suggest that men control their caloric intake to around 1500-1800 calories per day and women to around 1200-1500 calories; alternatively, reducing daily caloric intake by 500 calories can lead to approximately 0.45 kg of weight loss per week.
Rapid weight loss can sometimes lead to rebound weight gain.
An unbalanced diet may lead to muscle protein loss or accelerate fat accumulation, so caution is advised.
3.
Your physician's recommendations and management are very appropriate.
Type 2 diabetes does not occur suddenly; it develops over time due to factors such as obesity, poor dietary habits, lack of exercise, and unhealthy lifestyle choices.
Given your clinical condition, there is still an opportunity for reversal, which is why your physician has advised dietary and exercise control along with weight loss, rather than prescribing medication.
4.
My personal recommendations for you: Chew your food thoroughly and avoid overeating (aim for about 80% fullness), and limit high-calorie, high-fat, and high-sugar foods or beverages.
Reduce intake of high-cholesterol and trans fats (often found in creamers, butter, ghee, instant coffee mixes, milk tea, etc.) and high fructose corn syrup (commonly found in commercial beverages, desserts, sodas, pastries, etc.).
These types of foods may be harder for your body to metabolize, may contain empty calories that do not provide satiety, and can lead to increased blood sugar levels.
On the other hand, develop a regular exercise routine, such as playing sports, jogging, swimming, or cycling; in fact, taking a good walk for 30-60 minutes after each meal can be very effective.
In terms of lifestyle, avoid excessive stress and ensure adequate sleep; this will help reduce the secretion of related hyperglycemic hormones and increase the secretion of leptin, aiding in weight control.
If you have further questions, please discuss them in detail with your family physician.

Reply Date: 2017/02/10

More Info

Understanding Hemoglobin A1c (HbA1c) and its implications for Type 2 Diabetes is crucial for managing your health. Based on your recent HbA1c readings of 6.1% and 6.5%, it is important to clarify what these numbers mean in the context of diabetes diagnosis and management.

According to the American Diabetes Association, an HbA1c level of 6.5% or higher is indicative of diabetes. Your reading of 6.5% suggests that you are on the threshold of being diagnosed with Type 2 Diabetes. However, the previous reading of 6.1% indicates that you were in a pre-diabetic state, which is a critical point where lifestyle changes can significantly impact your health trajectory.

Your doctor’s recommendation to lose weight is a common and effective strategy for managing and potentially reversing Type 2 Diabetes. Weight loss can improve insulin sensitivity, lower blood sugar levels, and reduce the risk of complications associated with diabetes. The goal of weight loss in your case is not only to manage your current condition but also to potentially reverse it. Many studies have shown that individuals with Type 2 Diabetes who lose a significant amount of weight (around 5-10% of their body weight) can improve their blood sugar levels and, in some cases, achieve normal glucose metabolism.

The absence of medication at this stage suggests that your doctor believes you can manage your condition through lifestyle changes alone. This is a positive sign, as it indicates that your diabetes may still be in a manageable state. The focus on weight loss and monitoring your HbA1c levels is a proactive approach to prevent the progression of diabetes and its associated complications.

Regarding your concerns about not experiencing typical symptoms of diabetes, such as excessive thirst or frequent urination, it is important to note that not everyone with diabetes will exhibit these symptoms, especially in the early stages. Many individuals can have elevated blood sugar levels without noticeable symptoms, which is why regular monitoring is essential.

To answer your question about whether you can "recover" from diabetes: while the term "recovery" can be misleading, it is indeed possible for some individuals to achieve normal blood sugar levels and maintain them through lifestyle changes, including diet and exercise. This is often referred to as "remission" rather than a cure. It is essential to continue monitoring your HbA1c levels and work closely with your healthcare provider to adjust your management plan as needed.

In summary, your current HbA1c levels indicate that you are at risk for Type 2 Diabetes, and your doctor’s advice to lose weight is aimed at controlling your blood sugar levels and potentially reversing your condition. By adopting a healthier lifestyle, including a balanced diet and regular physical activity, you can significantly improve your chances of maintaining normal blood sugar levels and reducing the risk of complications associated with diabetes. Regular follow-ups with your healthcare provider will be crucial in monitoring your progress and making necessary adjustments to your management plan.

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