Editors' ChoiceMetabolism

Eating to stop diabetes

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Science Translational Medicine  24 Jun 2020:
Vol. 12, Issue 549, eabc8952
DOI: 10.1126/scitranslmed.abc8952

Abstract

Very low-calorie diets can induce and sustain significant weight loss and diabetes remission.

In 2019, the International Diabetes Federation estimated that the Middle East and North Africa had the highest age-adjusted prevalence of type 2 diabetes at 12.2%. Approximately, 40% of deaths due to diabetes will occur in people younger than age 60 living in this region. Younger people also have a high risk of complications from diabetes and have a high medication burden. In addition to prevention of diabetes, effective methods to induce remission early in the course of diabetes (glucose control without need for medications) are urgently needed.

Taheri et al. examined the effect of weight loss with very low-calorie meal replacement (~800 kcal/day) on diabetes remission. Obese men and women living in Qatar, with less than 3 years of type 2 diabetes, aged 18 to 50 years, were randomized to a very low calorie (820 kcal/day) diet and exercise or to usual care for a year. The diet consisted of 12 weeks of meal replacement followed by 12 weeks of structured food reintroduction and then 6 months of energy-restricted meals chosen by the participant. At 12 months, the meal replacement group on average lost 11.98 kg with 21% losing more than 15% of their body weight. The control group lost 3.98 kgs with only 1% losing greater than 15% body weight. Diabetes remission occurred in 61% of the participants in the intervention group compared with 12% in the usual care group. In addition to diabetes remission, many people in the dietary intervention group were able to discontinue blood pressure and cholesterol-lowering medications and reported an improved quality of life.

This study showed that dietary weight loss interventions are effective and sustainable for remission in a younger population from the Middle East and North Africa. Real-world studies are needed to effectively implement and sustain lifestyle interventions outside of a clinical trial.

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