It's certainly not a fact that T2D can be
easily controlled or reversed.
It's precisely to answer this question why studies such as the
Direct Remission Clinical Trial are carried out. Roy Taylor's research into how a VLC can put T2D into remission
for some patients is very promising. But bear in mind that his initial study showed that certain subjects were discovered to be 'non-responders' (18 out 30), and didn't achieve remission. Other people achieved remission but reverted after the trial ended. Furthermore, remission was defined as not having diabetic numbers, so many subjects were still getting high numbers in the 75ml glucose test.
We don't fully understand what happens over the long term to people who go on such a diet, maintain their weight, and eat a low-carb diet or a keto-diet. Do such diet arrest beta-cell decline, reverse it somewhat, slow it down? Do long term keto diets cause other low-term issues? These are hard questions which the medical community doesn't fully know the answer to. We can't actually look into people's pancreas to see the state of their beta-cells, so good control today doesn't necessarily mean there is no progression going on.
However, such interventions show real promise. We know the anecdotal evidence on these forums shows that people are able to achieve amazing results through lifestyle and diet change. And Professor Taylor's research seems to be making its way into the advice the medical community are giving. This is a good thing.
Personally, I think that the answer lies in between. I think for most patients T2D will tend to be progressive. However, for many lifestyle changes
can slow this progression down so much that it's essentially permanent remission. There's a big difference between needing to go on insulin in 10 years, and needing to go on metformin in 50 years. The latter is a sign of progression but for most people is essentially permanent remission. Roy Taylor's research demonstrated a strong correlation between the duration of the condition and the response. Non-responders tended to have been diagnosed more than 8 years ago.
For people who have been very recently diagnosed and take prompt radical action, non-progression seems to be a real possibility, and I think the medical community is finally waking up to this fact.
Professor Taylor puts it best himself:
"The study population represents a group of individuals motivated to regain their health, and this is an important point. The crucial factor which differentiates this dietary intervention from previous attempts is the clearly identified goal of becoming free of Type 2 diabetes. The distinction between the treatment of a potentially curable disease and that of a chronic progressive condition was made eloquently by one individual, who contrasted the often reported battle to ‘beat’ a life-threatening disease such as cancer with the learned helplessness induced by advice that diabetes was inevitably progressive. The responses clearly show that this minority of health-motivated people strongly resent being told that there is nothing that can be done to escape from Type 2 diabetes and that they must take medication. The overwhelming impression gained by doctors from their routine clinical practice is that people with Type 2 diabetes rarely succeed in losing weight, and the critical point that there is a subgroup who are strongly motivated by desire to regain health has not been widely recognized. Some doctors do know that occasionally people do reverse their diabetes, but this is not acknowledged by clinical guidelines."
