Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low‐calorie liquid diet‐based intervention in Barbados

Abstract

Aim In a high proportion of people with recently diagnosed Type 2 diabetes, a short (2-3-month) low-calorie diet is able to restore normal glucose and insulin metabolism. The aim of this study was to determine the feasibility of this approach in Barbados. Methods Twenty-five individuals with Type 2 diabetes diagnosed within past 6 years, not on insulin, BMI ≥ 27 kg/m 2 were recruited. Hypoglycaemic medication was stopped on commencement of the 8-week liquid (760 calorie) diet. Insulin response was assessed in meal tests at baseline, 8 weeks and 8 months. Semi-structured interviews, analysed thematically, explored participants' experiences. 'Responders' were those with fasting plasma glucose (FPG) < 7 mmol/l at 8 weeks. Results Ten men and 15 women (mean age 48, range 26-68 years) participated. Mean (SD) BMI was 34.2 kg/m 2 (6.0); FPG 9.2 mmol/l (2.2). Mean weight loss at 8 weeks and 8 months was 10.1 kg [95% confidence interval (CI) 8.1, 12.0] and 8.2 kg (95% CI 5.8, 10.6); FPG was lower by 2.2 mmol/l (95% CI 1.2, 3.2) and 1.7 mmol/l (95% CI 0.8, 2.7) respectively. Nine of 11 (82%) of those who lost ≥ 10 kg were 'responders' compared with 6 of 14 (43%) who lost < 10 kg (P = 0.048). The 30-min insulin increment was higher in responders at baseline and follow-up (P ≤ 0.01). A food culture based on starchy foods and pressures to eat large amounts at social events were among the challenges identified by participants. Conclusions The feasibility of this approach to weight loss and diabetes remission in a predominantly black population in Barbados was demonstrated.

Type 2 diabetes and remission: practical management guided by pathophysiology

“…However, those with type 2 diabetes have higher levels than those without, and it would appear unlikely that the aetiology of the commonest metabolic disease of our species would differ between subgroups. The achievement of weight loss‐induced remission of type 2 diabetes in African Americans such as observed in Look AHEAD and in the Barbados study underscores this point [39, 64].…”

“…A similar retrospective survey of older people observed slightly higher 8‐year rates of remission after dietary weight loss in Asian and Hispanic compared with White and African American groups [63]. A predominantly African Caribbean population in Barbados achieved comparable rates of weight loss‐induced remission to those documented in DiRECT with nine of 11 (82%) of those who lost more than 10 kg achieving remission [64].…”

Nutritional basis of type 2 diabetes remission

“…25 A recent study in Barbados on a predominantly African Caribbean population observed rates of weight loss induced remission similar to those documented in Direct. 32 This was achieved over eight weeks by using a hypocaloric liquid diet (760 kcal) with withdrawal of diabetes medication on day 1 of the diet. Nine of the 11 (82%) participants who lost at least 10 kg achieved non-diabetic fasting blood glucose levels compared with six of 14 (43%) who lost <10 kg.…”

Implementation of a Community-Based Low-Calorie Dietary Intervention for the Induction of Type-2 Diabetes and Pre-Diabetes Remission: A Feasibility Study Utilising a Type-2 Hybrid Design

“…The inclusion criteria were: age 20-69 years, BMI ≥ 27 kg/m2 and a diagnosis of T2DM for < 6 years or a diagnosis of pre-diabetes. The exclusion criteria were similar to those of the BDRS1 protocol (14). Eligible persons went through the informed consent process.…”