During a recent PW Podcast episode, Richard Rosenfeld, MD, MPH, MBA, DipABLM, senior liaison of medical society relations for the American College of Life-style Medicine, talked about his study on diet as a primary intervention for adults with T2D. The following includes highlights from that interview.
What makes diet as a primary intervention for T2D important to study?
The need is the incredibly increasing prevalence of diabetes in US adults. It’s currently about one in seven people, which is up from one in 10 20 years ago, have the condition. Of these, about 25% don’t even know they have it. Where-as optimal nutrition has always been part of diabetes management, often called medical nutrition therapy, it’s usually secondary to other things like medications, bariatric surgery, or weight loss. But we’re putting it out here for the first time as a primary way to achieve remission.
Our study was prompted by a position statement published by the American College of Lifestyle Medicine (ACLM) based on a literature review of nine key studies about lifestyle interventions, most of which had a very low-calorie diet and some physical activity. The studies showed that you re- ally could achieve remission of T2D, both partial and sometimes complete, using diet as an intervention. The position of the ACLM at the time recommended a whole food, plant-based diet. The problem was this was just the opinion of a couple of people reviewing the literature.
We wanted to take it to the next level, by seeing if we could get consensus from a diverse group using a structured process that’s been validated in other ways. We also wanted to know how to define remission.
What findings from your study are important to stress to our physician readers?
One of the most important consensus statements was that diet as a primary intervention, the main management tool, can achieve remission in many adults with T2D. That’s a very novel and probably the most important finding on which this group can agree. We defined remission of T2D as normal glycemic measures. The A1C and fasting glucose had to be normal for 3 months with no surgical devices or active pharmacologic therapy. We later agreed to be consistent with the new ADA definition on diabetes care in 2021, which sets the A1C at 6.5 as opposed to the normal level.
How would you like to see physicians incorporate your findings into their practice?
Our goal here was to reach consensus, not to make recommendations. But I think based on the consensus, the bottom line is there’s a remarkably empowering message here for patients and physicians that you can achieve remission of diabetes just with diet. That’s incredibly empowering for patients.