Lifestyle based remission in type 2 diabetes: implications for clinical practice

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Whitehill, Derek
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Type 2 diabetes is often thought of as a chronic and progressive disease. This paper evaluates three emerging methods of achieving remission of type 2 diabetes through dietary lifestyle interventions. These strategies have also highlighted the need for medication deprescribing guidelines. This paper reviews the efficacy, safety, adverse effects and implementation of very low energy diets, low-carbohydrate diets and intermittent fasting on type 2 diabetes. The very-low energy based on The Diabetes Remission Clinical Trial (DiRECT) demonstrated remission in 46% of participants after one year, with 74% taken off all anti-hyperglycemics. Low carbohydrate intake (<30g per day) in the Virta Health study demonstrated 83% of participants continuing to the one-year mark. Average HbA1c decreasing from 7.6 to 6.3 %, with an average weight loss of 13 kg. 94% of them reduced or eliminated insulin use. Intermittent fasting has been shown in literature to promote weight loss and glycemic control since the 1970’s, however recent case studies show patients removed of 70+ units of insulin daily in 5-18 days. The conclusion is while there is not yet a consensus best way to achieve remission of type 2 diabetes, nor a guarantee that it will work for all patients, there may need not be one. Practitioners should have the knowledge to discuss a variety of potential options with patients and assist them with the medication deprescribing that may be necessary.
Diabetes remission, very low energy diet, DiRECT Trial, low carbohydrate diet, Virta Health study, Intermittent fasting, time restricted feeding, medication deprescribing in type 2 diabetes