Dietary strategies for remission of type 2 diabetes: A narrative review

Abstract

Type 2 diabetes (T2DM) is a growing health issue globally, which, until recently, was considered to be both chronic and progressive. Although having lifestyle and dietary changes as core components, treatments have focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies that have set out to achieve remission, remission of T2DM has emerged as a treatment goal. A group of specialist dietitians and medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM and consequently undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests that a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss and, although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, it may rather constitute a ‘state of mitigation’ of T2DM. This technical point may not be considered as important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches that can help to achieve this.

Comparing the acceptability of total diet replacement and food-based low energy diets for type 2 diabetes remission amongst South Asians: a public and patient involvement activity

“…We understood this is mostly related to the association between diet and cultural identity which has been also backed by the literature 1 . Participants mentioned that this is linked to their culture (this statement is now added to the results section), and this aspect is particularly important for those who were born outside the UK.…”

“…Meeting information: The Mediterranean diet has also been shown to be able to engender remission from the PREDIMED study -please see my review 1 for details. Also, can you reference your comment related to the beneficial effects.…”

“…Type 2 diabetes (T2D) rates are increasing worldwide causing significant health and economic impacts 1,2 . It is estimated that 4 million people (6% of the population) in the UK have T2D 1 .…”

“…Type 2 diabetes (T2D) rates are increasing worldwide causing significant health and economic impacts 1,2 . It is estimated that 4 million people (6% of the population) in the UK have T2D 1 . Diabetes UK has been committed to address the increased diabetes prevalence in the UK population, and has invested heavily in ground-breaking research looking to treat T2D and reduce the pressure on the NHS 3 .…”

The potential prolonged effect at one-year follow-up after 18-month randomized controlled trial of a 90 g/day low-carbohydrate diet in patients with type 2 diabetes

“…The LCD was defined as <130 g/d carbohydrate or <26% of total energy intake from carbohydrate for a diet of 2000 Kcal/day, 130 to 225 g/d carbohydrate was defined as moderate carbohydrate intake and over 225 g/day as high carbohydrate intake [ 3 ]. Type 2 diabetes patients on LCD are mostly very low in carbohydrate (VLCD, <50 g carbohydrate/day) [ 4 , 5 ].…”