Objective: The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods: Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results: The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion: Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.
Background: Lifestyle interventions, including very low-calorie diets and liquid meal replacements, have been shown to achieve blood glucose improvements or remission. However, intensive lifestyle intervention using solid foods without calorie restriction has not been studied. Objective: The objective of this study is to describe changes in blood glucose, medication use and diabetes status among 50 patients who were prescribed intensive lifestyle changes to treat type 2 diabetes (T2D). Methods: Physicians were recruited by the American College of Lifestyle Medicine to submit case histories of patients who achieved blood glucose improvements and/or remission in QuestionPro, an online survey platform. Results: A total of 12 physicians reported on 50 patients, including 1 physician who reported on 37 patients. Mean (SD) age of patients was 66.4 (12.8) years (range 20-84), and 64% of patients were male. Primary lifestyle interventions included a whole food, plant-based diet (n=43), coaching program (n=3), ADA diet (n=2), whole food diet (n=1) and calorie restricted diet <1800kcal (n=1). No liquid meal replacements or other calorie restrictions were reported. Mean biometrics (SD) for time periods pre-intervention; 3-6 months post-; and most recent follow-up were: HbA1c 7.6 (1.5); 5.7 (0.3); 5.8 (0.4), fasting glucose 150.1 (53.4); 101.0 (30.8) ;105.2 (25.0), BMI 34.9 (14.4); 30.0 (6.0); 28.6 (5.2). A majority of patients were taking diabetes medications prior to interventions. At 3-6 months post intervention, a total of n=20 patients were not taking diabetes medications and of these, n=10 achieved either HbA1c<5.7 % or FSG<100 mg/dL. At most recent follow-up, n=21 were not taking diabetes medications and of these, n=9 achieved both HbA1c<5.7% and FSG<100 mg/dL, with n=1 for at least 12 months. Conclusion: Patients can improve blood glucose and may achieve remission of T2D using a whole food, plant-based dietary pattern, without liquid meal replacements. Disclosure M. Karlsen: None. G. Panigrahi: None. J. Kelly: None.
Background:The common coronary risk factors are hypertension, hyperlipidemia, obesity and diabetes. These can be improved with Plant-Based diet.Objective: To reduce coronary risk factors by Plant-Based diet with emphasis on diabetes. Methods:In the first part (Part A), the subjects are 805 patients treated for hypertension, hyperlipidemia, obesity, diabetes, and coronary artery disease (CAD) from January 2012 through October 2015. Primary prevention group (without CAD) consisting of 423 patients are compared to the Secondary prevention group (with CAD) consisting of 382 patients (Table 1). The second part (Part B) is to determine the effect of plant-based diet in reducing coronary risk factors in 20 patients with diabetes, divided in to two groups, dietary compliant vs. dietary non-compliant group.Results: Part A: Analysis of risk factors for CAD shows that risk ratio for hypertension is 1.4803 (p = 0.0002), hyperlipidemia 1.9118 (p = 0.0023), diabetes 1.5357 (p < 0.0001), obesity 0.8637 (p = 0.0565), age ≥ 65 years 1.4665 (p < 0.0001), male sex 1.6509 (p < 0.0001) (Table 2). Gender related analysis of CAD risk factors indicated higher incidence of diabetes in females compared to males (Table 3). Part B:In the diabetic cohort analysis of risk factors between dietary compliant and non-compliant group (Table 4) showed an average drop in HbA1c of 3.03% vs. decrease of 0.03%, p = 0.0049, total cholesterol decreased by 68.8 mg/dl vs. increase of 13.2 mg/dl, p = 0.0018, weight decreased by 9.02 kg vs. increase of 1.78 kg, p = 0.0071, BMI decreased by 3.28 kg/m 2 vs. increase by 1.22 kg/m 2 , p = 0.0071. There was no significant difference for systolic and diastolic blood pressures between the two groups (Table 5). The reduction in HbA1c was associated with reduction in the number of antidiabetic medications only in the compliant group and this is unchanged in the non-compliant groups, a decrease from 2.1 to 1.2 vs. no change from 2.6 to 2.6, p = 0.0753 (Table 6). Conclusion:Plant-based diet improved coronary risk factors, including decrease in HbA1c in the patients with diabetes. This is associated with the need for reduced number of antidiabetic medications.
Background: Prevalence of type 2 diabetes (T2D) is rising, and its burden on the healthcare system remains a challenge. Consumption of a plant-predominant diet is a promising approach for achieving remission, which has emerged as a therapeutic target. Objective: To establish feasibility of achieving T2D remission with a plant-predominant diet in a cohort of free-living individuals. Methods: Patients referred to a wellness clinic were treated with a low-fat, whole food, plant-predominant diet while receiving standard medical treatment. Included patients were adults, mostly elderly, with HbA1c > 6.5%, with or without use of antidiabetic medications. Results: N = 59 patients were included in this analysis, with mean age 71.5 years (range 41-89). Twenty-two (37%) patients achieved T2D remission. Mean differences showed a significant decrease post-lifestyle change (T2) compared to prior to lifestyle change (T1) for the following outcomes [least squares mean difference (95% CI)]: BMI [−2.6 (−4.8, −.3)] kg/m2; HbA1c [ −1.3 (−1.6, −1.0)] %; and fasting glucose [−29.6 (−41.8, −17.5)] mg/dL. No significant differences were observed for systolic or diastolic blood pressure, HDL, LDL, or triglycerides. Conclusion: A lifestyle-based treatment intervention promoting adherence to a plant-predominant diet and integrated as part of routine care can successfully achieve T2D remission in wellness clinic patients.
for prevention are crucial.The most clinically important risk factors for progression to vision loss include duration of diabetes, hyperglycemia, and hypertension. Besides these, hyperlipidemia and obesity are also found to be contributing risk factors in some studies [5,6].The current practice in the management DR has been primarily aimed at its neovascular complications, and rests upon the use of laser photocoagulation, intravitreal anti-VGEF injections, and on occasion glucocorticoid therapy. However, these treatments are not curative and there is increasing evidence that anti-VEGF treatment is unlikely to improve retinal perfusion and may not prevent gradual progression of nonperfusion or loss of peripheral visual field associated with worsening diabetes-related eye disease [7]. Moreover, there are many short term and long-term complications associated with these treatments. Diabetic retinopathy is the result of the convergence of many metabolic abnormalities leading to retinal vasculature dysfunction, inflammation, and neurodegeneration [8]. DR has been considered a microcirculatory disease of the retina. However, there is emerging evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR [9].
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