Feasibility and Impact of an Intensive Team-based Intervention on Type 2 Diabetes Reversal

Feasibility and Impact of an Intensive Team-based Intervention on Type 2 Diabetes Reversal

To evaluate the feasibility of a 6-month multidisciplinary program to reverse type 2 diabetes using the Mediterranean diet, intermittent fasting and exercise.

The morbidities associated with type 2 diabetes (Db2) are major, including cardiovascular and renal complications, but also cognitive impairment. Providing interventions targeting Db2 reversal has shown great potential to improve healthy aging.

A Db2 reversal clinic has been established at the Montreal Heart Institute's ÉPIC Center, with an approach based on the Mediterranean diet and exercise. First-year results showed a 0.6% decrease in Hb1Ac and an average weight loss at 3 months of 4.5 kg in diabetic patients. This improvement was maintained at 6 and 12 months. Although these results are encouraging, the literature in Db2 remission shows that a weight loss of 10 kg is the ideal goal.

Therefore, to offer the possibility of further metabolic improvement at 6 months, three interventions are proposed as additions to the current program: targeting ultra-processed food reduction, motivational coaching and intermittent fasting. The main objective of our pilot study is to determine the feasibility of this improved program in type 2 diabetic patients, aged 18 to 80 years.

Inclusion Criteria:

• Type 2 diabetes
• Ability to give written consent, to use a smartphone application or complete an adherence/compliance diary, and use a blood glucose and blood pressure machine at home.

Exclusion Criteria:

• All types of diabetes other than type 2
• Taking the following glucose-lowering agents: insulin, sulfonylureas
• BMI < 18,5 kg/m2
• Unintentional weight loss of more than 10 kg in the past year
• Moderate to severe retinopathy
• Pregnant or nursing woman
• Severe organ failure
• Pathologies predisposing to gastrointestinal bleeding, untreated
• Recent cholecystitis (3 months)
• Antibiotic use in the past 3 months, or untreated active infection
• Known impaired nutrient absorption
• Uninvestigated new anemia or Hb < 110 g/100 mL
• Currently following an intermittent or prolonged fasting protocol
• Currently following a specific diet (vegan, celiac/gluten free, ketogenic)
• Active diagnoses of psychiatric or neurological illness not controlled for at least 6 months
• Taking, stopping or adjusting a medication in the last 3 months resulting in an active weight change.