Lifestyle changes continue to be the foundation of therapy for patients with type 2 diabetes, but they are rarely successful in daily practice. At the same time, highly effective medical therapies are available. Should health professionals simply stop advising people to eat less and become more active and prescribe one of the increasingly powerful drugs instead? Expert opinion on this topic is widely divided, as demonstrated by the Diabetes Congress in Berlin, Germany.
Diets Promote Remission
Stephan Martin, MD, of the West German Center for Diabetes and Health in Dusseldorf, Germany, is convinced that lifestyle changes are necessary for the treatment of type 2 diabetes. See the article : Lifestyle announces this season’s sale. “It’s an opportunity to overcome type 2 diabetes simply by changing your daily habits.”
Low-calorie meal replacements have proven to be particularly effective. The effect of these liquid meals was investigated in a study of diabetes remission (DiRECT) on a total population of 306 patients with overweight and obese diabetes. Of these patients, 24% achieved weight loss of more than 15 kg, and 46% of diabetic patients experienced clinical remission. Clinical remission was defined as an A1c value of less than 6.5% after 12 months without taking antidiabetic drugs.
“Patients on average had type 2 diabetes for 4 years and sometimes took two or three medications before the study. All of these medications could be discontinued because the HbA1c value was below 6.5%,” Martin said.
New Diagnoses, Good Prognosis
Of the patients who lost at least 15 kg in the study, 86% achieved remission. “This means that if someone has just been diagnosed with diabetes, they probably have almost a 100% chance of achieving remission, with clear weight loss,” Martin said.
Among patients with type 2 diabetes, postprandial insulin production is reduced. This may interest you : These tips can help seniors maintain a healthy lifestyle. But the DiRECT study suggested that if patients lose weight, normal postprandial insulin secretion can be achieved within 8 weeks.
Waking Up Beta Cells
“For type 2 diabetes, it depends on whether the beta cells are broken or in a state of hibernation,” Martin said. See the article : Stand on one leg for 10 seconds and your health. During “hibernation”, beta cells move because the liver has reached its capacity to store fat and fat is now deposited in the pancreas, according to the hypothesis of the DiRECT study group.
“A radical change in diet leads to the liver losing that fat, even if nothing else happens to the subcutaneous adipose tissue, for example,” Martin explained. The working group assumes that if fat is lost from the liver, then fat is also lost from the pancreas.
Individual Fat Threshold
“It has long been thought that you have to lose a lot of weight to fight type 2 diabetes,” Martin said. “But that’s obviously not the case. Even patients with huge excess weight just need to fall below their individual fat threshold.”
With 306 participants, the DiRECT study was quite small. However, other studies have confirmed the results. In the DIADEM-1 study, conducted by Qatar with 147 patients, 61% achieved clinical remission. A comparable study in Canada, conducted in pharmacies, used a low-calorie meal replacement with a reduced carbohydrate content. With this diet, 35% of all participants were able to discontinue diabetes treatment after 1 year.
Patients Become Treatable Again
The TeLiPro study, conducted in Germany, also included telemedicine training with a low-calorie liquid diet with reduced carbohydrate content. The 200 patients in the study had type 2 diabetes for an average of 11 years. The intervention was associated with positive effects on A1c, weight, blood pressure, body mass index, hunger, and insulin requirement. “Patients become curable again, even if they have diabetes for many years,” Martin said.
There is no truly good predictor that patients will respond to an extremely low-calorie liquid diet and achieve remission. “That means we have to offer it to patients to see if it works, and most manage it,” Martin said. “These patients still have type 2 diabetes; they have not been cured and still have to continue. They are not excluded from the disease management program.”
Type 2 diabetes doesn’t have to be a one-way street, Martin said. “There’s a way to be healthy. But for that to happen, we have to demand something from our patients as well.” A low-calorie meal replacement is suitable for this, as it can lead to quick and visible success, which in turn strengthens patient motivation.
Stephan Jacob, MD, a diabetologist in practice for prevention and therapy at the Cardiometabolic Institute in Villingen-Schwellingen, has a much more pessimistic view of the potential for lifestyle intervention. “Type 2 diabetes is more than hyperglycemia. It is a cardiovascular-kidney disease that begins long before the first diagnosis of abnormally high blood sugar.”
Studies show that atherosclerotic changes usually develop at a time when blood sugar is not abnormally high. “Forty percent of patients had already developed some microvascular changes by the time of diagnosis,” Jacob said. “And more than 80% of type 2 diabetics have metabolic syndrome.”
Preventing Cardiovascular Events
People with type 2 diabetes are “absolutely risky patients who do not live longer due to the correction of blood sugar,” said Jacob. Improving factors such as blood pressure or blood sugar is only beneficial if cardiovascular and renal events are prevented as a result and survival is prolonged.
The evidence that lifestyle modification can do this is extremely limited. In a study by the Diabetes Prevention Program (DPP), beneficial effects on A1c, blood pressure, and weight were observed after 18 years, but there was no effect on cardiovascular effects or mortality.
Thirty years of data from the Da Qing study on the outcome of diabetes prevention show a reduction in severe cardiovascular events and reduced mortality in the lifestyle group. “But first you really have to live long enough to benefit,” Jacob commented.
Even the study with the highest expectations, the LookAHEAD study, failed to show any improvement in severe cardiovascular endpoints after intensive lifestyle intervention.
Pharmacotherapy’s Clear Successes
In stark contrast are the success stories from pharmacotherapy. “For patients with type 2 diabetes, SGLT2 inhibitors and GLP-1 receptor agonists have been successful in preventing serious cardiovascular events, even in primary prevention,” Jacob said.
“In light of clear data for medical interventions, we must not deny evidence-based therapy to our patients.” The times when patients are first advised to go on a diet are a thing of the past.
However, it may not be possible to obtain this type of clear data for lifestyle interventions, Martin explained. “For many, there is simply no necessary evidence, that’s true. But we will also never get this evidence.” He added: “Criteria for evidence-based medicine used in pharmacological studies cannot be transferred to lifestyle studies.”
Analyzing “Soft Parameters”
Martin also asked why “only heart attack prevention and prolonging survival” are important. He recommended that much greater importance be attached to “soft parameters”. “If I help a patient lose weight through a lifestyle intervention, I give him a chance to move more again, maybe avoid knee surgery. Then it’s much more important for the patient than living another 2 years after 30 years.”
This article was translated from the German edition of Medscape.
You can help prevent or delay type 2 diabetes by losing a modest amount of pounds by following a low-calorie diet plan and being physically active most days of the week. Ask your doctor if you should take the diabetes medication metformin link to prevent or delay type 2 diabetes.
What is the best lifestyle for a diabetic?
Our 10 best tips
- Choose healthier carbohydrates. All carbohydrates affect blood glucose levels so it is important to know which foods contain carbohydrates. …
- Eat less salt. …
- Eat less red and processed meat. …
- Eat more fruits and vegetables. …
- Choose healthier fats. …
- Reduce the amount of added sugar. …
- Be smart with snacks. …
- Drink alcohol reasonably.
What makes a person with diabetes better? Let each meal be well balanced. As much as possible, plan for each meal to have a good mix of starch, fruits and vegetables, protein and fat. Pay attention to the types of carbohydrates you choose. Some carbohydrates, such as fruits, vegetables, and whole grains, are better for you than others.
What is the lifestyle of type 2 diabetes?
Risk factors for type 2 diabetes include: being overweight, especially around the waist. low levels of physical activity, including more than 2 hours of television viewing per day. unhealthy eating habits, such as regular choices of foods high in fat, sugar, salt, or low in fiber.
How does type 2 diabetes affect lifestyle? It can cause symptoms like excessive thirst, need to urinate a lot and fatigue. It can also increase the risk of serious problems with the eyes, heart and nerves. It is a lifelong condition that can affect your daily life. You may need to change your diet, take medication and go for regular check-ups.
What are the causes and prevention of diabetes?
Although the causes of diabetes vary from body to body, some of the most common factors that can lead to diabetes are obesity, unhealthy diet, alcohol consumption and an inactive lifestyle. Age also plays a key role, more often than not. Diabetes can also be inherited genetically.
What are the causes of type 2 diabetes? Type 2 diabetes is a condition that the pancreas does not produce a sufficient amount of insulin or a body that does not adequately affect the body, or the two.
Quel organe est touché par le diabète ?
If the glucose in the blood is too late with the temples, the impact of a dommageable on the plush organs of the body, in principle: the nephropathy, the retinopathy of the neurological system (neuropathy)