"Reversing" Prediabetes May be Possible with Intensive Lifestyle Changes

By Chris Cardillo

At the ADA Postgraduate 2021 virtual conference, Dr. Samuel Dagogo-Jack discussed how intensive lifestyle changes can lead to prediabetes remission and prevent progression to type 2 diabetes.

Earlier this month our team attended the American Diabetes Association’s 2021 Advanced Postgraduate Course virtual conference, where prominent healthcare professionals, researchers, and diabetes-related organizations presented on a host of topics, including a fascinating talk on prediabetes “reversal” and how lifestyle changes may prevent type 2 diabetes.

Can prediabetes be reversed?

Dr. Samuel Dagogo-Jack of the University of Tennessee Health Science Center shared data from a recent trial showing that intensive lifestyle changes supported prediabetes remission and lowered a person’s risk for developing type 2 diabetes. The study included 158 African-American and European-American participants with prediabetes, who had a parental history of type 2 diabetes. The program included six intensive lifestyle modifications over the course of five years:

• Calorie restriction: participants ate 1,200-1,500 calories per day.

• Three hours of physical activity per week. Most participants chose brisk walking as their physical activity.

• A personal weight loss goal of 10% or more.

• Increased face-to-face visits with a healthcare professional: monthly sessions for the first six months, followed by quarterly visits for the rest of the time.

• Meal replacement: two shakes and two protein bars for two meals per day for participants who had not met their weight goals 6-12 months after the start of the study.

• Increased self-monitoring through logging of daily calorie intake and physical activity.

These lifestyle interventions were linked to positive results: only 6.5% of participants were diagnosed with type 2 diabetes over ten years, and 43.5% of the people in the study achieved prediabetes remission within ten years. Prediabetes remission was defined as “restoration of normal glucose regulation,” or a fasting glucose below 100 mg/dl and two-hour post-meal glucose below 140 mg/dl.

Based on this data, Dr. Dagogo-Jack argued that type 2 diabetes prevention and prediabetes “reversal” are achievable with lifestyle modification, and both should be primary goals in diabetes care. Though not everyone may be able to commit to such intensive lifestyle changes, these results are significant. Each person’s diabetes journey is different; making small steps toward achievable goals is a great place to start.