Diabetes
From lifelong medication to remission: Rethinking Type 2 diabetes management
Type 2 diabetes has long been regarded as a chronic, lifelong disease requiring continuous medication in the form of tablets or insulin.
However, advances in medical science and a deeper understanding of the disease have significantly altered this perception.
Today, diabetologists emphasize early diagnosis and treatment of the root cause—obesity—rather than focusing solely on blood sugar control.
Medical experts now agree that obesity, particularly abdominal or visceral fat, is the primary driver of type 2 diabetes in most individuals.
Excess fat around the abdomen leads to insulin resistance, a condition in which the body fails to use insulin effectively. In the early stages—prediabetes or newly diagnosed diabetes—insulin levels are often normal or even elevated, but the hormone cannot function properly due to this resistance.
Over the past decade, diabetes management has undergone a major shift. Instead of prescribing multiple drugs at the outset, clinicians now prioritize scientific treatment of obesity through structured diet plans, physical activity, and long-term lifestyle modification.
When patients visit a diabetes clinic, they undergo a comprehensive evaluation that includes assessment of body fat, blood pressure, and the health of vital organs such as the heart, kidneys, and liver. Investigations like blood tests and ECGs are conducted when required to ensure safe and holistic care.
Lifestyle intervention remains the cornerstone of treatment. Patients are encouraged to follow individualized diet and exercise programs on a lifelong basis. Medications are prescribed only when necessary, and often in minimal numbers, if lifestyle measures alone do not lead to adequate weight loss or metabolic control.
Importantly, medical evidence shows that type 2 diabetes can enter remission if treated proactively within the first five to six years of diagnosis. Remission refers to maintaining normal or near-normal blood sugar levels without medication, under medical supervision. Beyond this period, the disease may become progressive and require long-term medication due to declining pancreatic function.
A major concern among physicians is the widespread misconception that starting diabetes treatment automatically means lifelong dependence on medicines. This belief often leads newly diagnosed patients to delay treatment, increasing the risk of serious complications affecting the eyes, kidneys, nerves, and heart.
The growing burden of diabetes in India adds urgency to this issue. Diabetes is now a global public health challenge, and India is projected to become one of the countries with the highest number of diabetic individuals by 2045.
While traditionally associated with urban lifestyles, diabetes is increasingly affecting economically weaker sections as well. Current estimates indicate that nearly 8 per cent of India’s population has diabetes, while around 15 per cent are prediabetic—an alarming figure.
Experts stress that effective obesity management can prevent not only diabetes but also several related conditions, including hypertension, stroke, coronary artery disease, fatty liver disease, osteoarthritis, polycystic ovarian disease (PCOD), and certain cancers such as colon, breast, and prostate cancer.
Dietary habits are a key area of concern.
The traditional Indian diet is largely carbohydrate-rich, which, when combined with physical inactivity, contributes to weight gain and metabolic disorders. Doctors recommend a gradual shift towards balanced diets rich in protein, fiber, and essential nutrients. However, diet alone is not sufficient; regular physical activity is essential to burn excess calories and improve insulin sensitivity.
Medical professionals emphasize that type 2 diabetes should no longer be viewed with inevitability or fear. With early detection, scientific management of obesity, sustained lifestyle changes, and appropriate medical guidance, diabetes can be prevented, effectively controlled, and in many early cases, reversed.
Awareness and timely action, they say, are the most powerful tools in combating this silent epidemic.
About the writer
Dr. Asis Mitra, MBBS - Calcutta National Medical College 1997, MD (General Medicine) - VVS Medical College - Sambalpur University 2004, MRCP - Ireland 2017, MRCP - UK 2018, MSc (Endocrinology) - Chester University 2024, F. I. D. F. - Fellow International Diabetes Federation - Brussels 2024
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Dr Asis Mitra @ https://www.facebook.com/asis.
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