- The increasing number of people with type 2 diabetes is a major healthcare concern worldwide.
- Numbers are rising fastest in developed countries, with more children and young people now affected by a condition that was previously associated with older age.
- A new study has found that a very low energy diet, combined with supervised exercise can reverse type 2 diabetes in younger people.
- At the end of the 24-week study, 54% of those who completed the diet and exercise program achieved remission from their diabetes.
Type 2 diabetes is a condition where blood glucose levels increase because the body stops responding to insulin, the hormone that controls the movement of glucose from the blood to cells.
It is more likely in people over the age of 45 years, but recently, the condition has
A new study has shown that it may be possible to reverse young-onset diabetes through diet and exercise. In the study, in which participants with diabetes and obesity followed a very low energy diet combined with supervised exercise, more than half achieved remission from their type 2 diabetes in just a few weeks.
The study findings are reported in a paper which appears in
Kaberi Dasgupta, MD, MSc, FRCPC, lead and corresponding author of the study, who is a Professor of Medicine at McGill University, Montreal, Canada, told Medical News Today:
“We specifically focused on young adults 18 to 45 years old with type 2 diabetes. At this young age, the onset of complications like heart disease, stroke, kidney disease, and eye disease can happen by middle age or earlier, when people are trying to continue their working and home lives, and supporting others. Early onset type 2 diabetes actually has an accelerated progression. It is also a period when it would be good to have non medication options, given that many medications are not recommended during conception, pregnancy, and lactation. We demonstrated that our intervention could work in this young at risk population.”
Eamon Laird, PhD, a Nutrition lecturer at ATU Sligo and Adjunct Professor at Trinity College, Dublin, in Ireland, who was not involved in the study, told MNT that the study showed that “remission is an achievable goal for some younger adults with type 2 diabetes.”
“The combination of weight loss with resistance and aerobic exercise is important because muscle strength and physical fitness matter alongside blood glucose control,” Laird said.
“However,” he cautioned, “the study involved only 96 participants and lasted six months. There was also no diet-only group, so we cannot determine how much additional benefit came from exercise.”
What did the intervention look like?
Researchers recruited adults aged 18 to 45 who had received a diagnosis of early-onset type 2 diabetes no more than 6 years earlier.
all had
All participants also had obesity, a stable body weight, no recent changes to diabetes medication, normal blood pressure, were not using weight-loss medication and had no other health conditions.
The researchers divided the 96 participants randomly into two groups, which were well matched for age,
For the 24-week study, the 50 people in the intervention group undertook a very low energy — 800-900 kilocalories (kcal) per day — diet, made up of 30% protein, 50% carbohydrate and 20% fat.
Additionally, they had twice-weekly aerobic and resistance exercise and once-weekly independent exercise in the first 12 weeks, “followed by a weight-maintenance diet with independent exercise” for the rest of the intervention period.
The control group (46 people) continued their usual routine care.
The researchers evaluated the participants at the start of the study, at 12 weeks, and at the 24-week endpoint of the study. Five people from the intervention group, and five from the control group dropped out of the study.
58% of participants achieved diabetes remission
At 12 weeks, 29 of the 50 people (58%) in the intervention group had achieved remission of their type 2 diabetes, with just 2 of the 46 in the control group in diabetes remission.
At 24 weeks, 27 of the intervention group were still in remission from diabetes, and 2 in the control group.
The intervention group also lost more weight than the control group.
“This is a good result and it is clinically meaningful. It is not surprising as other studies have shown that intensive weight loss can reduce the risk of diabetes/increase remission rates. Those in the study were relatively young and also had a very recent diagnosis of diabetes so perhaps this was in their favor to get an even better result. It would be interesting to test this in older diabetics who have been diagnosed more than 10 years to see if we achieve similar results.”
–Eamon Laird, PhD
David Cutler, MD, a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study, also voiced reservations.
“The subjects were intended to follow a regimented diet totaling 800–900 calories per day and engage in two one-hour sessions of intensive supervised exercise weekly. This resulted in unequivocally greater remission from diabetes, as well as weight loss and reduced body fat,” Cutler noted.
“However, achieving these results came with challenges,” he added. “Approximately 86% of participants following the diet and exercise program experienced adverse effects, including constipation, headaches, dizziness, and increased sensitivity to cold. By comparison, only 13% of participants receiving usual care reported similar symptoms.”
Can these improvements be sustained?
Cutler told us that “it is discouraging to know that
According to him, “while many may immediately turn to the newest medications to address this growing health crisis, lifestyle changes, including diet, weight loss, and exercise, can also play an important role in improving blood sugar levels and, in some cases, achieving diabetes remission.”
Laird cautioned that the 800-900 calorie a day diet would be challenging for many people to maintain alongside work, family commitments and social occasions. He also highlighted the side effects people reported, particularly during the early stages of the program.
He strongly emphasized that this approach should be taken only under clinical supervision, and should not be presented as a diet people should undertake independently as “it would be very difficult for a non-health professional to design such a diet that still gives all the required micronutrients, vitamins and minerals as well to make sure none are low or deficient.”
Both Laird and Cutler highlighted that with the program lasting only 6 months, it is hard to know how durable the results might be.
However, Dasgupta pointed out that while most people generally regain weight after a program that involves weight loss “they can still stay in remission for some time after weight gain, and previous studies show that more time in remission means lower chance of eventually developing the complications of diabetes like heart disease and kidney disease.”
“It is important to note that temporary remission is not a permanent cure,” Laird told us, but added that “even for those who did not get full remission, there were benefits in terms of better physical fitness and strength which is important even if they still need medications.”
