Nutrition and lifestyle intervention in type 2 diabetes: pilot study in the Netherlands showing improved glucose control and reduction in glucose lowering medication

Introduction Prevalence of type 2 diabetes (T2D) is increasing rapidly and lifestyle interventions to reverse diabetes are seen as a possible solution to stop this trend. New practice-based evidence is needed to gain more insight in the actual, and above all scientific, basis for these claims. Methods This observational study with a pretest post-test design aimed to pilot a 6-month multicomponent outpatient group-based nutrition and lifestyle intervention programme on glycaemic control and use of glucose lowering medication in motivated T2D patients with a body mass index (BMI) >25 kg/m2 in the Netherlands (February 2015–March 2016). Results 74 T2D patients (56% female) aged 57.4±8.0 years with mean BMI 31.2±4.2 kg/m2 and mean waist circumference 105.4±10.2 cm were included in the study. Compared with baseline, mean HbA1c levels at 6 months were 5 mmol/mol lower (SD=10, p<0.001) and the number of participants with HbA1c levels ≤53 mmol/mol after intervention had increased (from 36% (n=26/72) to 60% (n=43/72)). At baseline, 90% of participants were taking at least one type of glucose lowering medication. At 6 months, 49% (n=35/72) of the participants had reduced their medication or eliminated it completely (13%). Secondary outcomes were significantly lower fasting glucose levels (− 1.2±2.6 mmol/L), body weight (−4.9±5.1 kg), BMI (−1.70±1.69 kg/m2) and waist circumference (−9.4±5.0 cm). Plasma lipids remained unchanged except for a decrease in triglyceride levels. Furthermore, self-reported quality of life was significantly higher while experienced fatigue and sleep problems were significantly lower. Conclusion This pilot study showed that a 6-month multicomponent group-based program in a routine care setting could improve glycaemic control and reduce the use of glucose lowering medication in motivated T2D diabetics. A fully scaled study is needed to confirm these results.

[1]  F. Gallé,et al.  Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy , 2018, BMC Public Health.

[2]  Paul T. Williams,et al.  Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study , 2018, Diabetes Therapy.

[3]  Angela M Rodrigues,et al.  Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial , 2017, The Lancet.

[4]  S. C. Jansen,et al.  Effect and maintenance of the SLIMMER diabetes prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled trial , 2017, Nutrition & diabetes.

[5]  J. McCarter,et al.  A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes , 2017, JMIR diabetes.

[6]  A. Astrup,et al.  Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes , 2017, BMJ Open Diabetes Research and Care.

[7]  Sung Hee Choi,et al.  Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes , 2016, Acta Diabetologica.

[8]  Benjamin Aribisala,et al.  Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders , 2016, Diabetes Care.

[9]  Jonathan D Buckley,et al.  Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. , 2015, The American journal of clinical nutrition.

[10]  Melissa M. Parker,et al.  Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study , 2014, Diabetes Care.

[11]  T. Greenhalgh,et al.  Evidence based medicine: a movement in crisis? , 2014, BMJ : British Medical Journal.

[12]  Laura R. Saslow,et al.  A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes , 2014, PloS one.

[13]  R. Taylor,et al.  Population response to information on reversibility of Type 2 diabetes , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[14]  Roy Taylor.  Type 2 Diabetes , 2013, Diabetes Care.

[15]  J. Pinkney,et al.  Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. , 2013, The American journal of clinical nutrition.

[16]  C. Abraham,et al.  Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions , 2011, BMC public health.

[17]  Rena R Wing,et al.  Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. , 2010, Archives of internal medicine.

[18]  Reneé H Moore,et al.  Effects of a Low‐intensity Intervention That Prescribed a Low‐carbohydrate vs. a Low‐fat Diet in Obese, Diabetic Participants , 2010, Obesity.

[19]  W. Yancy,et al.  The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus , 2008, Nutrition & metabolism.

[20]  Lawrence W Green,et al.  Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? , 2008, Family practice.

[21]  J. V. Nielsen,et al.  Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up , 2008, Nutrition & metabolism.

[22]  H. Dashti,et al.  Beneficial effects of ketogenic diet in obese diabetic subjects , 2007, Molecular and Cellular Biochemistry.

[23]  W. Yancy,et al.  A low-carbohydrate, ketogenic diet to treat type 2 diabetes , 2005, Nutrition & metabolism.

[24]  C. Homko,et al.  Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes , 2005, Annals of Internal Medicine.

[25]  Steve N Caritis,et al.  Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization , 2004, The New England journal of medicine.

[26]  G. Brinkworth,et al.  Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial , 2004, Diabetologia.

[27]  Mark R Conaway,et al.  Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study. , 2004, Diabetes care.

[28]  R. Petrella,et al.  Lifestyle interventions for type 2 diabetes. Relevance for clinical practice. , 2003, Canadian family physician Medecin de famille canadien.

[29]  T. Valle,et al.  Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. , 2001, The New England journal of medicine.

[30]  L. Epstein,et al.  Year-long weight loss treatment for obese patients with type II diabetes: does including an intermittent very-low-calorie diet improve outcome? , 1994, The American journal of medicine.

[31]  W. Bauman,et al.  Early and long-term effects of acute caloric deprivation in obese diabetic patients. , 1988, The American journal of medicine.

[32]  G. Nijpels,et al.  NHG-Standaard Diabetes mellitus type 2 , 2009 .

[33]  Remi Rabasa-Lhoret,et al.  The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. , 2008, The American journal of clinical nutrition.

[34]  C. Mathers,et al.  WHO Library Cataloguing-in-Publication Data , 2001 .

[35]  M. Mcdermott,et al.  Effects of diet composition and ketosis on glycemia during very-low-energy-diet therapy in obese patients with non-insulin-dependent diabetes mellitus. , 1996, The American journal of clinical nutrition.