Why Type 2 Diabetes is NOT a Chronic and Progressive Disease?

The traditional thinking of type 2 diabetes is as follows. Once you have it, you have it. You cannot cure it. You cannot reverse it. You can only manage it. Patients are often told that, you will have Type 2 Diabetes for life. It will get worse and then you’ll go blind or leg amputated. You will soon be on insulin, get used to it! The best you can hope for is to slow its progression through your diet, exercise, and oral medicine or insulin.

If you have to get worse, if you can’t avoid complications and premature death, then why struggle with your diet and managing your diabetes?

Actually, it is simply a BIG lie. Contrary to popular belief, the pancreas is not burnt out beyond repair. Instead, the pancreas is simply clogged with fat. Once you unclog the fat, the pancreas starts to work again and insulin is secreted normally. Type 2 diabetes is both preventable and reversible, not chronic and progressive. It is not a life sentence. However, taking medications will not cure the disease.  Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon, but diabetes remission by cutting calories is rarely discussed. 

In June 2019 DiRECT study data announced at the 79th annual Scientific Sessions of the ADA shows restoration of beta cell function is possible. The study proves that type 2 diabetes is a reversible disease and patients who once suffered may be able to regain their previous quality of life. But in Jan 2021 the DiRECT study in the UK has demonstrated total remission of type 2 diabetes, including the withdrawal of glucose lowering medications, for periods of up to 3 years. The intervention involved an initial period of marked weight loss (typically around 15kg) induced by using very low-calorie formula diets.

Importantly, the primary care-based Diabetes Remission Clinical Trial (DiRECT) showed that 46% of people with type 2 diabetes could achieve remission at 12 months, and 36% at 24 months, mediated by weight loss. This major change in our understanding of the underlying mechanisms of disease permits a reassessment of advice for people with type 2 diabetes.

Diabetes reversal, not just treatment, should be a goal in the management of type 2 diabetes. Unfortunately, most of the actors in the health care system do not have financial incentives to get you healthy and keep you healthy. Profits are made through visits, prescriptions, and tests. 

At least five approaches have claimed to reverse Type 2 diabetes in many people.

Bariatric surgery

Bariatric surgery such as gastric bypass and gastric banding frequently puts Type 2 diabetes into remission. This means that the signs of diabetes disappear – often within days, before any significant weight is lost. Actually, this fact had been known since 1982. The 10 year follow up of a group of surgical patients had shown that many patients maintained normal blood sugars even off medications.

Type 2 diabetes is a curable disease

Researchers from King’s College London say metabolic surgery can essentially “cure” patients with severe cases of type 2 diabetes. They found that 37.5 percent of patients having gastric bypass or biliopancreatic diversion surgery remained diabetes-free throughout a 10-year follow-up period. In 2009, the American Diabetes Association defined a “cure” as any treatment which causes diabetes remission for over five years. The findings from this study provide the most robust scientific evidence yet that full-blown type 2 diabetes is a curable disease, not inevitably progressive and irreversible

Extreme caloric restriction

A new study from Newcastle and Glasgow Universities shows that low-calorie diet caused remission in 90% of trial patients who lost 15kg or more, even those who had been diabetic for six years.

Low Carb High Fat diet

The new study conducted by Virta Health shows dramatic improvements in type 2 diabetes with a model which relies on extremely  low-carb diet – less than 30 grams of carbs per day – paired with a diet high in fat and moderate in protein. Many patients were even able to completely quit diabetes medications, suggesting that type 2 diabetes is highly reversible. Virta Health’s Treatment for Sustained Type 2 Diabetes Reversal Provides New Hope for Chronic Disease Patients. San Francisco-based Virta Health, the first company with a clinically proven treatment to safely and sustainably reverse type 2 diabetes (T2D) and other chronic metabolic diseases without the use of medications or surgery, has raised a $45 million series B funding round, bringing the total equity funding to $75 million to date.

One Duke University study followed 82 obese people with Type 2 diabetes who were assigned to either a very-low-carb or a low-calorie diet. After six months, the low-carb group had a lower average HbA1c level and had lost more weight than the low-calorie group, and 95% were able to reduce or totally eliminate their diabetes medicines.

Whole food plant-based diet

The Physicians Committee for Responsible Medicine [PCRM], has long contended a whole food plant-based diet can prevent, manage – and even reverse – type 2 diabetes. The American Diabetes Association has maintained that a plant-based eating pattern is an effective option for type 2 diabetes management in its 2018 Standards of Medical Care in Diabetes.

Raw Food Diet

A really interesting watch is the Raw for 30 documentary in which 6 people with a combination of type 1 and type 2 diabetes each joined a program to go raw for 30 days. Some members of the group were able to completely come off all diabetic medications and were effectively reversed diabetes.

Too good to be true?

The idea of reversing Type 2 diabetes is still considered somewhat extreme. Opposing voices raise several objections, such as there aren’t any large, well-controlled for an extended period studies on dietary approaches like those that exist for drugs. Type 2 diabetes it is not a death sentence. It starts with changing your belief about what’s possible. Whether you are on medication or insulin or just ignoring it hoping it will go away, you can make changes to improve your health.

Zen Healthcare is just one example of a health care provider that believes type 2 diabetes is reversible and has data to back that up. It was born out of the passionate desire and commitment to make Nepal a Diabetes Free Zone. 

Zen Healthcare has a bolder mission than most health-care companies. Rather than encouraging customers to follow their drug regimen, it aims to reverse chronic disease through lifestyle change — and ultimately to wean its users off their medications entirely.

Our holistic approach actually reverses Type 2 Diabetes rather than delaying complications from ongoing management. This is much better because it eliminates suffering and saves far more money than traditional approaches. We can reverse and then sustain Type 2 diabetes  while substantially improving obesity, blood pressure, cardiovascular disease risk and inflammation. 

We have a unique opportunity to define the standard of care for chronic disease treatment and go from ‘care’ to ‘cure.

Would you like to be a part of  our Diabetes Free Nepal campaign and contribute to make Nepal a proud nation?

If you want to participate in our Diabetes Reversal Program, please contact us at info@zenhealthcare.com.np or call +97714381427.

By | 2021-02-03T07:15:45+00:00 February 2nd, 2018|Uncategorized|9 Comments

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  1. zen February 16, 2018 at 13:08

    रिसर्च में दावा: मोटापे और मधुमेह की बीमारियों के कारण लोगों में कैंसर होने का खतरा

    दुनियाभर में 8 लाख से भी ज्यादा ऐसे लोगों को कैंसर हुआ है, जो मोटापे और डाइबिटीज की बीमारी से ग्रस्त हैं। यह बात एक स्वास्थ्य पत्रिका में छपी रिसर्च में सामने आई है। इस रिसर्च में दावा किया गया है कि आज के जीवन में आम बन चुकी मोटापे और मधुमेह की बीमारियों के कारण लोगों में कैंसर जैसे जानलेवा रोग होने का खतरा काफी ज्यादा बढ़ गया है।

    इस शोध के अनुसार साल 2012 में ऐसे 8 लाख से ज्यादा लोगों में कैंसर पाया गया, जो मोटापे और डाइबिटीज से ग्रस्त थे। इस शोध में विज्ञानिकों ने पाया कि 12 प्रकार के घातक कैंसरों में से एक तिहाई कैंसर इन दोनों समस्याओं के कारण ही हुए। इस रिसर्च के मुताबिक ज्यादा वजन और मधुमेह की बीमारी से होने वाला कैंसर पुरुषों के मुकाबले महिलाओं में दोगुना ज्यादा होता है।

    शोध में आगाह किया गया है कि अगले 20 सालों से भी कम समय में इन दो कारणों से होने वाला कैंसर महिलाओं में 30 प्रतिशत बढ़ सकता है। वहीं पुरुषों में ये 20 प्रतिशत बढ़ सकता है। इस रिसर्च से जुड़े एक वैज्ञानिक का कहना है, मोटापे से कैंसर होता है, यह बात पहले भी सामने आ चुकी थी। लेकिन डाइबिटीज भी कैंसर को जन्म देती है, ये हाल ही में पता चला है।

    उन्होंने कहा कि अकेले मधुमेह या फिर मोटापे के साथ, हर साल हजारों की संख्या में लोगों को कैंसर होता है। इस शोध में सामने आया है कि पुरुषों में 40 प्रतिशत लिवर कैंसर मधुमेह और मोटापे की वजह से ही होता है। वहीं महिलाओं में एक तिहाई यूटेरीन कैंसर और ब्रेस्ट कैंसर के लिए डाइबिटीज और मोटापा जिम्मेदार हैं।

  2. zen June 18, 2019 at 07:57

    Insulin-Producing Beta Cells Can Be RESTORED in Type 2 Diabetes

    Pancreatic beta cells that do not produce sufficient insulin in people with type 2 diabetes (T2D) are not permanently damaged during the early stages of the disease and can be restored to normal function through the removal of excess fat in the cells, according to a study entitled “Remission of Type 2 Diabetes for Two Years Is Associated with Full Recovery of Beta-Cell Functional Mass in the Diabetes Remission Clinical Trial (DiRECT)” presented today at the American Diabetes Association’s® (ADA’s) 79th Scientific Sessions®. More than one-third (36%) of the participants who took part in an intensive weight management program saw remission of their T2D after two years.

    Type 2 diabetes is a progressive disease over time, and previous research has suggested beta cell death is the root cause of increasing failure of insulin-production and severity of T2D. Findings presented today examined beta cell production within a geographically-defined subgroup of the original DiRECT participants who had already achieved remission of T2D through diet-induced weight loss. The study found, however, beta cells are not permanently damaged in early T2D and can be rescued by removing the metabolic stress of excess fat within the cells. The findings are the result of the examination of insulin production on a subgroup at baseline (starting weight), immediately after weight loss (five months), and upon follow up of one and two years. Researchers defined participants as “in remission” if long-term blood glucose levels (HbA1c) were less than 48mmol/mol (6.5%) and their fasting glucose plasma (FPG) levels were less than 126mg/dl, without the use of any T2D medications.

    The researchers used a Stepped Insulin Secretion Test with Arginine (SISTA) to quantify functional beta cell mass (maximum insulin secretory response during hyperglycemia). Insulin secretion rates were estimated by de-convolution, and participants’ A1C and fasting plasma glucose (FPG) levels were assessed. Analysis determined that many from the group who had initially achieved remission of T2D – blood glucose levels capable of achieving non-diabetic blood glucose control although not considered normal – had remained in remission two years after the study. Within the 40 people who had initially achieved remission of T2D, 20 participants (13 male/seven female) remained in remission, 13 gained weight and relapsed, and seven did not maintain follow-up. Furthermore, when compared to a nondiabetic comparator (NDC) group used in the study, which matched the age/gender of the DiRECT intervention group participants after weight loss, the study participants’ maximum rate of insulin secretion was comparable. The intervention group participants’ insulin secretion increased from a median of 0.58 nmol/min/m2 at baseline to 0.94 nmol/min/m2 after two years, and the insulin secretion of the NDC group had a median insulin secretion rate of 1.02 nmol/min/m2 at 24-months follow up.

    DiRECT is the latest in a series of studies to test the 2008 Twin Cycle hypothesis. Research released in 2011 reported a dramatic fall in liver fat and a significant decrease in intra-pancreatic fat levels following 33 pounds of weight loss with recovery of some beta cell function in people with T2D. In 2016, scientists reported that maintaining a healthy weight for nine months after a period of weight loss assisted in beta cell recovery. The open-labeled, cluster-randomized controlled trial involved 306 participants from 49 primary care practices in Scotland and England between 2014 and 2017. Patients ranged in ages from 20 to 65, had a body mass between 27-45 kg/m 2, were not receiving insulin and with up to six years duration of T2D. Practices were randomly selected to offer participants one of two treatments, both of which had already been shown to be effective. DiRECT aimed to ascertain which treatment option was more effective.

    The control group was based on best-practice care guidelines from the National Institute for Health and Care Incidence (NICE) and the ADA’s Standards of Medical Care in Diabetes (including antihyperglycemic and antihypertensive medications), while the intervention group became involved in a weight management program that included withdrawal of antihyperglycemic and anti-hypertensive drugs, total diet replacement (825-853 kcal/day for three to five months), structured food introduction and structured support for long-term weight loss maintenance.

    “Our research explains the observed recovery from T2D. Equally as important, though, is the finding that recovery can be achieved through primary care as part of routine health care following current standards of care,” said co-lead study investigator Roy Taylor, professor of medicine and metabolism at Newcastle University and Newcastle Hospitals NHS Trust. “People with type 2 diabetes have a choice rather than a life sentence. If the simple, effective method of weight loss and minimization of weight regain is undertaken, individuals with early type 2 diabetes can return to normal health with a profound decrease in risk of serious long-term complications associated with diabetes such as cardiac disease. Type 2 diabetes is a reversible condition, and remission can be achieved and sustained. Our research has also discovered a key message surrounding weight loss treatments. The current slow, steady approach is difficult and successful for only a few. In contrast, the approach of rapid, short-term weight loss followed by a long-term phase of avoidance of weight gain has been shown to be more productive.”

  3. zen June 18, 2019 at 08:00

    Provided weight regain is minimized, remission of type 2 diabetes is durable over 2 years, with a gradual increase to normal beta cell functional mass.

    Remission of Type 2 Diabetes for Two Years Is Associated with Full Recovery of Beta-Cell Functional Mass in the Diabetes Remission Clinical Trial (DiRECT)

    79th Scientific Sessions
    News Briefing: Reversal and Management of Type 2 Diabetes, Saturday, June 8, 8:45 AM PT

    Session Type: Oral Presentations
    Location: W-2001 (West, Level 2)
    Session Time: Saturday, June 8, 2019, 8:00 am – 10:00 am


    Aims: Observational studies have suggested that beta cell functional mass inevitably decreases over time. We assessed this after 2 years in a geographically defined subgroup of DiRECT who achieved initial remission after diet-induced weight loss.
    Methods: A Stepped Insulin Secretion Test with Arginine (SISTA) was used to quantify functional beta cell mass (maximum insulin secretory response during hyperglycemia). Insulin secretion rates were estimated by de-convolution; 40 subjects initially achieved remission (HbA1c<6.5% and FPG <126mg/dl on no antidiabetic drug therapy). At 2 years 20 subjects (13M/7F) remained in remission, 13 gained weight and relapsed, and 7 lost to follow-up. A nondiabetic Comparator (NDC) group, matched for age/gender of DiRECT intervention group participants after weight loss, was studied.
    Results: In the responder group, median (IQ range) maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p=0.017 from baseline) at 12 months, and 0.94(0.64 to 1.44) (p=0.030 from baseline) nmol/min/m2 at 24 months. This was comparable to NDC (1.02(0.86 to 1.51) nmol/min/m2) by 12 (p=0.064) and 24 months (p=0.244).
    Median first phase insulin response increased in responders from 0.042 (0.004 to 0.0637) at baseline to 0.108 (0.058 to 0.163) nmol/min/m2 (p<0.0001) at 5 months, to (0.110(0.059 to 0.201) then 0.125(0.066 to 0.166) nmol/min/m2; p<0.0001)] at 12 and 24 months.
    Those who failed to maintain remission were characterized by more weight regain 5-24 months (11. 3±1.9 vs. 6.6±1.0 kg, p=0.036). In responders mean HBA1C was 6.0±0.0% at 24 months.
    Conclusion: Provided weight regain is minimized, remission of type 2 diabetes is durable over 2 years, with a gradual increase to normal beta cell functional mass.

  4. zen June 18, 2019 at 08:03

    Is Type 2 Diabetes Reversible?

    Short answer: Yes. Long answer: It depends – and even when possible, it may be a tall order.

    COMMONLY WHEN A PERSON is diagnosed with Type 2 diabetes, the focus turns to managing the disease – for a lifetime. And typically that’s exactly the course it takes; once an individual develops diabetes, that person has the chronic condition – in which the body isn’t able to use insulin produced by the body to bring blood sugar levels into a normal range.

    However, increasingly research finds that in some instances diabetes may be reversed, or – to use the parlance more commonly associated with cancer – a person may be able to achieve remission. That is, in some people previously diagnosed with diabetes, their blood sugar is now back in a non-diabetic range without medication.

    That’s exactly what happened for more than one-third (36%) of participants randomly assigned to a weight management program, according to a two-year follow-up of a trial published in The Lancet Diabetes & Endocrinology in March. The most recent follow-up of the Diabetes Remission Clinical Trial, or DiRECT, assessing the impact of intensive weight management in primary care concluded, “Sustained remission was linked to the extent of sustained weight loss.” Nearly half (or 46%) of those in the intervention group had achieved and sustained remission at one-year, according to previous follow-up research published in The Lancet in 2018. The research involved individuals 20 to 65 years old who’d had diabetes for less than six years at the outset of the study.

    Precisely who may be able to bring diabetes into remission and when it’s possible – let alone achievable for most individuals – remains unclear. Given that lack of clarity around when, and to what extent diabetes remission is possible, controversy still exists around how to discuss diabetes reversal. But, experts say that the early-going in the disease course seems to offer the best opportunity for potentially reversing the disease. And some clinicians and researchers say this should be more of an aim in primary care for patients who are newly diagnosed with the disease.

    “It’s not impossible at all to reverse diabetes,” says Dr. Peter Arvan, chief of the division of metabolism, endocrinology and diabetes at the University of Michigan. Certainly, though, experts are quick to point out that often what it takes to do so, such as wholesale changes to completely alter the way one eats and shifting one’s schedule to prioritize exercise, can be challenging to say the least.

  5. zen June 18, 2019 at 08:06

    What is The Difference Between Reversal and Remission of Type 2 Diabetes?

    Some speak of having “reversed” Type 2 Diabetes (T2D) as a result of dietary changes whereas others refer to having achieved “remission”. What is the difference and why is the distinction important?

    What is meant by Type 2 Diabetes “reversal”
    “Reversal” of a disease implies that whatever was causing it is now gone and is synonymous with using the term “cured”. In the case of someone with Type 2 Diabetes, reversal would mean that the person can now eat a standard diet and still maintain normal blood sugar levels. But does that actually occur? Or are blood sugar levels normal only while eating a diet that is appropriate for someone who is Diabetic, such as a low carbohydrate or ketogenic diet, or while taking medications such as Metformin?

    If blood sugar is only normal while eating a therapeutic diet or taking medication then this is not reversal of the disease process, but remission of symptoms.

    We do see Type 2 Diabetes reversal in a majority of T2D patients who have undergone a specific kind of gastric bypass surgery called Roux-en-Y; with 85% having achieving normal blood sugar levels within weeks of having the surgery, without taking any blood sugar lowering medications or following any special diet[1]. The mechanism that is thought to make Type 2 Diabetes reversal possible with this type of surgery are (a) that the operation results in more of the incretin hormone GIP being released in the upper part of the gut (duodemum, proximal jejunum) which results in less insulin resistance [2,3] or (b) that the presence of food in lower gut (terminal ilium, colon) stimulates the lower incretin hormone GLP-1, which results in more insulin being secreted [3], which lowers blood sugar levels.

  6. zen June 18, 2019 at 08:09

    Can Diet Reverse Type 2 Diabetes?

    It is currently believed that T2D may be reversible by non-surgical intervention if diagnosed very early on in the progression of the disease. Type 2 diabetes can be reversed not only with an extremely low calorie diet, but it can also be reversed with an extremely healthy diet.

    One matter that needs to be overcome is that both the mass and function of the β-cells of the pancreas that produce insulin are thought to be reduced by 50% by the time someone is diagnosed with Type 2 Diabetes. Furthermore, the β-cells are thought to continue to deteriorate the longer a person has Type 2 Diabetes.

  7. zen June 18, 2019 at 08:12

    Can Intermittent Fasting Reverse Type 2 Diabetes?

    A new study involving three men concluded that occasional fasting can help reverse type 2 diabetes.

    Three men with type 2 diabetes were able to stop insulin treatment altogether after intermittent fasting, but experts are warning that people shouldn’t try such a practice on their own.

    A small study published in BMJ Case Reports looked at three men between the ages of 40 and 67 who tried occasional fasting for approximately 10 months.

    All of the men were able to stop insulin treatment within a month after starting the intermittent fasting. One of the men was able to stop insulin treatment after only five days of the fasting technique.

    “This study shows that a dietary intervention — therapeutic fasting — has the potential to completely reverse type 2 diabetes, even when somebody has suffered with the disease for 25 years. It changes everything about how we should treat the disease,” Dr. Jason Fung, author of the study and director of the Intensive Dietary Management Program, told Healthline.

    Fung’s assertions that type 2 diabetes can be reversed is contrary to the views of other diabetes experts who spoke with Healthline.

    “It’s potentially dangerous to tell patients their diabetes has been reversed, because one is always at risk for progression, even if not being treated by medication,” Dr. Matthew Freeby, director of the Gonda Diabetes Center in Los Angeles and the associate director of diabetes clinical programs at the David Geffen UCLA School of Medicine, told Healthline.

    Dr. Robert Gabbay, chief medical officer at the Joslin Diabetes Center in Massachusetts, agrees.

    “We don’t think of reversing it, but more that it is in remission. Still need to screen for complications as far as we know,” he told Healthline.

  8. zen January 24, 2021 at 07:13

    Type 2 diabetes is reversible and curable

    Type 2 diabetes is curable if you ignore your doctor’s advice. Diabetes is not the hopeless disease that most doctors have led us to believe it is.

    Like all chronic diseases, the western medical establishment does not want you or your doctor to become aware of the true causes of diabetes and certainly does not want you to be able to receive treatments that will prevent diabetes from destroying your life.

    There are doctors who cure diabetes and how do they do it? The first thing that such doctors understand is that diabetes is an inflammatory disease caused by a combination of factors including stress, chemical and heavy metal toxicity, exposure to radiation, magnesium, iodine and bicarbonate deficiencies; and nutritional imbalances centered on excessive intake of carbohydrates which all combine to burn the cell house in slow motion, excess sugar and dehydration to work creating inflammation in the body and this begins a long process that ends with people suffering from serious diseases, including cancer.

  9. zen February 3, 2021 at 07:19

    Bariatric Surgery Gives 10-Year Cure for Some Advanced Diabetes

    A small, single-center randomized trial of patients with obesity and advanced type 2 diabetes, defined as diabetes for ≥ 5 years and A1c ≥ 7%, found that a quarter to a half of patients who had metabolic surgery had diabetes remission (cure) that lasted 5 to 9 years.

    That is, of the 60 randomized patients, 50% who had biliopancreatic diversion and 25% who had Roux-en-Y gastric bypass — but none who had received current medical therapy — still had diabetes remission a decade later.

    Until now, there had only been 5-year follow-up data from this and similar trials, Geltrude Mingrone, MD, PhD, and colleagues note in the study published online January 23 in The Lancet.

    These results provide “the most robust scientific evidence yet that full-blown type 2 diabetes is a curable disease, not inevitably progressive, and irreversible,” said senior author Francesco Rubino, MD, chair of bariatric and metabolic surgery at King’s College London, UK, in a statement from his institution.

    “The results of this trial will make a noticeable difference in the field and convince even the most skeptical of clinicians about the role of metabolic surgery as part of optimal care for their patients with difficult to control type 2 diabetes,” predict two editorialists.

    Alexander D. Miras, PhD, section of metabolism, digestion, and reproduction, Imperial College London, and Carel le Roux, MBChB, PhD, from the Diabetes Complications Research Centre, University College Dublin, Ireland, penned the accompanying commentary.

    Patients who had metabolic surgery also had greater weight loss, reduced medication use, lower cardiovascular risk, better quality of life, and a lower incidence of diabetes-related complications than those who received medical therapy.

    “Clinicians and policymakers should ensure that metabolic surgery is appropriately considered in the management of patients with obesity and type 2 diabetes,” advise Mingrone, of King’s College London and the Catholic University of Rome, Italy, and colleagues.

    “Reassuring Results, Will Make A Difference in the Field”
    “It is reassuring that we now have 10-year data showing greater efficacy of metabolic surgery than conventional medical therapy,” say Miras and le Roux in their commentary.

    There were no unexpected risks associated with surgery, they note, and the findings are consistent with those of 12 other randomized controlled trials in the past 12 years.

    “New generations of diabetologists are now more open to the use of metabolic surgery for patients with suboptimal responses to medical treatments,” write the editorialists, rather than endlessly intensifying insulin and blaming poor response on poor compliance.

    And Miras and le Roux “eagerly await” 10-year data from the 150-patient STAMPEDE trial — which is examining sleeve gastrectomy, currently the most widely performed bariatric procedure, as well as Roux-en-Y gastric bypass and medical therapy — following the 5-year results published in 2017.

    Diabetes for at Least 5 Years, Mid 40s, Half on Insulin
    Mingrone and colleagues previously reported 5-year findings from the 60 patients with obesity and advanced diabetes who were seen in a single center in Rome and randomized to three treatments (20 in each group) in 2009-2011.

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