Study shows adopting a whole-food, plant-predominant eating pattern can lead to type 2 diabetes remission

A lifestyle-based treatment intervention promoting adherence to a whole-food, plant-predominant eating pattern and integrated into routine care can successfully achieve type 2 diabetes remission, according to a research study published in the American Journal of Lifestyle Medicine.

The case series determined that a sample of 59 patients from a cardiac wellness program, who also had type 2 diabetes, achieved significant improvements in blood glucose control, and in 37% of cases, full remission of their diabetes. The patients were treated with a low-fat, whole-food, plant-predominant dietary pattern while also receiving standard medical treatment at a wellness center in Virginia. Improvements in glucose control were accompanied by significant reductions in BMI.

Previous studies have demonstrated that whole-food, plant-predominant eating patterns can improve diabetes outcomes but that research primarily involved substantial calorie restriction, often relying on liquid meal replacements, or fasting. This study, published in collaboration with the American College of Lifestyle Medicine (ACLM), is unique in its assessment of remission as a primary outcome and contributes novel information on the feasibility of achieving remission simply by eating healthy food.

"The prevalence of diabetes is growing, as is recognition in the health care community that diet as the primary intervention can achieve lasting remission in individuals with type 2 diabetes," said Gunadhar Panigrahi, MD, FACC, DipABLM, the first author of the study.

"This case series further supports the effectiveness of a whole-food, plant-predominant eating pattern as a primary intervention to achieve remission as well as the need for increased education for both clinicians and patients on the successful application of lifestyle medicine principles and dietary interventions in everyday medical practice."

Researchers reviewed electronic health records of patients treated at the wellness clinic between 2007 and 2021 to identify those who adopted a whole-food, plant-predominant eating pattern and achieved meaningful improvements in HbA1c or blood glucose control, as well as remission of type 2 diabetes. Data points were extracted from the periods immediately before the lifestyle intervention and the most recent post intervention.

The study used the 2022 consensus definition of remission published by ACLM of HbA1c less than 6.5% for at least three months without surgery, devices, or active pharmacologic therapy to lower blood glucose. That expert consensus statement was endorsed by the American Association of Clinical Endocrinology, supported by the Academy of Nutrition and Dietetics and co-sponsored by the Endocrine Society.

The mean age of the patients was 71.5 years and ranged in age from 41 to 89 years. Twenty-two of the 59 patients met the criteria for type 2 diabetes remission. The study also reported an average de-escalation of glucose-lowering medications among patients following lifestyle change. The reduction in glucose-lowering medications was consistent with that mentioned in a recent qualitative case series that provided the first published examples of protocols to help guide clinical decision making on when and how to deprescribe medications following lifestyle intervention. Medication deprescribing is a process that is supervised by a physician when a medication is no longer benefiting a patient.

The study highlighted that many patients did not first self-select into a lifestyle medicine treatment program for type 2 diabetes, but were rather educated on the merits of a whole-food, plant-predominant dietary pattern and regular physical activity as part of their routine care at the wellness center.

"There is a perception that many patients may not accept the idea of adopting a whole-food, plant predominant eating pattern, but there is a growing abundance of research that in fact shows adherence to a plant-predominant dietary pattern is feasible, and even enjoyable," said Micaela Karlsen, ACLM Senior Director of Research. "Although full remission may not be possible for every patient, our research shows that every patient deserves to know that it may be possible through the adopting of appropriately dosed therapeutic lifestyle change."

Future research should measure the proportion of patients in typical medical practices who are willing to consider lifestyle changes as part of routine treatment and examine the factors leading to successful implementation of a plant-predominant dietary intervention, the authors said.