The short-term impact and sustainability of multiple lifestyle interventions on metabolic health and remission of prediabetes and type 2 diabetes: a two-year experience

Funding Acknowledgements

Type of funding sources: None.

Background

Different intensive lifestyle interventions have been shown to be useful for effective control and even reversal of prediabetes and type 2 diabetes (T2D).

Objectives

Our heart institute cardiovascular prevention center started a comprehensive lifestyle clinic in 2019 to study the impact of 6 and 12-month non-pharmacological interventions on metabolic health and remission of these two conditions.

Methods

Between January 2019 and December 2020, 81 prediabetic (HbA1c ≥ 5.7%) and 184 T2D (HbA1c ≥ 6.5%) were recruited. All participants received regular nutritional counselling (therapeutic moderate carbohydrate restriction Mediterranean diet) and personalized physical exercise prescription (≥30 minutes of moderate aerobic training, 5 times a week, and strength training). Anthropometric measures and fasting blood analysis were measured at 0, 3, 6 and 12 months. Glucose-lowering therapies were not modified, unless necessary.

Complete remission of prediabetes and T2D was defined as HbA1c <5.7%, whereas partial remission of T2D was defined as HbA1c <6.5% for at least 3 months, and it was calculated for all the participants that completed the 12-month program. Remission was further evaluated according to pharmacological status (drug-naïve or on glucose-lowering therapy).

Results

231 participants completed the short-term program (87%) and 117 were followed-up to 12 months. Mean age was 67.1 (9.1) years, 67% male, 48.3% with CHD, 53.5% with glucose-lowering therapies. All metabolic health measures were improved, particularly among T2D participants (Table 1). Gains were achieved at 3 months and were maintained during the remainder of the program without significant change.

Complete remission of prediabetes was achieved in 24% (95CI: 10.7 to 45.4%) of participants. Complete and partial remission of T2D were achieved in 5.4% (95CI: 2.2 to 12.5%) and 41.3% (95CI: 31.6 to 51.7%) of participants respectively and was observed in both with or without glucose-lowering therapies subgroups (Table 2).

Conclusions

Prioritizing lifestyle changes were shown to improve metabolic health measures even to the point of achieving remission among subjects with prediabetes or T2D. These metabolic changes were mostly achieved after 3 months and persisted throughout the intervention. Future research is required to better understand which non-pharmacological interventions work best among subjects with varying metabolic profiles and pharmacotherapy, how long should the interventions last and how partial or complete normalization of glucose impacts long-term outcomes.