Energy-restricted interventions are effective for the remission of newly diagnosed type 2 diabetes: A systematic review of the evidence base

Jacob, Elizabeth; Avery, Amanda

Abstract

Background: Type 2 diabetes (T2DM) is a chronic, progressive disease. Caloric restriction and subsequent weight loss have been associated with both improvements and, in some cases, remission of T2DM.

Aim: To systematically review the safety and effectiveness of calorie-restricted diets on weight change and the remission of T2DM.

Methods: Electronic databases were searched. Intervention trials including a calorie restriction, published between 2010 and 2020, evaluating the remission of T2DM (HbA1c ≤6.5% without diabetes medication) were selected. Risk of bias was assessed.

Results: Eight trials met inclusion criteria including four randomised controlled and four single arm trials. Three controlled trials found greater remission in the calorie-restricted arm (p ≤0.05). A recent diagnosis of diabetes was associated with higher remission rates (75-80%) with an inverse association between duration of diabetes and rate of remission (r = -0.94). A higher level of remission was observed with greater calorie restriction in non-new diagnosis studies. Greater weight loss was associated with increasing rates of remission (r = 0.83). No reported adverse events led to withdrawal from trials. There was great heterogeneity in study design.

Conclusion: Remission rate of T2DM achieved through calorie restriction is high. and similar to that reported in the bariatric surgery literature. Remission should be the aim at diagnosis and calorie-restriction could be used to achieve this. The target weight loss should be >10% body weight in people with obesity. More research is needed into the optimum level of calorie-restriction and the support required for long-term remission. National guidelines should be updated to reflect recent evidence.

Citation

Jacob, E., & Avery, A. (2021). Energy-restricted interventions are effective for the remission of newly diagnosed type 2 diabetes: A systematic review of the evidence base. Obesity Science and Practice, 7(5), 606-618. https://doi.org/10.1002/osp4.504

• Journal Article Type: Article
• Acceptance Date: Mar 7, 2021
• Online Publication Date: Mar 16, 2021
• Publication Date: 2021-10
• Deposit Date: Mar 15, 2021
• Publicly Available Date: Mar 16, 2021
• Journal: Obesity Science and Practice
• Electronic ISSN: 2055-2238
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 7
• Issue: 5
• Pages: 606-618
• DOI: https://doi.org/10.1002/osp4.504
• Public URL: https://nottingham-repository.worktribe.com/output/5396427
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1002/osp4.504