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How Lifestyle Medicine can prevent and reverse type 2 diabetes



World Diabetes Day, held annually on November 14, was created in response to growing concerns about the escalating health threat posed by diabetes. Today, diabetes is a leading cause of heart disease, stroke, blindness, kidney failure and lower limb amputation.

But by adopting healthy lifestyles, including consuming a nutritious diet and exercising regularly, we can prevent 80% of cases of type 2 diabetes.

ASLM President, Dr Sam Manger, says “Lifestyle interventions are one of the most effective options for diabetes treatment and reversal we have. The DiRECT trial1 showed that on average, 46% of those put on a low calorie diet could reverse their diabetes in just 8 weeks. And even more impressive was that diabetes reversal was achieved in 86% of the patients who lost more than 15kg. This is huge, and something that most health professionals can initiate with the proper training.

But it is not just about our nutrition. Movement re-sensitizes the body to insulin (hence reversing the pathological mechanism of diabetes insulin resistance in the liver and skeletal muscle), uses stored glycogen and triglycerides, improves diabetic HbA1c control by on average 0.75% (which is more than many common medications) and improves your mood, emotional health and motivation levels2,3.

But it doesn’t stop there! Stress management and sleep improvement can also play key roles. In a meta-analysis4 of 12 trials of patients with type 2 diabetes randomly assigned to psychological intervention or usual care, mean A1C was lower in the intervention group by 0.76%. Also, obstructive sleep apnoea worsens DM control and may contribute to DM-related complications, for example, high risk diabetic retinopathy5.

Hence, as always, we need a whole patient and whole society lifestyle-based approach to managing the epidemic of diabetes. It’s the best medicine we have.”

  1. Lean MEJ et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label cluster-randomised trial. The Lancet [Internet]. 2017 [cited 2018 Nov 13]; 391(10120): 541-551. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext. DOI: https://doi.org/10.1016/S0140-6736(17)33102-1
  2. Madden KM. Evidence for the benefit of exercise therapy in patients with type 2 diabetes. Diabetes Metab Syndr Obes [Internet]. 2013 [cited 2018 Nov 13]; 6: 233-239. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704296/. DOI: 10.2147/DMSO.S32951
  3. Standford KI, Goodyear LJ. Exercise and type 2 diabetes: molecular mechanisms regulating glucose uptake in skeletal muscle. Adv Physiol Educ. [Internet]. 2014 [cited 2018 Nov 13]; 38(4): 308-314. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315445/. DOI: 10.1152/advan.00080.2014
  4. Schmidt CB, van Loon BJP, Vergouwen ACM, Snoek FJ, Honig A. Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes-distress. Diabet Med [Internet]. 2018 [cited 2018 Nov 13]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29896760. DOI: 10.1111/dme.13709
  5. Doumit J, Prasad B. Sleep Apnea in Type 2 Diabetes. Diabetes Spectrum [Internet]. 2016 [cited 2018 Nov 13]; 26(1): 14-19. Available from: http://spectrum.diabetesjournals.org/content/29/1/14. DOI: https://doi.org/10.2337/diaspect.29.1.14

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