Reversing Type 2 Diabetes: A Narrative Review of the Evidence

Hallberg, Sarah; Gershuni, Victoria M.; Hazbun, Tamara L.; Athinarayanan, Shaminie J.

doi:10.3390/nu11040766

Cited by 129 publications

(151 citation statements)

References 108 publications

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“…5 That LCHF diets have the potential to put T2D into remission is becoming increasingly recognized, especially in trials with a high level of patient monitoring and support. 3,8 The 7 participants from the current study who started their LCHF diet soon after diagnosis responded particularly well, which agrees with the notion that an LCHF diet may be especially effective for remission in newly diagnosed T2D patients or those taking less medication. 3,14 The selection of highly motivated participants may explain why our findings are considerably more favorable than conclusions from a number of recent metaanalyses of RCTs.…”

Section: Discussionsupporting

confidence: 84%

“…Partial T2D remission was defined as HbA1c below 6.5% without taking diabetes medications other than metformin at both First Assessment and Follow Up. 3 Remissions were referred to as "potential" if these criteria were only met at Follow-Up.…”

Section: Remission Assessmentmentioning

confidence: 99%

“…1,2 In recent years, there has been growing interest to not only delay the progression of T2D but also in reversing the condition. 3,4 Remission from T2D with standard treatment is rare 5 but occurs with greater frequency after bariatric surgery 6 and severe calorie restriction (850 kcal per day or less). 7 More recently, severe carbohydrate restriction has also gained attention due to the potential for T2D remission.…”

mentioning

confidence: 99%

“…7 More recently, severe carbohydrate restriction has also gained attention due to the potential for T2D remission. 3,8,9 There has been much scientific interest in carbohydrate restricted diets to manage T2D, with at least 22 randomized control trials, 10 non-randomized control trials, and 10 systematic reviews (9 with meta-analyses) that have investigated the effects of carbohydrate restriction on glycemic control in patients with T2D. 10−13 While there is considerable heterogeneity in findings, this evidence generally shows that the lower carbohydrate dietary interventions are at least as effective as control diets for improving HbA1c, T2D medication requirements, body weight, and dyslipidemia.…”

mentioning

confidence: 99%

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<p>Diet, Diabetes Status, and Personal Experiences of Individuals with Type 2 diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat diet</p>

Webster¹,

Murphy²,

Larmuth³

et al. 2019

DMSO

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Background: Low carbohydrate high fat (LCHF) diets are increasing in popularity amongst patients with type 2 diabetes (T2D), however it is unclear what constitutes a sustainable LCHF diet in a real-world setting. Methods: This descriptive multi-method study characterized the diets, T2D status, and personal experiences of individuals with T2D who claimed to have followed an LCHF diet for at least 6 months. Participants completed a medications history, mixed-method dietary assessment, provided a blood sample, and were interviewed in-depth about their experiences with the diet (First-Assessment). Past medical records were obtained corresponding to T2D diagnosis and prior to starting their LCHF diets. Additionally, participants were followed up 15 months later to assess T2D remission (Follow-Up). Results: Twenty-eight participants completed First-Assessment and 24 completed Follow-Up. Habitual carbohydrate intake was 20 to 50 g/d for 10 participants and 50 to 115 g/d for 17 participants. Commonly reported foods were full-fat dairy, non-starchy vegetables, coconut oil, eggs, nuts, olives and avocados, olive oil, and red meat and poultry with fat. Median (interquartile range) for HbA1c was 7.5 (6.5-9.5) % prior to starting their diets, 5.8 (5.4-6.2) % at First-Assessment and 5.9 (5.3-6.6) % at Follow-Up. Reported body weight and glucose-lowering medication requirements were considerably lower at both assessments than when starting the diet. At Follow-Up, 24 participants had been following their LCHF diets for 35 (26-53) months, the majority of which were in full or partial T2D remission. Participants perceived reduced hunger and cravings as one of the most important aspects of their diets. Of concern, many participants felt unsupported by their doctors. Conclusion: This study described the foods and characteristics of an LCHF "lifestyle" that was sustainable and effective for certain T2D patients in a real-world setting. Plain Language SummaryUntil recently, low carbohydrate high fat (LCHF) diets were not supported by most T2D dietary guidelines, and the high fat component of these diets is still controversial due to concerns over long-term health outcomes. Despite this, there are a growing number of individuals following their own version of an LCHF diet to manage their T2D. The aim of this study was to characterize the diets, health, and personal experiences of individuals with T2D who claimed to have followed an LCHF diet for at least the previous 6 months.A total of 28 participants completed the study and 24 of these participants were assessed for a second time after 15 months. We found that:

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Section: Discussionsupporting

confidence: 84%

Section: Remission Assessmentmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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<p>Diet, Diabetes Status, and Personal Experiences of Individuals with Type 2 diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat diet</p>

Webster¹,

Murphy²,

Larmuth³

et al. 2019

DMSO

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“…Multiple studies in diverse populations have shown that 7% body weight loss significantly reduces the risk of developing diabetes by > 50% and imparts long‐lasting, albeit reduced, protection even in the face of weight regain . More pronounced weight loss (>15%) achieved by very low‐calorie diets is associated with remission of type 2 diabetes . Obesity drugs are therefore useful adjuncts to achieve weight loss goals and meaningful metabolic improvements; however, if an obesity drug prescribed at the highest recommended dose has not resulted in 5% body weight loss at 3 months, then alternate pharmacotherapy (Table ) or metabolic and bariatric surgery should be considered.…”

Section: Importance Of Weight Lossmentioning

confidence: 99%

Medical and surgical management of obesity and diabetes: what's new?

et al. 2020

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We conducted a narrative review of the medical and surgical management of people with obesity and diabetes. Results of this review showed that a 5-10% loss in body weight can be achieved with a change in lifestyle, diet and behaviour and with approved pharmacological therapies in people with obesity and diabetes. New targeted therapies are now available for patients with previously untreatable genetic causes of obesity. Compared to medical treatment, metabolic and bariatric surgery is associated with significantly higher rates of remission from type 2 diabetes and lower rates of incident macrovascular and microvascular complications and mortality. The National Institute for Health and Care Excellence and the American Diabetes Association endorse metabolic and bariatric surgery in obese adults with type 2 diabetes and there may also be a role for this in obese individuals with type 1 diabetes. The paediatric committee of the American Society for Metabolic and Bariatric Surgery have recommended metabolic and bariatric surgery in obese adolescents with type 2 diabetes. Earlier and more aggressive treatment with metabolic and bariatric surgery in obese or overweight people with diabetes can improve morbidity and mortality.

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