"Reversing" Prediabetes May be Possible with Intensive Lifestyle Changes
At the ADA Postgraduate 2021 virtual conference, Dr. Samuel Dagogo-Jack discussed how intensive lifestyle changes can lead to prediabetes remission and prevent progression to type 2 diabetes.
Earlier this month our team attended the American Diabetes Association’s 2021 Advanced Postgraduate Course virtual conference, where prominent healthcare professionals, researchers, and diabetes-related organizations presented on a host of topics, including a fascinating talk on prediabetes “reversal” and how lifestyle changes may prevent type 2 diabetes.
Can prediabetes be reversed?
Dr. Samuel Dagogo-Jack of the University of Tennessee Health Science Center shared data from a recent trial showing that intensive lifestyle changes supported prediabetes remission and lowered a person’s risk for developing type 2 diabetes. The study included 158 African-American and European-American participants with prediabetes, who had a parental history of type 2 diabetes. The program included six intensive lifestyle modifications over the course of five years:
- Calorie restriction: participants ate 1,200-1,500 calories per day.
- Three hours of physical activity per week. Most participants chose brisk walking as their physical activity.
- A personal weight loss goal of 10% or more.
- Increased face-to-face visits with a healthcare professional: monthly sessions for the first six months, followed by quarterly visits for the rest of the time.
- Meal replacement: two shakes and two protein bars for two meals per day for participants who had not met their weight goals 6-12 months after the start of the study.
- Increased self-monitoring through logging of daily calorie intake and physical activity.
These lifestyle interventions were linked to positive results: only 6.5% of participants were diagnosed with type 2 diabetes over ten years, and 43.5% of the people in the study achieved prediabetes remission within ten years. Prediabetes remission was defined as “restoration of normal glucose regulation,” or a fasting glucose below 100 mg/dl and two-hour post-meal glucose below 140 mg/dl.
Based on this data,
Dr. Dagogo-Jack argued that type 2 diabetes prevention and prediabetes “reversal” are achievable with lifestyle modification, and both should be primary goals in diabetes care. Though not everyone may be able to commit to such intensive lifestyle changes, these results are significant. Each person’s diabetes journey is different; making small steps toward achievable goals is a great place to start.
BMJ Open Diabetes Res Care
. 2020 Jun;8(1):e000899.
Pathobiology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC) Study: design of lifestyle intervention
Free PMC article
Introduction: Intensive lifestyle intervention (ILI) prevents progression from prediabetes to type 2 diabetes (T2D) but reversal of prediabetes is less well studied.
Research design and methods: The overall objectives of the Pathobiology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC) Study (ClinicalTrials.gov ID: NCT02027571) are to determine the natural history and reversibility of prediabetes. The study tests specific hypotheses on the patterns of progression to prediabetes among normoglycemic African-American (AA) and European-American (EA) offspring of parents with T2D; emergence of microvascular and macrovascular complications during transition from normal to impaired glucose regulation; significance of the 'metabolically healthy' obese phenotype; and effect of duration of the prediabetic state on its reversibility with lifestyle intervention. Participants who developed incident prediabetes were offered ILI and evaluated quarterly for 5 years. The primary outcome was restoration of normal glucose regulation (fasting plasma glucose <100 mg/dL and two-hour plasma glucose (2hrPG)<140 mg/dL).
Results: Of the 223 subjects enrolled in the PROP-ABC Study, 158 participants with incident prediabetes started ILI. The mean age was 53.3±9.28 years; body mass index 30.6±6.70 kg/m2; 70% were female, 52.4% AA and 47.6% EA. The ILI program used goal setting, weight-based calorie restriction, physical activity (180 min/week), self-monitoring, and meal replacement. Monthly face-to-face (F2F) counseling sessions during the initial 6 months, and quarterly visits thereafter, were supplemented with electronic and postal contacts. Attendance at F2F sessions was highly correlated with weight loss (r=0.98, p<0.0001). Meal replacement induced ~5 kg weight loss within 3 months in participants with recrudescent weight pattern. Self-reported exercise minutes correlated with pedometer step counts (r=0.47, p<0.0001).
Conclusion: The PROP-ABC Study has demonstrated the feasibility of executing an ILI program designed to test reversibility of incident prediabetes in a biracial cohort.
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