Diabetes remission after a lifestyle-medicine intervention on type 2 diabetes in lean and obese Chinese subjects: a prospective study

Background: Whether diabetes remission still happened among non-obese type 2 diabetes (T2DM) patients with a body mass index (BMI) <25 kg/m2 following lifestyle-medicine interventions was quite necessary to be reported because many diabetes happened with normal or low BMI in China.

Methods: The criteria for subject inclusion: <20 years after T2DM diagnosis, ≥6 months treatment with oral anti-diabetic drugs, without serious complications, and no history of insulin use. They were divided into two groups: the obesity group (BMI ≥25 kg/m2) and the lean group (BMI <25 kg/m2). All subjects received the following lifestyle-medicine interventions: stopping oral anti-diabetic therapy, initiating a low-carbohydrate (contributing by 35-40% to calorie intake) diet for the first month (gradual transition to a normal diet for the next 5 months), participating in resistance and aerobic exercise, and receiving strengthen management. Diabetes remission was defined as glycosylated hemoglobin (A1C) level <6.5% (<48 mmol/mol) after 6 months of not taking any anti-diabetic medications during the lifestyle-medicine intervention. Finally, 125 individuals completed the lifestyle-medicine intervention in the prospective study. The efficacy and safety of lifestyle-medicine intervention were assessed and compared between lean and obese Chinese subjects with T2DM.

Results: We found that 64.52% of the T2DM subjects in the obese group and 60.64% of T2DM subjects in the lean group achieved diabetes remission [i.e., an A1C level <6.5% (48 mmol/mol)] without any anti-diabetic medications after the 6-month lifestyle-medicine intervention. Our multiple linear regression analysis showed that decreases in the fasting plasma glucose (FPG) level had the most powerful effect on decreases in the A1C level after the intervention (R2=0.3072).

Conclusions: Lifestyle-medicine interventions may have increased effectiveness in controlling mild T2DM as compared with the oral antidiabetic-based treatment; unexpectedly, there seems no further improvement in lean relative to obese patients. Three in five subjects could achieve diabetes remission though the lifestyle-medicine intervention regardless of whether their BMI was below or above 25 kg/m2.