Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Abstract

Objective: The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods: Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results: The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion: Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.

The Effect of Dietary Patterns on Inflammatory Biomarkers in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In line with the hypothesis, the duration of interventions could be impact in the results and mostly should be > six months to observe favorable changes in T2DM [ 68 ]. In our study, we found that the duration of the interventions was, on average, mostly one year.…”

Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus

“…Zudem gelang bei der Hälfte der Teilnehmer, die zusätzlich eine Formuladiät erhielten, die Konversion von einem Prädiabetes in eine Normoglykämie, während dies bei weniger als einem Drittel der ausschließlich mit einer Lebensstilintervention behandelten Teilnehmer der Fall war [115]. Aus den genannten Gründen sehen Fachgesellschaften eine Remission sogar als primäres Behandlungszie an [116].…”

Control and complications of diabetes in urban primary care units in Thailand: a cross-sectional study

“…This large discrepancy between a proportion of patients who met the POC and TOC may due to the nature of diabetes, financial burden, work and environment related factors. Recent statement from the American College of Lifestyle Medicine suggested that an ability of diabetes control or even diabetes remission is related to its intensity of preventive interventions [11]. Therefore, it is explainable that this result will help us drive the healthcare system that we then need to use our data to implement more intense interventions with patients to improve TOC indicators.…”

“…This provides free health care at the point of service in order to guarantee access to essential health care at primary care units (PCUs) [10]. Moreover, a resilient health system and management support team are a fundamental tenet of the diabetes care model linked to improved outcomes of diabetes control [11]. Services include health promotion, education, and screening for risk factors that lead to diabetes complications driven by interdisciplinary collaboration, proactive policies, and holistic care approaches [10,12,13].…”

“…Services include health promotion, education, and screening for risk factors that lead to diabetes complications driven by interdisciplinary collaboration, proactive policies, and holistic care approaches [10,12,13]. This concept is also aligned with the guidelines of team-based care outlined by the Institute of Medicine (IOM) and the American Association of Colleges of Nursing (AACN), which recognize the patient as the center of the care team and must be aligned with cost containment mechanisms of a UHC to ensure long-term governmental financial sustainability [11].…”