A rare case of type 2 diabetes remission following non-pharmacological intense lifestyle modification in a liver transplantation recipient: A case report

Abstract

Solid organ transplantation, especially liver transplantation, is higher in patients with Type 2 Diabetes (T2D), with further worsening of glycemic control post-transplantation. This vicious cycle increases the risk of cardiovascular mortality, emphasizing the need for an effective T2D management strategy. We present a unique case of T2D remission through intensive lifestyle modification in a liver transplant recipient. A 55-year-old male liver transplant recipient with a history of T2D since 1995 and insulin therapy for 17 years experienced severe non-alcoholic fatty liver disease (NAFLD) and liver cirrhosis, necessitating a liver transplant in 2016. Post-transplant, he was on insulin and immuno-suppressants. In 2021, the patient joined our one-year diabetes management program, involving intense lifestyle modifications, including a plant-based, low-carbohydrate diet, physical activity, stress management, mindfulness meditation, and medical management. Insulin dose adjustments were made based on daily glucose monitoring. After three months, the patient experienced hypoglycemia, and insulin was discontinued. T2D remission was confirmed by normal blood glucose levels, and HbA1c of 6.3 %, and clearing of oral glucose tolerance tests (OGTT) twice post remission (at 9 and 21 months). This case report provides the first-ever documented evidence of T2D remission through non-pharmacological intervention after liver transplantation. Additionally, it reports the first-ever OGTT clearance following T2D remission post-liver transplantation.