The American College of Lifestyle Medicine has issued a consensus statement on dietary strategies that have been shown to support remission of type 2 diabetes. The statement is also supported by the Academy of Nutrition and Dietetics, and is co-sponsored by the Endocrine Society. It was published in the American Journal of Lifestyle Medicine.
Remission of type 2 diabetes means having normal blood glucose levels without taking any glucose-lowering medications. Recent studies have shown that diabetes remission may be more common than was previously suspected — affecting as many as one in 20 people with type 2 diabetes — and that it may be the result of different treatment and lifestyle strategies. Bariatric (weight-loss) surgery has been shown to promote remission of type 2 diabetes and prediabetes in people with obesity, and certain dietary strategies — including low-calorie diets and low-carb diets — may also be effective.
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For the latest consensus statement, members of the American College of Lifestyle Medicine reviewed 131 potential statements based on a wide-ranging review of published research on diet and remission of type 2 diabetes in adults. Out of these potential statements, 69 met the criteria for consensus and were included in the final published article.
The statement authors agreed that remission of type 2 diabetes should be defined as an A1C level (a measure of long-term blood glucose control) below 6.5% “with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose.” They also agreed that dietary strategies can be used to achieve remission in many adults, and that the success of these strategies often depends on “the intensity of the intervention.” Any dietary strategy is most likely to succeed, they noted, when it emphasizes whole plant-based foods and “minimal consumption of meat and other animal products” and is paired with regular moderate physical activity.
While the statement authors recognized that bariatric surgery can be an effective way to achieve diabetes remission, they noted that this surgery carries risks, and that people who undergo it often regain their lost body weight — while also losing the benefits of diabetes remission. In contrast, they wrote, “sufficiently intensive lifestyle intervention” in the areas of diet, exercise, and sleep may be just as effective as bariatric surgery when it comes to diabetes remission.
Significant calorie reduction needed
The statement authors agreed that diabetes remission “requires a sufficient reduction in absorbed calories to decrease adiposity and insulin resistance.” This can be achieved in a number of different ways, including liquid meal replacements and food-based approaches. Reducing your caloric intake through food-based approaches, they notes, means emphasizing “water-rich foods such as fruits and vegetables, and other high-fiber, low-fat foods, such as whole grains and legumes.” Meanwhile, ultra-processed foods should be minimized or avoided entirely.
The statement also noted that education and behavioral support are key to following lifestyle strategies for diabetes remission, and that these strategies should “accommodate patient preferences and values, and be culturally sensitive and appropriate” rather than emphasizing specific foods to eat. It’s also important, the statement noted, to have medical supervision of this process so that glucose-lowering medications can be reduced as necessary based on blood glucose self-monitoring.
Unfortunately, the statement authors wrote, insurance companies rarely cover food-based interventions for diabetes even though they may lead to significant cost savings over time. “Adherence of patients to dietary recommendations is likely to increase if insurance coverage recognizes nutrition prescriptions for the remission of [type 2 diabetes] as at least equivalent to the coverage offered for traditional pharmaceutical or medical therapies,” they noted.
Want to learn more about diabetes remission? Read “Type 2 Diabetes Remission — Can It Be Done?”