Changes in body composition through a lifestyle intervention program lead to remission of type 2 diabetes, prediabetes, and early insulin resistance

Type 2 diabetes (T2D), prediabetes (Pred), and insulin resistance (IR) were previously believed to be irreversible conditions. However, thanks to numerous studies on bariatric surgery, we know that remission can be achieved when substantial weight loss is achieved. To offer individuals a more comprehensive range of options, exploring alternative therapeutic models that prioritize lifestyle changes could be of great value. Between November 2021 and August 2022, a cohort of 27 individuals with T2D (glycated hemoglobin [A1C] ≥6.5%, 39 with Pred (A1C 5.7% to 6.4%), and 28 with early IR (A1C<5.7% and a homeostatic model assessment for IR [HOMA-IR] ≥3) accepted to participate in an ongoing multidomain lifestyle intervention clinic. The intervention consisted of expert-guided educational and nutritional counseling to promote the Mediterranean diet and an 8:16 time-restricted eating approach. Additionally, participants received a personalized exercise training prescription that included aerobic and resistance training sessions. Body composition measurements were taken by bioimpedance, and blood samples were drawn at 0, 3, and 6 months. Data were compared pre- and post program using an ANOVA with repeated measures. Remission of T2D, Pred, and IR was defined, respectively, by the return of A1C to <6.5%, <5.7% and a HOMA-IR <3, after 3 months, and its maintenance for an additional 3 months without hypoglycemic pharmacotherapy. The methodology and results of this study are summarized in Figure 1. Results: After the 6-month intervention, mean weight loss was of –5.0±4.7 kg, p<0.001, and % of visceral fat mass loss was of –16.4%±20.0%, p<0.001. We also observed a change in body fat mass loss (–3.9±3.7 kg; p<0.001), waist circumference (–5.6±9.4 cm; p<0.001), HOMA-IR (–1.8±4.2; p<0.001), and low-density lipoproteins (–0.2±0.7 mmol/L; p=0.003). Complete results are shown in Table 1. Mean reduction of A1C after 6 months was of –0.2%±0.4%, p<0.001. Remission criteria were reached in 19% of T2D, 21% of Pred, and 57% of IR. The results of this study show that changes in lifestyle habits through a 6-month synchronous nutritional intervention and physical training program can improve metabolic and anthropometric values in T2D, Pred, and IR individuals, reaching criteria of remission in a considerable number of participants. A 12-month follow-up will be provided to all participants to evaluate long-term maintenance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)