Evidence shows that patients with type 2 diabetes can achieve remission—leaving researchers and clinicians alike wondering how best to manage patients so they can reach that goal. Four investigators will examine the latest research during the two-hour symposium Lifestyle Interventions for Type 2 Diabetes Remission, which will begin at 8:00 a.m. Sunday, June 14.

Alison C. Barnes, RD, Senior Research Associate at Newcastle University, Newcastle upon Tyne, United Kingdom, will review the physiology of diabetes remission during her presentation “The DiRECT Trial and Very-Low-Calorie Eating Plans.”

“As part of DiRECT (Diabetes Remission Clinical Trial), we did a lot of metabolic studies to see what happens in remission, and what happens if the type 2 diabetes comes back,” Barnes said. “Remission is only recently being recognized as a therapeutic target, so I want to explain what’s happening in the body to achieve remission and review what low-calorie or low-energy eating plans are, what it’s like to use them, and what impact they can have on type 2 diabetes.”

Barnes will address some misconceptions regarding low-calorie eating plans and review key findings from DiRECT, a research project funded by Diabetes UK that was designed to determine whether a low-calorie diet, with structured support to reintroduce food and keep weight off, could achieve diabetes remission when delivered in a routine primary care setting. The trial results demonstrate how a low-energy dietary approach, used as part of a structured program of support, can help people lose and maintain significant amounts of weight, she said.

“We used to tell patients they’d always have type 2 diabetes, but now we know biologically that we can reverse the underlying processes, and that sustained remission is possible with the right support,” Barnes said. “Many people with type 2 diabetes are hugely motivated by that.”

Hana Kahleova, MD, PhD, MBA, Director of Clinical Research at the Physicians Committee for Responsible Medicine, will present “High-Fiber Diets and Plant-Based Eating Plans for Treating Type 2 Diabetes.” She will review the benefits of fiber in diabetes prevention and treatment, and also discuss eating plans that emphasize the consumption of fruits, vegetables, whole grains, seeds, and legumes, including the Mediterranean, DASH, Nordic, and vegetarian and vegan diets. She will also share data from recent meta-analyses designed to quantify the benefits of each of these dietary patterns.

“All of these diets emphasize the consumption of plant foods and all have been shown to be beneficial in the prevention and treatment of diabetes,” Dr. Kahleova said. “In fact, it’s fairly surprising how fast the changes happen once people switch to a plant-based diet. Usually within a few days, people with type 2 diabetes need to reduce their medications. And even patients with type 1 have found they need to reduce their insulin dose when they consume more fiber. The results are pretty impressive.”

Dr. Kahleova will also share data demonstrating the impact of fiber consumption on all-cause mortality, cardiovascular mortality, and the risk of type 2 diabetes.

“In a general population, one meta-analysis of 185 studies with 135 million people—so a robust analysis—showed a 15% decrease in all-cause mortality in general population,” she said. “Using the same approach in a type 2 population, all-cause mortality was reduced by 45%.”

Kristian Karstoft, MD, PhD, DMSc, from the Centre of Inflammation and Metabolism/Centre for Physical Activity Research in Copenhagen, Denmark, will present “Exercise Alone, or Is It a Combination of Diet and Exercise?” He will review results from the U-TURN (Lifestyle and Glucose Lowering Medication in T2DM) trial, a randomized controlled trial that assessed an intensive lifestyle intervention focused on exercise and a healthy diet.

“We used a treat-to-target approach to determine the extent to which intensive interventions, including dietary alterations and large volumes of exercise, may result in type 2 diabetes remission and which patient characteristics favor lifestyle-induced remission of diabetes,” Dr.  Karstoft said. “I’ll also review literature assessing the importance of exercise vs. dietary changes for bringing type 2 diabetes into remission.”

The session’s other presenter, William S. Yancy Jr., MD, MHS, Associate Professor of Medicine at Duke University Diet and Fitness Center, will discuss low-carbohydrate eating plans.

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