IMPACT OF MULTIPLE LIFESTYLE INTERVENTION ON BODY WEIGHT, INSULIN SENSITIVITY AND REMISSION OF TYPE 2 DIABETES: A SINGLE-CENTER EXPERIENCE

Abstract

BACKGROUND Type 2 diabetes (T2D) and pre-diabetes are mostly lifestyle diseases associated with high rates of morbidity, mortality, and health care expenditures. Different intensive lifestyle interventions have shown to be useful for effective control and even reverse these conditions. However, these strategies are rarely implemented as first-line choices. Objectives The Montréal Heart Institute Cardiovascular Prevention Center (EPIC) started a comprehensive lifestyle clinic for patients with T2D in 2019. We sought to study the impacts of a 12-month non-pharmacological intervention on body weight, insulin sensitivity and remission of T2D. METHODS AND RESULTS Between January and December 2019, 105 diabetic patients (HbA1c ≥ 6.5%) were recruited. Anthropometric measures and fasting blood analysis were measured at 0-3-6 and 12 months. All patients received regular nutritional counselling (therapeutic moderate carbohydrate restriction Mediterranean diet) and personalized physical exercise prescription (≥30 minutes of moderate aerobic training, 5 times a week, and strength training). Glucose-lowering therapies, if taken, were not modified unless necessary. Partial and complete remission of diabetes were defined by HbA1c < 6.5% and HbA1c < 5.7% respectively, for at least 3 months. Differences in means across variables with repeated observations were assessed with ANOVA. Factors associated with obtaining partial remission at 3 months were analyzed using a multivariate logistic model. 96 patients completed the intervention (91%), mean age was 67.5 (SD=10.5) years, 72% male, 37% with CHD, 23% without glucose-lowering therapies. Mean initial HbA1c was 7.3% (SD=0.8). At program end, all anthropometric and insulin resistance measures were significantly improved (Table 1); HbA1c -0.78 (95CI: -0.57 à -0.98, p < 0.001). Gains were achieved at 3 months and were maintained during the program without significant change. Partial remission was achieved in 56.1% (95CI: 45.1 to 66.5%) and complete remission of diabetes was attained in 11% (95CI: 5.7 to 19.9%) of participants. Among patients without glucose-lowering therapies (n=22), 73.7% (95CI: 48.4 to 51.6%) and 10.5% (95CI: 2.4 to 36.1%) attained partial and complete remission respectively. Adjusted by age, sex, treatment, basal HbA1c and weight loss at 3 months; individuals with low HbA1c (p=0.01) and those that lost >3.5Kg at 3 months (OR 4.1, 95%CI: 1.5 to 11.1, p=0.005) were significantly more likely to attain partial remission. CONCLUSION Prioritizing lifestyle changes were shown to improve anthropometric and insulin resistance measures even to the point of normalizing some metabolic values among subjects with T2D. These changes were mostly achieved after 3 months and were maintained throughout the intervention. Type 2 diabetes (T2D) and pre-diabetes are mostly lifestyle diseases associated with high rates of morbidity, mortality, and health care expenditures. Different intensive lifestyle interventions have shown to be useful for effective control and even reverse these conditions. However, these strategies are rarely implemented as first-line choices. Objectives The Montréal Heart Institute Cardiovascular Prevention Center (EPIC) started a comprehensive lifestyle clinic for patients with T2D in 2019. We sought to study the impacts of a 12-month non-pharmacological intervention on body weight, insulin sensitivity and remission of T2D. Between January and December 2019, 105 diabetic patients (HbA1c ≥ 6.5%) were recruited. Anthropometric measures and fasting blood analysis were measured at 0-3-6 and 12 months. All patients received regular nutritional counselling (therapeutic moderate carbohydrate restriction Mediterranean diet) and personalized physical exercise prescription (≥30 minutes of moderate aerobic training, 5 times a week, and strength training). Glucose-lowering therapies, if taken, were not modified unless necessary. Partial and complete remission of diabetes were defined by HbA1c < 6.5% and HbA1c < 5.7% respectively, for at least 3 months. Differences in means across variables with repeated observations were assessed with ANOVA. Factors associated with obtaining partial remission at 3 months were analyzed using a multivariate logistic model. 96 patients completed the intervention (91%), mean age was 67.5 (SD=10.5) years, 72% male, 37% with CHD, 23% without glucose-lowering therapies. Mean initial HbA1c was 7.3% (SD=0.8). At program end, all anthropometric and insulin resistance measures were significantly improved (Table 1); HbA1c -0.78 (95CI: -0.57 à -0.98, p < 0.001). Gains were achieved at 3 months and were maintained during the program without significant change. Partial remission was achieved in 56.1% (95CI: 45.1 to 66.5%) and complete remission of diabetes was attained in 11% (95CI: 5.7 to 19.9%) of participants. Among patients without glucose-lowering therapies (n=22), 73.7% (95CI: 48.4 to 51.6%) and 10.5% (95CI: 2.4 to 36.1%) attained partial and complete remission respectively. Adjusted by age, sex, treatment, basal HbA1c and weight loss at 3 months; individuals with low HbA1c (p=0.01) and those that lost >3.5Kg at 3 months (OR 4.1, 95%CI: 1.5 to 11.1, p=0.005) were significantly more likely to attain partial remission. Prioritizing lifestyle changes were shown to improve anthropometric and insulin resistance measures even to the point of normalizing some metabolic values among subjects with T2D. These changes were mostly achieved after 3 months and were maintained throughout the intervention.