Can type 2 diabetes be reversed? What’s the best way to do it?

Those are the questions asked by Dr. McInnes, a medical researcher. To investigate, her team gave study participants insulin and oral medications to tightly control their blood sugars. These medications gave the pancreas a “rest” from producing insulin. Participants were also advised to reduce their caloric intake and increase their physical activity. Compared to normal diabetes treatment, this intervention provided a temporary return to normal blood sugars for more people (3). 

This study got me wondering about whether there were any more success stories. And what people can do to slow the progression of diabetes, maybe even reverse the disease. 

I found two more studies that fit the criteria. Look AHEAD was a multi-centre trial that provided intensive lifestyle interventions for overweight and obese people with type 2 diabetes. Why WAIT was a study that provided intensive drug therapy and lifestyle interventions for patients with type 2 diabetes.

 

  Look AHEAD (6) Why WAIT (1) McInnes et al (3)
Study Design Randomized Clinical Trial (2 arms) Observational Study Randomized Clinical Trial (3 arms)
Number of Participants N= 5145 N= 126 N=83
Intervention Elements Diet for weight loss + Exercise prescription + Behavioural therapy + Group diabetes education Diet for weight loss + Exercise prescription + Frequent diabetes medication review / adjustments + Behaviour therapy + Group diabetes education Diet for weight loss + Exercise prescription + Tight glycemic control via insulin and diabetes medications
Intervention Duration 6 months of weekly sessions, then 3x/month for 6 months, then support 2x/month for 2 years 12 weekly 2 hr long sessions Arm 1= 16 weeks

Arm 2= 8 weeks

 

Participant’s Mean Age 59 years 54 years 57 years
Duration of Diabetes Mean= 6.8 years Mean= 9.8 years < 3 years (study inclusion criteria)
Baseline HbA1C (%) 7.2 (intervention), 7.3 (control) 7.5 6.6
% complete or partial remission at 1-year follow up Intervention: 12%

Control: 2%

4% 16-wk: 22%

8-wk: 25%

Control: 10.7%

Reversing Diabetes: What the Studies Show

The 3 studies were designed differently, but they show some similar results. Compared to usual diabetes education, intensive lifestyle management (with or without medication adjustments): 

  • Reduced the use of diabetes medications, including insulin (2, 3, 4)
  • Improved blood glucose control (1, 4, 5), lipid control, blood pressure, quality of life, sexual function (5)
  • Less sleep apnea, liver fat, depression, urinary incontinence, kidney disease progression, retinopathy, knee pain, inflammation, health-care costs (5)

Reversing diabetes seem to be a more likely outcome for patients: 

  • With shorter duration of diabetes (2, 4, 5)
  • On fewer oral antihyperglycemic medications (4)
  • With A1C <8% at baseline (4)
  • Who had lost more weight (5)
  • Who improved fitness better (5)

Since all the participants in the McInnes trial had diabetes for 3 years or less, it’s not surprising that this group showed a higher rate of remission. 

Reverse Diabetes: Action Points

Taking a page from these research studies, here’s what you can do to help manage diabetes.

Get Active

Exercise prescriptions in the studies ranged from 150 min to 360 min/ week of moderate – vigorous physical activity (1, 3, 6). Here’s what you can do: 

  • Aim for 30 minutes of moderate-vigorous physical activity 5 days/ week 
  • Try dancing, brisk walking, swimming, water aerobics, jogging, or gardening 
  • Add strength training to maintain lean muscle muscle. Squats, push-ups, and chair dips are some examples of body weight exercises you can do at home
  • Use a fitness tracker: myfitnesspal or mapmyfitness to record your activity levels and keep yourself accountable 
  • Use a pedometer to track your steps and gradually work your way up to 8000-10000 steps/ day 
Reduce Caloric Intake

Reducing food intake by 500-750 kcal/day, and maintaining this way of eating was a goal for all 3 studies (1, 3, 6). Study participants were given a daily caloric goal that ranged from 1200-1800 kcal/day depending on their usual intake and body weight (1, 6). Since storing extra body fat is believed to be a part of the disease process for diabetes, losing excess body fat improves blood sugar control. If you believe you’re overeating, here’s what you can do: 

  • Use a Food Diary to track your intakes, your hunger, your environment, and your feelings
  • Tune in to your hunger and fullness cues as you eat. Ask yourself “Am I physically hungry?” before eating, and aim to eat until 80% full 
  • Replace white bread, potatoes, and rice with whole grain pasta, beans, and lentils
  • Enjoy smaller portions of what you already eat. Serve yourself less food or try to leave 2-3 bites on your plate at the end of lunch & supper
  • Snack on vegetables and fruits between meals: carrots, cucumber, cherry tomatoes, sweet bell peppers, berries, apple, pear, orange, plum 
  • Look for and purchase lower fat and lower calorie versions of: cheese, mayonnaise, salad dressings, cookies, crackers, creamy soups, ground meats, frozen desserts, deli meats, potato chips, sour cream, and other ready-to-eat foods
  • Try a meal replacement (such as Glucerna) for lunch/ breakfast if you’re in a pinch
  • Aim to fill 1/2 your plate with non-starchy vegetables, a 1/4 lean protein, and 1/4 starch 
  • Manage your stress with self-care strategies that does not involve food. Try giving yourself a 5-minute massage, listen to your favourite song, or call a friend to chat 

Get Support

All of these trials offered nurses and dietitians to help participants to meet their goals and problem-solve (1, 3, 6). Here’s what you can do: 

  • Set up your own support group with a few friends who have similar goals as yourself, meet weekly to set goals, share successes, and troubleshoot setbacks 
  • Join a fitness class, a walking/ running club, or an outdoors group to make physical activity fun
  • Call 8-1-1 to speak with a nurse, dietitian, or pharmacist to help you with your goals (BC residents only)
  • Plan regular checking ins with your diabetes team or primary health care provider 
Make it a Habit

Stopping type 2 diabetes isn’t a realistic goal for everyone. Even the most promising treatment in people with a short duration of diabetes only had 1/5 people in remission one year after treatment (6). But everyday actions can help slow down its progression and improve your quality of life (1, 2, 4, 5)!

  • Focus on making one changes at a time. Trying to change everything at once may leave you feeling overwhelmed
  • Falling off the wagon for a few days/ months/ years is okay. It’s never too late to take charge of your health
  • Treat yourself gently: offer yourself words of encouragement and forgiveness instead of criticism 
  • Have fun! Find foods and physical activities you enjoy and share it with people you love

What’s your experience with type 2 diabetes? Have you tried any of these strategies? I’d love to hear from you! Write a comment below or email cathy@mindfulnutrition.co 

 

Sources Cited 

1. Hamdy, O., & Carver, C. (2008). The why WAIT program: Improving clinical outcomes through weight management in type 2 diabetes. Current Diabetes Reports, 8(5), 413-420. doi:10.1007/s11892-008-0071-5

2. Kyithar, M. P., & Dinneen, S. F. (2013). An intensive lifestyle intervention increased remission from type 2 diabetes in overweight adults. Annals of Internal Medicine, 158(10). doi:10.7326/0003-4819-158-10-201305210-02004

3. McInnes, N., Smith, A., Otto, R., Vandermey, J., Punthakee, Z., Sherifali, D., . . . Gerstein, H. (2017). Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial. The Journal of Clinical Endocrinology & Metabolism. doi:DOI: 10.1210/jc.2016-3373

4. Mottalib, A., Sakr, M., Shehabeldin, M., & Hamdy, O. (2015). Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese Patients with Type 2 Diabetes. Journal of Diabetes Research, 2015, 1-4. doi:10.1155/2015/468704

5. Pi-Sunyer, X. (2014). The Look AHEAD Trial: A Review and Discussion of Its Outcomes. Current Nutrition Reports, 3(4), 387-391. doi:10.1007/s13668-014-0099-x

6. The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It. (2006). Obesity, 14(5), 737-752. doi:10.1038/oby.2006.84 

 

Reverse Diabetes with Diet and Exercise?
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