"There is no special diet. You've got to eat fewer calories than your body burns," says Dr Robert Rizza, a Mayo Clinic endocrinologist and former president of the ADA.

Many doctors stop short of calling these successful patients cured.

Philipp Scherer, director of the diabetes research center at University of Texas Southwestern, describes diabetes as a one-way road. He says it can be stopped in its tracks with diet and exercise, but there's no turning back.

Dr Kevin Niswender, an assistant professor in the department of medicine at Vanderbilt Medical Center says: "Technically, you could call somebody cured" but that patient still needs to be followed closely.

Doctors caution that, for some diabetics, lowering blood sugar may be only temporary. Stress, weight gain and other factors can push it back to unhealthy levels.

"Blood sugars can come down to normal. The issue is how long does that last?" says Dr Sue Kirkman, vice-president of clinical affairs for the diabetes association. "Sometimes people start putting weight back on and their blood sugars come back up."

In other cases, patients are diagnosed so late that blood sugar levels can't be brought back to normal, even with weight loss, she says. As the disease progresses, even those who make diet and lifestyle changes might eventually have to go on medication.

That's one reason Wagner and some other diabetics who've managed their disease through diet and exercise are also reluctant to consider themselves "cured".

"American culture, our environment, is not conducive to having good health," says Wagner. She believes diabetes will always be lurking in the background, waiting for her to slip.

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