A Scoping Review of Trials Designed to Achieve Remission of Type 2 Diabetes with Lifestyle Intervention Alone: Implications for Sub-Saharan Africa

M Grace Duhuze Karera; Annemarie Wentzel; M C Sage Ishimwe; Jean de Dieu Gatete; Ram Jagannathan; Margrethe F Horlyck-Romanovsky; Anne E Sumner

doi:10.2147/DMSO.S403054

A Scoping Review of Trials Designed to Achieve Remission of Type 2 Diabetes with Lifestyle Intervention Alone: Implications for Sub-Saharan Africa

Diabetes Metab Syndr Obes. 2023 Mar 9:16:677-692. doi: 10.2147/DMSO.S403054. eCollection 2023.

Authors

M Grace Duhuze Karera^{1

2}, Annemarie Wentzel^{3

4}, M C Sage Ishimwe², Jean de Dieu Gatete¹, Ram Jagannathan⁵, Margrethe F Horlyck-Romanovsky^{1

6}, Anne E Sumner^{1

7}

Affiliations

¹ Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
² Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda.
³ Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa.
⁴ South African Medical Research Council, Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
⁵ Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁶ Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, New York, NY, USA.
⁷ National Institute of Minority Health and Health Disparities, NIH, Bethesda, MD, USA.

Abstract

According to the International Diabetes Federation, sub-Saharan Africa is experiencing the highest anticipate increase in the prevalence of type 2 diabetes (T2D) in the world and has the highest percent of people living with T2D who are undiagnosed. Therefore, diagnosis and treatment need prioritization. However, pharmacological hypoglycemics are often unavailable and bariatric surgery is not an option. Therefore, the ability to induce T2D remission through lifestyle intervention alone (LSI-alone) needs assessment. This scoping review evaluated trials designed to induce T2D remission by LSI-alone. PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed to induce T2D remission through LSI-alone. Of the 928 identified, 63 duplicates were removed. With abstract review, 727 irrelevant articles were excluded. After full-text review, 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. These trials were published between 1984 and 2021 and were conducted in 10 countries, none of which were in Africa. Remission rates varied across trials. Predictors of remission were 10% weight loss and higher BMI, lower A1C and shorter T2D duration at enrollment. However, LSI-alone regimens for newly diagnosed and established T2D were very different. In newly diagnosed T2D, LSI-alone were relatively low-cost and focused on exercise and dietary counseling with or without calorie restriction (~1500 kcal/d). Presumably due to differences in cost, LSI-alone trials in newly diagnosed T2D had higher enrollments and longer duration. For established T2D trials, the focus was on arduous phased dietary interventions; phase 1: low-calorie meal replacement (<1000 kcal/day); phase 2: food re-introduction; phase 3: weight maintenance. In short, LSI-alone can induce remission in both newly diagnosed and established T2D. To demonstrate efficacy in Africa, initial trials could focus on newly diagnosed T2D. Insight gained could provide proof of concept and a foundation in Africa on which successful studies of LSI-alone in established T2D could be built.

Keywords: bariatric surgery; hypoglycemics; low-income countries; non-communicable diseases.

Publication types

Review

Grants and funding

P30 DK111022/DK/NIDDK NIH HHS/United States