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Retnakaran R, Kashyap SR, Gerstein HC, Aroda VR. Contemporary Clinical Perspectives on Targeting Remission of Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:1179-1188. [PMID: 38108415 DOI: 10.1210/clinem/dgad746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
It has long been known that some patients with type 2 diabetes (T2DM) can experience sustained metabolic improvement to near-normal levels of glycemia either spontaneously or after medical intervention. Now recognized as remission of diabetes, this intriguing state is currently more feasible than ever before due to profound advances in metabolic surgery, pharmacologic therapy, and regimens of lifestyle modification. This enhanced capacity to induce remission has revealed new pathophysiologic insights, including the presence of a reversible component of the pancreatic beta-cell dysfunction that otherwise drives the chronic progressive nature of T2DM. In doing so, it has changed the therapeutic landscape by offering new potential management objectives and considerations for patients and providers. However, the excitement around these developments must also be tempered by the sobering realities of our current understanding of remission, including the recognition that this condition may not be permanent (resulting in glycemic relapse over time) and that beta-cell function may not be normalized in the setting of remission. These limitations highlight both the many gaps in our current understanding of remission and the caution with which clinical discussions must be handled for clear patient-directed communication of the pros and cons of targeting this outcome in practice. In this mini-review, we consider this rapidly growing literature, including its implications and its limitations, and thereby seek to provide objective balanced perspectives on targeting remission of T2DM in current clinical care.
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Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON M5S 3H2, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Sangeeta R Kashyap
- Division of Endocrinology, Diabetes, and Metabolism, New York Presbyterian-Weill Cornell Medicine, New York, NY 10021, USA
| | - Hertzel C Gerstein
- Division of Endocrinology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Aas AM, Axelsen M, Churuangsuk C, Hermansen K, Kendall CWC, Kahleova H, Khan T, Lean MEJ, Mann JI, Pedersen E, Pfeiffer A, Rahelić D, Reynolds AN, Risérus U, Rivellese AA, Salas-Salvadó J, Schwab U, Sievenpiper JL, Thanopoulou A, Uusitupa EM. Evidence-based European recommendations for the dietary management of diabetes. Diabetologia 2023; 66:965-985. [PMID: 37069434 DOI: 10.1007/s00125-023-05894-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.
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Tabák AG, Sattar N, Kivimäki M. Response by Tabák et al to Letters Regarding Article, "Risk of Macrovascular and Microvascular Disease in Diabetes Diagnosed Using Oral Glucose Tolerance Test With and Without Confirmation by Hemoglobin A1c: The Whitehall II Cohort Study". Circulation 2023; 147:988-989. [PMID: 36944036 PMCID: PMC7614407 DOI: 10.1161/circulationaha.123.063545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
- Adam G. Tabák
- UCL Brain Sciences, University College London, London, UK
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Hills S, Terry D, Gazula S, Browning C. Practice nurses' communication with people living with type 2 diabetes: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2664-2670. [PMID: 35393227 DOI: 10.1016/j.pec.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/05/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To identify the key characteristics of practice nurses' communication with people living with Type 2 Diabetes (T2D) where lifestyle activities are discussed. METHODS A scoping review of the peer-reviewed literature was conducted. Reflexive thematic analysis was used to identify key themes that emerged. The PRISMA-ScR checklist was followed. RESULTS 25 studies were retained in the final review. Nurses who were committed to engaging in lifestyle discussions created supportive environments and built rapport to enable change conversations. However, this was present in just 20% of the studies. In most studies, (60%) nurses continued to use traditional health education communication styles, had little understanding of behaviour change theories, lacked skills in behaviour change counselling and were reluctant to engage in behaviour change discussions with people with T2D . CONCLUSIONS Nurses require a deeper understanding of behavioural change theories and skills in behavioural counselling. PRACTICE IMPLICATIONS Practice nurses have a unique opportunity to facilitate T2D remission by engaging in evidence-based behaviour change communication. A behaviour change training intervention is needed that recognises the environment of practice nurse consultations. It needs to be pragmatic and fully consider the enablers and barriers to addressing behaviour change in both the nurse and the person with T2D.
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Affiliation(s)
- Sharon Hills
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Daniel Terry
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Swapnali Gazula
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Colette Browning
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia; Australia Research School of Population Health, Australian National University; Health Innovation and Transformation Centre, Federation University.
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Kolltveit BCH, Graue M, Orvik E, Fløde M, Haltbakk J. Diabetessykepleieres rolle i primærhelsetjenesten – en kvalitativ studie. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wei J, Chen J, Wei X, Xiang X, Cheng Q, Xu J, Xu S, Chen G, Liu C. Long-term remission of type 2 diabetes after very-low-calorie restriction and related predictors. Front Endocrinol (Lausanne) 2022; 13:968239. [PMID: 36171906 PMCID: PMC9510590 DOI: 10.3389/fendo.2022.968239] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Very low-calorie restriction (VLCR) can induce remission of type 2 diabetes mellitus (T2DM), but its long-term remission and related predictors have not been clarified. The aim of present study is to investigate the effect of VLCR in inducing long-term T2DM remission, and the underlying predictors. METHODS A total of 61 participants with T2DM who received 9 days of VLCR from Dec 2012 to Oct 2020 were followed up in Nov 2021, and divided into responders and non-responders groups. Responders were defined as HbA1c < 6.5% over at least 3 months in the absence of pharmacotherapy. Clinical characteristics were compared between responders and non-responders. Potential predictors were examined by logistic regression analyses based on clinical data before and after VLCR. RESULTS Forty-four participants were successfully followed up, including 19 males and 25 females. Long-term remission was observed in 17 participants (38.64%) after VLCR, with a median 7.83 years. Compared with non-responders, responders had a shorter disease duration, a lower fasting blood glucose (FBG) level, a higher fasting insulin level, and better HOMA-β after VLCR. Besides, acute insulin response (AIR), insulin area under curve in intravenous and oral glucose tolerance test (IVGTT-IAUC and OGTT-IAUC) in responders were higher than those in non-responders after VLCR. Multivariable logistic analysis showed that higher post-VLCR IVGTT-IAUC predicted a longer T2DM remission. CONCLUSIONS After VLCR, more than one third of the participants presented remission over up to 8 years. The improvement of β-cell function, especially the restoration of first-phase insulin-secreting capacity, could prolongate the remission.
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Affiliation(s)
- Jie Wei
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jie Chen
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiao Wei
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiaoduo Xiang
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Qing Cheng
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jiechao Xu
- Department of Nutrition, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Guofang Chen, ; Chao Liu,
| | - Chao Liu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Guofang Chen, ; Chao Liu,
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Chew BH, Vos RC, Widyahening IS, Khunti K. Editorial: Achieving Efficient Diabetes Care Through Understanding the Risk Factors, Markers, and Patient Experiences. Front Endocrinol (Lausanne) 2022; 13:854167. [PMID: 35432197 PMCID: PMC9005900 DOI: 10.3389/fendo.2022.854167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/23/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia (HPUPM Teaching Hospital), Persiaran MARDI - UPM, Serdang, Malaysia
- *Correspondence: Boon-How Chew, ;
| | - Rimke C. Vos
- Department Public Health and Primary Care/Leiden University Medical Center (LUMC)-Campus The Hague, Leiden University Medical Center, Hague, Netherlands
| | - Indah Suci Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kamlesh Khunti
- National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester, United Kingdom
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
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Churuangsuk C, Hall J, Reynolds A, Griffin SJ, Combet E, Lean MEJ. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 2022; 65:14-36. [PMID: 34796367 PMCID: PMC8660762 DOI: 10.1007/s00125-021-05577-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/28/2021] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Weight reduction is fundamental for type 2 diabetes management and remission, but uncertainty exists over which diet type is best to achieve and maintain weight loss. We evaluated dietary approaches for weight loss, and remission, in people with type 2 diabetes to inform practice and clinical guidelines. METHODS First, we conducted a systematic review of published meta-analyses of RCTs of weight-loss diets. We searched MEDLINE (Ovid), PubMed, Web of Science and Cochrane Database of Systematic Reviews, up to 7 May 2021. We synthesised weight loss findings stratified by diet types and assessed meta-analyses quality with A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. We assessed certainty of pooled results of each meta-analysis using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (PROSPERO CRD42020169258). Second, we conducted a systematic review of any intervention studies reporting type 2 diabetes remission with weight-loss diets, in MEDLINE (via PubMed), Embase and Cochrane Central Register of Controlled Trials, up to 10 May 2021. Findings were synthesised by diet type and study quality (Cochrane Risk of Bias tool 2.0 and Risk Of Bias In Non-randomised Studies - of Interventions [ROBINS-I]), with GRADE applied (PROSPERO CRD42020208878). RESULTS We identified 19 meta-analyses of weight-loss diets, involving 2-23 primary trials (n = 100-1587), published 2013-2021. Twelve were 'critically low' or 'low' AMSTAR 2 quality, with seven 'high' quality. Greatest weight loss was reported with very low energy diets, 1.7-2.1 MJ/day (400-500 kcal) for 8-12 weeks (high-quality meta-analysis, GRADE low), achieving 6.6 kg (95% CI -9.5, -3.7) greater weight loss than low-energy diets (4.2-6.3 MJ/day [1000-1500 kcal]). Formula meal replacements (high quality, GRADE moderate) achieved 2.4 kg (95% CI -3.3, -1.4) greater weight loss over 12-52 weeks. Low-carbohydrate diets were no better for weight loss than higher-carbohydrate/low-fat diets (high quality, GRADE high). High-protein, Mediterranean, high-monounsaturated-fatty-acid, vegetarian and low-glycaemic-index diets all achieved minimal (0.3-2 kg) or no difference from control diets (low to critically low quality, GRADE very low/moderate). For type 2 diabetes remission, of 373 records, 16 met inclusion criteria. Remissions at 1 year were reported for a median 54% of participants in RCTs including initial low-energy total diet replacement (low-risk-of-bias study, GRADE high), and 11% and 15% for meal replacements and Mediterranean diets, respectively (some concerns for risk of bias in studies, GRADE moderate/low). For ketogenic/very low-carbohydrate and very low-energy food-based diets, the evidence for remission (20% and 22%, respectively) has serious and critical risk of bias, and GRADE certainty is very low. CONCLUSIONS/INTERPRETATION Published meta-analyses of hypocaloric diets for weight management in people with type 2 diabetes do not support any particular macronutrient profile or style over others. Very low energy diets and formula meal replacement appear the most effective approaches, generally providing less energy than self-administered food-based diets. Programmes including a hypocaloric formula 'total diet replacement' induction phase were most effective for type 2 diabetes remission. Most of the evidence is restricted to 1 year or less. Well-conducted research is needed to assess longer-term impacts on weight, glycaemic control, clinical outcomes and diabetes complications.
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Affiliation(s)
- Chaitong Churuangsuk
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Julien Hall
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Reynolds
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, Otago, New Zealand
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
- Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, Otago, New Zealand.
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