733-P: Diabetes Remission Outcomes Protocol (DROP)—Early Observation

Abstract

A 12-week multidisciplinary intensive lifestyle intervention (ILI) was shown to induce diabetes remission (A1C <6.5%, on no medications for ≥3 months), particularly among participants with short diabetes duration. Diabetes remission was also achieved with very low-calorie diet (VLCD) or bariatric surgery. Diabetes Remission Outcomes Protocol (DROP) at Joslin Diabetes Center is an ILI designed to induce diabetes remission in patients with type 2 diabetes who meet 3 criteria: 1- duration of diabetes <5 years, 2- A1C <8%, 3- On up to 2 antihyperglycemic medications, but no insulin. It involves two phases: an intervention phase for 12 weeks and a maintenance phase for 9 months. During intervention phase, participants follow a time-restricted fasting for 16 hours and VLCD (800-1000 Kcal/day). Participants also receive cognitive behavioral support and perform exercises designed to maintain lean muscle mass (LMM). They stop all diabetes medications at the beginning of the program and are monitored by CGM. Reintroduction of medications is suggested if glucose time in range (70-180 mg/dL) (TIR) drops to <70%. During maintenance phase, participants return to 1500-1800 calorie diet with the aim of maintaining weight loss and diabetes remission. We tested feasibility of DROP in a pilot of 5 participants with mean age of 52.8±11.4 years, diabetes duration of 13.2±11.8 months, and A1C of 6.44±0.3% on 2 medications. By the end 12-weeks, average weight loss was 19.9 lbs (8.1%). A1C decreased to 6.14±0.48% (p=0.02) on no medications and TIR was 98%. LMM /total body weight significantly increased by 0.03±0.02 (p=0.03). Patient-reported quality of life measures showed significant improvements in the World Health Organization-5 Well-Being Index (p=0.03), Diabetes Distress Scale-17 (p=0.05) and 36-Item Short Form Survey (p=0.04) submodules. DROP is promising approach to induce diabetes remission and improve patients’ quality of life in selected patients with type 2 diabetes. Larger cohorts should be evaluated for longer duration. Disclosure K.Kibaa: None. A.Khater: None. R.Mccarragher: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation. S.E.Dhaver: None. C.Johnson: None. J.L.Votta: None. J.I.Shahar: None. C.Mitchell: None. J.M.Beaton: None. T.Salah: None. M.Al-badri: None.