There are many patients who can manage the condition with this type of primary intervention.
A healthy diet is a critical component of today’s lifestyle guidelines for treating type 2 diabetes. Photo: Shutterstock.
The American College of Lifestyle Medicine (ACLM) document was developed to help clinicians treating adult patients with type 2 diabetesand achieve the remission, using diet as the main intervention. A panel of 15 experts from seven societies reached a consensus on 69 statements.
“A diet healthy It is a fundamental component of current lifestyle guidelines for the treatment of type 2 diabetesbut often overlooked due to lack of clinician training and patient awarenesssaid Felice A. Caldarella, MD, MBA, president of the American Association of Endocrinology Clinic (AACE), in an ACLM news release.
“The consensus statements produced by this panel of experts are invaluable to raise awareness of the value of diet for diabetes remissionin addition to control,” he summarized.
The initiative was co-sponsored by the Society for Endocrinologyendorsed by AACE and supported by the Academy of Nutrition and Dietetics. The expert panel also included representatives from the American College of Cardiology, the American Heart Association and the American Academy of Family Physicians.
Amy E. Rothberg, MD, PhD, representing the Endocrine Society on the panel, said, “I think many patients would do the challenging job of make lifestyle modifications if that meant the remission from [la diabetes tipo 2] and it would save them the burden and cost of medication or surgery.
For his part, Rothberg, a science professor at nutrition of the University of Michigan School of Public Health, Ann Arbor, noted that “by changing the course of the disease, that is, if they are in remission, they are unlikely to have the related complications with the type 2 diabetes“.
Consensus on 69 Statements
The panel used a modified Delphi process to develop the consensus statement. They identified 49 articles from the literature on dietary interventions in adults with type 2 diabetes.. They reached a consensus on 69 statements covering seven topics: definitions and basic concepts; diet and remission of the type 2 diabetes; dietary specifications and types of diets; adjuvant and alternative interventions; support, monitoring and adherence to therapy; weightloss; and payment and policy.
Rothberg identified six key areas:
Definition of referral: the remission of the type 2 diabetes defined as A1c <6.5% for at least 3 months without surgery, devices or drug therapy active to lower blood glucose, according to the schedule of remission of the diabetes published in 2021 by the American Association of Diabetes. The remission does not exclude the possibility of recurrence and is a realistic goal, achievable for some adults with type 2 diabetes.
High-intensity diet, short-term diabetes: patients are more likely to achieve remission with a high intensity diet (eg, a high level of restrictions, more frequent patient contact or counseling) accompanied by physical activity and if the patient has had diabetes for 4 years or less. A high fiber diet is essential.
Fewer calories, preferably plant-based foods: Calorie reduction could be achieved by reducing food volume, portion size, or energy density, or by use of liquid meal replacements, or through a combination of these approaches. It should include mainly whole foods of plant origin (whole grains, vegetables, legumes, fruitnuts and seeds) and avoiding or minimizing meat and other animal productsrefined foods, ultra-processed foods and foods with added fats.
A very low energy diet as an initial intervention is optional: there was consensus that this approach can achieve remissionbut there was no agreement that the low calorie content was essential to achieve remissionRothberg noted.
Beyond type 2 remission: diet as a main intervention can also reduce the risk of cardiovascular disease and improve lipoprotein profile.
Self-management, support and monitoring: The group recognizes the importance of patient education and support. “This can play a vital role and should be part of any comprehensive lifestyle treatment,” Rothberg said. The strategies of diet and lifestyle they should be acceptable to most patients, easy to comply with, accommodate patient preferences and values, and be culturally sensitive.
An intensive change in lifestyle can be equivalent to bariatric surgery
Most doctors and experts do not believe that diabetes can be reversed, but only controllednoted Handelsman, medical director of the Metabolic Institute of America in Los Angeles, California.
“We have always approached the treatment of type 2 diabetes with a lifestyle (diet, exercise and (latterly) sleep) as the mainstay of therapy,” he noted.
Nevertheless, most patients do not adhere to dietary modifications at 6 months and especially at one year, which has led to universal recommendations to add medications to the lifestyle from the start, he continued.
Most of the doctors have not been trained in lifestyle modalities. And many patients with type 2 diabetes do not adhere to medications, which “led to the relative success of bariatric surgery that led to the remission (at least for 3 to 5 years).”
“The remissionwhich generally means the disappearance of signs and symptoms, should be a top priority for people with type 2 diabetes“, write the authors of the consensus statement.
“Yes ok [la cirugía bariátrica] can induce the remission in 25% to 80% of selected patients, it carries a risk and its efficacy diminishes as subjects regain their lost weight,” and “a change [de estilo de vida] more drastic and intensive produces rates of remission equivalent to those of bariatric surgery” they point out.
Need for more randomized trials
Handelsman also emphasized that the remission it can be temporary. “Three months or 6 months cannot be a measure of success. We must have at least 1 year,” she added, “in fact, there is data showing that the remission requires 3 years”. However, the consensus statement highlights the importance of lifestyle in remission of the diabetesHe agreed.
The expert panel also noted that patients can benefit from a lifestyle healthyeven if they do not reach the remissionRothberg noted.
Going forward, the statement concludes that “there is a continuing need for further randomized controlled trials to evaluate sustainable plant-based dietary interventions with whole or minimally processed foods, as a primary means of treating [la diabetes tipo 2] with the objective of remissionas well as the factors that lead to successful patient adherence and the effective dissemination and implementation of such interventions.”
This study was supported by the Lisa Wendel Memorial Foundation. Rothberg has revealed to be the medical director of Rewind, a virtual platform created for weight control with the aim of “beating” the type 2 diabetes, and consultant to a study for which Nestlé provides products. Handelsman has disclosed receiving research grants and consulting and speaker fees from Amarin, Amgen, Applied Therapeutic, AstraZeneca, Bayer, Boehringer Ingelheim, Corcept, Esperion, Ionis, Mankind, Merck, Merck-Pfizer, Novartis, Novo Nordisk, Regor, Sanofi and Vertis.
Source consulted here.