Abstract P352: A Review of Trials Designed to Achieve Diabetes Remission With Lifestyle Intervention Alone: Implications for Sub-Saharan Africa

Abstract

Introduction: As the prevalence of type 2 diabetes (T2D) in sub-Saharan Africa rises and pharmacological hypoglycemics are often unavailable or prohibitively expensive, the ability to induce T2D remission through medication-free lifestyle interventions (LSI) needs urgent assessment. Objective: This scoping review evaluated trials designed to induce T2D remission by LSI without hypoglycemic medications. Methods: Using a combination of controlled vocabulary terms and key words specific to each database, PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed induce diabetes remission through LSI alone and were published before September 16, 2021. Of the 928 identified, 63 duplicates were removed. After title and abstract review, 727 irrelevant articles were excluded. After full-text review 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. So each trial would be represented by one article, the latest publication from each trial was included. Of the 16 trials, 7 trials were on newly-diagnosed, treatment-naïve T2D and 9 trials were on established T2D with LSI initiated after discontinuation of medications. Results: The 16 trials were published between 1984 and 2021. They were conducted in 10 different countries. None were conducted in Sub-Saharan Africa. Median number of participants was 180 and 20 for the newly-diagnosed and established T2D respectively. Median duration was 5 years for newly-diagnosed T2D and 5 months for established T2D. For newly-diagnosed T2D, LSI involved dietary counseling with or without calorie restriction (~1500 kcal/d) and exercise. For established T2D trial the main focus was dietary intervention most often divided into 3 phases; Phase 1: low-calorie meal replacement; Phase 2: food re-introduction; and Phase 3: weight maintenance. Median remission rate for the 16 trials was 55%. The consensus across trials was with or without exercise, T2D remission requires diet modification and weight loss. Predictors of remission were: higher BMI and lower A1C at enrollment, shorter T2D at enrolment, and a 10% loss of baseline weight. Nonglycemic benefits of LSI included improved blood pressure, renal function and lipid profile as well as enhanced quality of life. Conclusions: LSI without medications can induce remission in both newly-diagnosed and established T2D. In sub-Saharan Africa, LSI as the initial therapeutic option needs exploration.