Intensive lifestyle changes associated with diabetes remission by 3 months

LOUISVILLE, Ky. — Adults with prediabetes or type 2 diabetes participating in a program with tailored diet and exercise programs had improved insulin sensitivity measures by 3 months, with some participants achieving diabetes remission.

Type 2 diabetes and prediabetes are considered “lifestyle diseases” associated with high rates of morbidity, mortality and health care expenditures, Josep Iglesies-Grau, MDfellow in preventive cardiology at the Montreal Heart Institute, said during a presentation at the American Society for Preventive Cardiology Congress on CVD Prevention. Different lifestyle interventions can control and even reverse some cardiometabolic diseases; however, such strategies are rarely implemented effectively as first- line choices, he said.

“To address this issue, we started a free clinic that proposed to patients living with prediabetes and type 2 diabetes a 6- or 12-month multidisciplinary program to help them learn and implement healthy habits in a progressive fashion,” Iglesies-Grau said during the presentation. “During follow-up, patients had the opportunity of individualized nutrition counseling sessions, in which a plant-based Mediterranean diet with moderate carbohydrates and intermittent fasting was proposed. They also had the opportunity for a personalized physical exercise prescription and educational visits with nurses, who also addressed social determinants of health.”

In a prospective, nonrandomized study, Iglesies-Grau and colleagues analyzed data from 265 adults with prediabetes (n = 81) and type 2 diabetes (n = 184), recruited from 2019 to 2020. The mean age of participants was 68 years; 67 % were men; 48% had CHD and 54% were prescribed glucose-lowering therapies. Participants completed six nutritional counseling visits and three personalized physical exercise visits over 6 months. Participants provided blood samples and anthropometric data at baseline, 3, 6 and 12 months ; glucose-lowering therapies were not modified unless necessary. Researchers defined partial remission of type 2 diabetes as HbA1c of less than 6.5% for at least 3 months; complete remission of prediabetes and type 2 diabetes was defined as an HbA1c of less than 5.7% for at least 3 months.

Researchers found that all metabolic health measures, including waist circumference, weight, BMI, glucose, insulin and HbA1c, improved during the intervention, particularly for participants with type 2 diabetes.

“Gains were achieved at 3 months and were maintained for the remainder of the program without significant change,” Iglesies-Grau said.

Within the cohorts, 41.3% of participants achieved partial remission of type 2 diabetes and 5.4% achieved complete remission, whereas 24% of participants with prediabetes achieved complete remission. In models adjusted for age, sex, treatment, HbA1c and weight loss at 3 months , researchers found that participants with a low baseline HbA1c (P = .01) and those who lost at least 3.5 kg by 3 months (OR = 4.1; 95% CI, 1.5-11.1; P = .005) were more likely to attain prediabetes or diabetes remission.

“Prioritizing lifestyle changes was shown to improve anthropometric and insulin sensitivity measures even to the point of achieving remission among subjects with prediabetes or type 2 diabetes,” Iglesies-Grau said.

Iglesies-Grau said more research is needed to better understand which nonpharmacological interventions work best among adults with varying metabolic profiles and pharmacotherapy, how long interventions should last and how partial or complete normalization of glycemia impacts long-term outcomes.

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American Society for Preventive Cardiology