Episode 33 – Exploring Non-traditional Approaches to Type 2 Diabetes Management Part 2

Key Topics Covered

Very Low Calorie Diets

The DiRECT Trial – 2017

  • 149 people in the intervention group – The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825–853 kcal/day formula diet for 3–5 months), stepped food reintroduction (2–8 weeks), and structured support for long-term weight loss maintenance. This would be EXTREMELY difficult.
  • Remission was achieved in 46% of participants in the intervention compared to control which only had 4%.
  • Remission varied with weight loss. 76 participants who gained weight did not achieve remission, however, the following did:
    • 7% who maintained 0–5 kg weight loss
    • 34% 5–10 kg loss
    • 57% with 10–15 kg loss
    • 86% of participants who lost 15 kg or more

2019 Follow-up (2 years later)

  • 24% of the intervention group were still >10kg down from their starting weight and 64% of those people were in remission.  
  • This doesn’t sound great until you compare it to other statistics such as 1) weight regain stats on average 2) diabetes remission rates.
  • Another interesting thing this group measured is pancreas size and fat content. The pancreas is typically smaller in those with T2DM and contains more fat, than those without T2DM. At the 2 year follow-up – this group identified an increase in pancreas size and decrease in fat content.

2020 Study on Insulin Dependent Patients

  • The same concept as the Direct trial except with insulin-dependent T2DM and it had similarly good results – lower remission rates, but a dramatic reduction in medication and insulin requirements.

Bariatric surgery is still the most successful and sustainable intervention for T2DM remission.

Downsides to the approach

  • The feasibility of completing this restrictive protocol for 2 months.
  • The need for continual support from a medical team to adjust medications + what happens if medications are adjusted but the diet isn’t followed.
  • Mental burden/ feeling of failure if remission was not achieved.

Low Carb Diets

  • A more common approach that involves the management of Type 2 diabetes.
  • Addresses the glucose circulating in the blood, while the individual is on the diet. Less CHO means, less glucose and less insulin required.
  • CSIRO study – Individuals consumed <50g CHO per day, then increased to <70g CHO per day. It actually had similar adherence to their control group which was higher carb and lower fat.
  • Ketogenic diets have shown great results when adhered to. Typically only small-scale studies. But they dramatically reduce the need for medication. Adherence is the key though since statistically speaking, the adherence rates are usually very low.  

Plant Based Diets

  • A 2009 study compared a low-fat vegan diet to conventional diabetes management – average weight loss was 4.4kg compared to 3kg in control.
  • Though the weight loss was not significant, the vegan diet did improve HbA1c more than the control.
  • The vegan diet is a relatively high-carb diet and still provided better results than what most people see with diabetes. Highlighting that focusing purely on CHO intake is missing the bigger picture.

Broad Approach 

  • Exercise – Building muscle and decreasing excess body fat. Exercise also burns glucose, 10/30 min of walking is equivalent to metformin.
  • Calorie deficit until as lean as desired
  • Keeping protein high – Muscle is associated with insulin sensitivity and managing appetite.
  • Fibre high – Low GI, slowing down the absorption of CHO and how quickly they convert to glucose in the blood.
  • Avoid going overly high in carbs, particularly high GI carbs 

Relevant Links/ Resources

Studies Mentioned

Relevant Blog Posts