New expert consensus statement published on achieving remission of type 2 diabetes using diet as a primary intervention

The American College of Lifestyle Medicine has released an expert consensus statement to assist clinicians in achieving remission of type 2 diabetes in adults using diet as a primary intervention. The expert consensus statement is endorsed by the American Association of Clinical Endocrinology (AACE), supported by the Academy of Nutrition and Dietetics (AND) and cosponsored by the Endocrine Society.

This unique publication in the American Journal of Lifestyle Medicine is the first to focus on diet as primary means of achieving lasting remission of diabetes—without medications or procedures—in contrast with the usual role of diet as an adjunctive therapy. Knowing that diet alone can achieve remission is an empowering message for many adults with type 2 diabetes, especially when supported by consensus among internists, cardiologists, family physicians, endocrinologists, nutritionists, dieticians and lifestyle medicine specialists.

Titled "Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission," the expert consensus statement was written by a multidisciplinary panel of 15 experts using a trustworthy, modified Delphi process. The panel agreed that diet as a primary intervention can achieve remission in many adults with type 2 diabetes, defined as normal glycemic measures (normal HbA1c <6.5% and normal fasting glucose) for at least three months without surgery, devices, or active pharmacologic therapy to lower glucose. Diet as a primary intervention was considered most effective when emphasizing whole, plant-based foods including whole grains, vegetable, legumes, fruits, nuts and seeds.

"Remission is the optimal outcome for individuals with type 2 diabetes," said Richard Rosenfeld, MD, MPH, MBA, DipABLM, lead author of the expert consensus statement and Senior Liaison for Medical Society Relations at ACLM. "The consensus statements will not only empower clinicians and patients to use a plant-predominant diet as 'food as medicine' for achieving remission of type 2 diabetes, but will facilitate shared management decisions based on current best evidence and structured expert consensus."

It is essential to reduce the prevalence of type 2 diabetes, which is estimated to affect 10.5% of U.S. adults and cost $327 billion annually in direct costs and decreased productivity, according to the publication. Without adequate treatment and management, the condition can result in blindness, kidney disease, cardiovascular diseases, amputation and other co-morbidities that diminish quality of life and contribute to mortality rates.

"A healthy diet is a foundational component of current lifestyle guidelines for treatment of type 2 diabetes, but it is often overlooked because of the lack of physician training and patient awareness," AACE President Dr. Felice Caldarella said. "The consensus statements produced by this panel of experts are invaluable in bringing awareness to the value of diet for diabetes remission in addition to management."

In all, the expert panel achieved consensus on 69 statements, relating to diet and remission of type 2 diabetes, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, payment and policy. The expert panel called for more research into areas that include evaluating the impact of reducing animal foods in promoting remission and assessing whether remission can be obtained with ad libitum food intake consuming whole food, plant-based dietary patterns. Also needed are more randomized controlled trials to assess sustainable plant-based dietary interventions with whole or minimally processed foods, as a primary means of treating type 2 diabetes with the goal of remission.