Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine

Abstract

Objectives. The present review represents the position of the American College of Lifestyle Medicine on type 2 diabetes (T2D) and remission treatment. Background. Research now reveals that sufficiently intensive lifestyle interventions can produce remission of T2D with similar success to bariatric surgery, but with substantially fewer untoward side effects. Methods. A literature review was conducted to examine lifestyle modifications targeting T2D remission, with most studies using a combination of blood glucose markers and treatment history. Results. There were notable differences in the dosing intensity of lifestyle interventions between therapeutic interventions and subtherapeutic interventions. Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%, while studies with subtherapeutic dosing typically used more moderate caloric restrictions (reducing energy intake by 500-600 kcal/day) and the weighted mean remission rate was 6.9%. Conclusions. Remission should be the clinical goal in T2D treatment, using properly dosed intensive lifestyle interventions as a primary component of medical care for T2D patients.

Hepatic-Metabolite-Based Intermittent Fasting Enables a Sustained Reduction in Insulin Resistance in Type 2 Diabetes and Metabolic Syndrome

“…Diabetes remission was always accompanied by weight loss as a symptomatic effect of the metabolic improvements. Kelly et al [77] reported a mean diabetes remission rate of 49.4 % applying very low calorie diets. The VLCD part of the intermittent hepatic therapy, which is focused on the cause of insulin resistance, delivers more effective results, as our reported data show (▶Fig.…”

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

“…At the tissue level, studies using magnetic resonance imaging have demonstrated lipid deposition in muscle and liver cells, leading to insulin resistance ( 52 ). Interventional trials using plant-based diets suggest that these diets can improve and potentially even reverse the course of diabetes ( 53 ).…”

What’s in a Name? Redefining Type 2 Diabetes Remission

“…This discussion becomes even more pertinent, considering the fact that these glucose-lowering therapies are being exapted for use in non-glycemic indications such as obesity, heart failure and chronic kidney disease [12][13][14]. If calorie restriction can be accepted as a part of lifestyle medicine [1], while defining diabetes remission, the use of a calorie restriction mimetic should be accepted as well.…”

“…Diabetes remission is an often-discussed topic in contemporary endocrinology. A recent position statement suggests that the remission should be the primary clinical goal of diabetes management [ 1 ]. Whether this is possible or not for persons living with established type 2 diabetes, complicated type 2 diabetes, type 1 diabetes or pancreatic diabetes is a debate in itself.…”

“…However, the classic definition of remission, proposed in 2009 [ 5 ], and endorsed in 2020 [ 1 ], needs to be revisited. Enhanced interest in this field, improved understanding of glycemic targets and the need for comprehensive baro-vasculo-metabolic control, development of newer glucose-lowering drugs that can be used for non-glucose lowering indications and semantic evolution in disciplines such as oncology support the need for this discussion.…”