It is with a new energy and spring in his step that Kapil Dev Chauhan goes about his day, work and family responsibilities. In his early 40s, Chauhan owns apple orchards near Shimla, his work taking him across the region in harvest season. Three years ago, he had severe diabetes with a HbA1c (average blood sugar count of three months) of 9.5 per cent, was overweight and had excruciating pain in his feet.Today, his HbA1C is down to 5.7 per cent, his weight is constant at 65 kg and he can weave through the rows of his orchard with ease. His diabetes is now in remission.Chauhan became a part of a small clinical study that has shown that through a carefully designed and practical strategy, Type 2 diabetes remission can be achieved with a combination of medication and lifestyle changes. Led by Dr Rama Walia, additional professor of endocrinology, PGI, Chandigarh, and a team of researchers, the DiaRem-1 study, which was published in the Indian Journal of Endocrinology and Metabolism, aimed to explore whether tight blood sugar control using modern medicines, combined with lifestyle changes, could push the disease into remission.When stress became a triggerChauhan admits to letting himself go when he lost his father to Covid. “My business was struggling in the aftermath of Covid. I was stressed and totally ignored my diet, health or exercise,” he says. A visit to PGI for a consultation for his mother and a suggestion to get a check-up done revealed high blood glucose levels. “Since diabetes can lead to complications if not addressed immediately, I decided to seek treatment at PGI,” shares Chauhan.That’s when Dr Walia selected him among 29 adults diagnosed with Type 2 diabetes. “For three months, these participants were placed on a combination of proven diabetes medications and guided through diet and physical activity,” says Dr Walia. After that, all medications were stopped, and for the following three months, researchers monitored whether their blood sugar levels could remain in the normal range, drug-free. “About one in three participants (31 per cent) achieved diabetes remission, meeting the internationally defined benchmark of maintaining HbA1c below 6.5 per cent without medication for at least three months. Both treatment groups, one using newer medications like liraglutide and dapagliflozin, and the other using more commonly available medicines like glimepiride and vildagliptin, saw similar remission rates,” explains Dr Walia.A daily reportage of activitiesChauhan was motivated from the word go, walking the extra mile to follow the doctors’ treatment plans, with a strict yet practical diet and regular exercise. Dr Walia shows her phone photo gallery, which is brimming with pictures of platefuls of healthy meals that her patients, including Chauhan, send her daily, to keep her abreast of the diet protocols they follow, along with snapshots of the number of steps or the exercise routines they are complying with. They also log in their weight gain or loss and blood glucose levels. “This intensive monitoring is essential to reorient my patients. Then there are counselling, motivation sessions and diet plans. Hit early, hit hard and results are possible if both the doctor and patient work together, as we witnessed in this study. MRI scans in select participants showed dramatic declines in internal fat stores, a 51 per cent drop in liver fat and 48 per cent drop in pancreatic fat, which are crucial contributors to insulin resistance and worsening diabetes,” says Dr Walia.Chauhan’s medication has been stopped for over a year. “My feet don’t pain anymore, the glow on my face is back and I feel both energetic and positive,” he says.Changes behind a turnaroundFrom sleeping late at night to beginning his day at leisure, Chauhan has got his sleep cycle in place, beginning his day at 6 am, and as recommended, having one to two litres of water. For someone who didn’t have an exercise schedule and considered daily movement as a workout, he began to walk a few kilometres, with the hilly terrain helping in building stamina, strength and muscle.While the first few weeks were tough, he began walking faster with more gusto after about a month. “I was a volleyball player. So I resumed playing. That relaxed my body and mind completely. Now even when I am travelling, I make sure to complete my steps and do a few stretching exercises,” adds Chauhan.Story continues below this adDiet was a part that the entire family worked together to change, and though it meant a change in eating habits, the shift happened slowly and steadily. “We had counselling sessions on diet, with the team giving us minute details of what to have, how and when. I replaced namkeens with a handful of nuts and flaxseeds, dealt with my hunger pangs by drinking coconut water, vegetable juice with fibre, beetroot and cucumber smoothie. I ate every two to three hours. Before each meal, I had a plateful of fibrous salad — cucumber, tomatoes, radish, apples and so on. That limited my portion automatically. I would chew some neem leaves in the morning and we started omitting tadka (tempering) in my dals, opting for lightly cooked vegetables. That made me less picky about flavours. My wife replaced rice with millets. I gave up sugar, street food and fries. I walk for about 10 minutes after every meal. This change is now life-long, and the fact that my diabetes is in control gives me confidence,” he says.Dr Walia and her team worked together to devise a diet plan that was high on fibre and protein, low in fat and was not too expensive or cumbersome to put together. “Weight loss is easy, all we need is motivation, will and simple tweaks, like snacking on nuts and makhanas, making sprout pancakes in place of rotis, having more dals and vegetables instead of extra chapatis and getting fibre with salads. We had a 37-year-old come down from 111 kg to 93 kg in about six months, with regular exercise, clean diet and three litres of water a day. Medication may help get the results faster but diet and exercise are integral to remission,” says Dr Walia.She is now working on a multi-centre study on diabetes remission funded by the Indian Council of Medical research (ICMR). Researchers are now focussing on how long the treatment lasts. “Diabetes progression,” says Dr Walia, “is driven by glucotoxicity, where too much sugar damages beta cells of the pancreas that produce the sugar-regulating hormone insulin, and lipotoxicity, where fat accumulation impairs insulin action. By reversing these with medication and lifestyle therapy, the pancreas gets a much-needed break and, in some cases, begins to function more normally again.”However, remission is not the same as being cured because blood sugar levels can rise again without ongoing lifestyle commitment. “The breakthrough is that normal levels can be sustained without medication, even if temporarily,” adds Dr Walia.