DPR-session-1-Can Type 2 diabetes be reversed?

Pre-diabetes (IGT and IFG)

Systematic reviews of randomised controlled trials (level 1 evidence)
7 trials with more than 4,000 predominantly middle-aged people
1 in 2 can prevent type 2 from developing in the medium to long-term (1 – 6 years)
From 3 trials, 1 in 3 can prevent type 2 diabetes for more than 10 years

Uusitupa et al. Nutrients, 2019

Lifestyle recommendations:

5% – 7% reduction in body weight, with larger weight reductions associated with lower risk of type 2 diabetes
Reduced energy diet (↓ 2,000 kilojoules/day) → 6,700 kJ/d for average Australian adult
- Reduced total (<35% of energy, or 63 g/d) and saturated fat (<10% E, or 18 g/d)
- High in dietary fibre (> 25 g/day)
Exercise
- at least 30 minutes per day or 150 minutes per week

Foods and nutrients:

Reduced risk
Green leafy vegetables, some fruits (e.g., bilberries, blueberries, grapes, apples, and pears), dairy products (e.g., yoghurt and cheese), whole grains (preferably low GI), nuts and legumes (e.g., beans, lentils and chickpeas)
Increased risk
Processed meats, unprocessed red meat, white rice, potatoes, and sugar-sweetened beverages

Specific dietary patterns:

Glycemic index and glycemic load

All available evidence from prospective cohort studies
6.9 million person years of follow-up.
Consuming a diet with an average GI of 76 vs 48:
- 87% higher risk of developing diabetes
Consuming a diet with a GL of 257g vs 73g per 8,400 kJ:
- 89% higher risk of developing diabetes

Type 2 diabetes remission

2021 Consensus Report

Remission of type 2 diabetes can be diagnosed when a person with confirmed type 2 diabetes has achieved the following criteria:
HbA1c <48 mmol/mol (6.5%) or fasting plasma glucose (<7.0 mmol/L ) for at least 3 months;
the attainment of these glycaemic parameters following the complete cessation of all glucose-lowering therapies.
Remission is not the same as “cure” or “resolved”.
The term “remission” retains the implication that there is susceptibility of a return of type 2 diabetes if abdominal adiposity returns, or simply due to advancing age.

DiRECT study

Cluster randomised-controlled trial in the UK.
298 adults with type 2 diabetes < 6 years duration. Average weight 101 kg.
Total diet replacement (3,450 – 3,570 kJ/day) for 3 – 5 months.
Hypoglycaemic medication ceased on program commencement.
Stepped food re-introduction for 2 – 8 weeks.
Average reduction in body weight of 10 kg (~10% of initial body weight) at 12 months.
46% (~ 1 in 2) achieved remission at 1 year
36% (~ 1 in 3) achieved remission at 2 years.
Remission closely related to the degree of weight loss – participants who maintained at least 15 kg (~15% of initial body weight) weight loss at 1 year – 86% achieved remission.

DIADEM-I