Abstract
From a biological view, most of the processes involved in insulin resistance, which drives the pathobiology of type 2 diabetes, are reversible. This theoretically makes the disease reversible and curable by changing dietary habits and physical activity, particularly when adopted early in the disease process. Yet, this is not fully implemented and exploited in health care due to numerous obstacles. This article reviews the state of the art in all areas involved in a diabetes cure-focused therapy and discusses the scientific and technological advancements that need to be integrated into a systems approach sustainable lifestyle-based healthcare system and economy. The implementation of lifestyle as cure necessitates personalized and sustained lifestyle adaptations, which can only be established by a systems approach, including all relevant aspects (personalized diagnosis and diet, physical activity and stress management, self-empowerment, motivation, participation and health literacy, all facilitated by blended care and ehealth). Introduction of such a systems approach in type 2 diabetes therapy not only requires a concerted action of many stakeholders but also a change in healthcare economy, with new winners and losers. A “call for action” is put forward to actually initiate this transition. The solution provided for type 2 diabetes is translatable to other lifestyle-related disorders.
Highlights
Current health care in the area of lifestyle-related diseases does not focus on reversal of the cause of the disease, but rather on controlling disease corollaries by manipulating biochemical pathways
We provide evidence for the reversibility of insulin resistance and the remission of type 2 diabetes, by diet and lifestyle
We demonstrate that T2D is a “systems disease” with multiple organs and processes involved and deserves to be treated in a personalized manner, if necessary in a “personalized lifestyle-personalized medicine combination.”
Summary
Current health care in the area of lifestyle-related diseases does not focus on reversal of the cause of the disease, but rather on controlling disease corollaries by manipulating biochemical pathways (gluconeogenesis by metformin, hepatic cholesterol synthesis by statins, insulin secretion by sulfonylureas, fatty acid housekeeping by PPAR agonists, etc.). Already in 2002, the Diabetes Prevention Program demonstrated in a large 4-year study that, metformin and lifestyle both were effective in maintaining fasting plasma glucose, the plasma glucose response to an oral glucose tolerance test (OGTT) (a core aspect of phenotypic flexibility) was more efficiently restored by lifestyle change than medication [13]. A third person may accumulate liver fat due to a shortage of carnitine, causing inadequate fatty acid oxidation [34], etc Each of these processes needs to be mapped out to carefully design a specific (food and lifestyle based) therapy [35]. Multi-biomarker panels are needed to reflect well-defined and accepted health-related processes (Table 1) that can be used as diagnostics of systems flexibility by quantification in response to standardized stress testing This type of method allows to quantify the relative contribution of many relevant processes in pancreas, liver, muscle, intestine, adipose tissue, vasculature, and. Low (saturated) fat diet; weight loss; very low-caloric diet; intermittent fasting; wholegrain; choline; carnitine; resveratrol; cinnamon extract; metformin
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