Nutrition and lifestyle intervention in type 2 diabetes: pilot study in the Netherlands showing improved glucose control and reduction in glucose lowering medication

Gerda K Pot; Marieke Ce Battjes-Fries; Olga N Patijn; Hanno Pijl; Renger F Witkamp; Marianne de Visser; Nynke van der Zijl; Maaike de Vries; Peter J Voshol

doi:10.1136/bmjnph-2018-000012

Nutrition and lifestyle intervention in type 2 diabetes: pilot study in the Netherlands showing improved glucose control and reduction in glucose lowering medication

BMJ Nutr Prev Health. 2019 May 14;2(1):43-50. doi: 10.1136/bmjnph-2018-000012. eCollection 2019.

Authors

Gerda K Pot^{1

2}, Marieke Ce Battjes-Fries¹, Olga N Patijn¹, Hanno Pijl³, Renger F Witkamp⁴, Marianne de Visser⁵, Nynke van der Zijl⁶, Maaike de Vries⁷, Peter J Voshol¹

Affiliations

¹ Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands.
² King's College London, Division of Diabetes and Nutritional Sciences, London, UK.
³ Division of Internal Medicine, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
⁴ Division of Human Nutrition and Health, Wageningen Universiteit, Wageningen, The Netherlands.
⁵ Department of Neurology, AMC, Amsterdam, The Netherlands.
⁶ General Practitioner, Medical Centre te Cleeff, Haarlem, The Netherlands.
⁷ Springh, Den Haag, The Netherlands.

Abstract

Introduction: Prevalence of type 2 diabetes (T2D) is increasing rapidly and lifestyle interventions to reverse diabetes are seen as a possible solution to stop this trend. New practice-based evidence is needed to gain more insight in the actual, and above all scientific, basis for these claims.

Methods: This observational study with a pretest post-test design aimed to pilot a 6-month multicomponent outpatient group-based nutrition and lifestyle intervention programme on glycaemic control and use of glucose lowering medication in motivated T2D patients with a body mass index (BMI) >25 kg/m² in the Netherlands (February 2015-March 2016).

Results: 74 T2D patients (56% female) aged 57.4±8.0 years with mean BMI 31.2±4.2 kg/m² and mean waist circumference 105.4±10.2 cm were included in the study. Compared with baseline, mean HbA1c levels at 6 months were 5 mmol/mol lower (SD=10, p<0.001) and the number of participants with HbA1c levels ≤53 mmol/mol after intervention had increased (from 36% (n=26/72) to 60% (n=43/72)). At baseline, 90% of participants were taking at least one type of glucose lowering medication. At 6 months, 49% (n=35/72) of the participants had reduced their medication or eliminated it completely (13%). Secondary outcomes were significantly lower fasting glucose levels (- 1.2±2.6 mmol/L), body weight (-4.9±5.1 kg), BMI (-1.70±1.69 kg/m²) and waist circumference (-9.4±5.0 cm). Plasma lipids remained unchanged except for a decrease in triglyceride levels. Furthermore, self-reported quality of life was significantly higher while experienced fatigue and sleep problems were significantly lower.

Conclusion: This pilot study showed that a 6-month multicomponent group-based program in a routine care setting could improve glycaemic control and reduce the use of glucose lowering medication in motivated T2D diabetics. A fully scaled study is needed to confirm these results.

Keywords: lifestyle intervention; multidisciplinary; nutrition; proof of practice; reversing; type 2 diabetes.