(DCP066) TYPE 2 DIABETES REMISSION WITH AN INTENSIVE MULTIDISCIPLINARY INTERVENTION: THE DIABEPIC 2 PILOT STUDY

Background: The most studied strategies for type 2 diabetes (T2D) remission are bariatric surgery and continuous low-calorie diet that both induce fat mass loss.

Objective: The DIABEPIC 2 pilot study evaluated the feasibility of a 6-month T2D remission program based on a combination of a dietary re-education (low-carbohydrate Mediterranean diet, intermittent fasting (IF), withdrawal of ultraprocessed food) and an aerobic and strength training program.

METHODS AND RESULTS: From January 2022 to April 2023, 42 participants aged 18 to 80 years with T2D (Hb1Ac > 6.5% or on oral hypoglycemic agents, without insulin or sulfonylurea) were recruited from the Montreal Heart Institute's ÉPIC Center. A blood test and body composition analysis (bioimpedance) were performed at the beginning and end of the study.

Results: Feasibility was demonstrated with recruitment rate (6 patients/month) and completion rate (>70%). Six participants were excluded and two dropped out of the study. Thirteen of the 34 participants who completed the program achieved T2D remission criteria at 6 months highlighting that 38% of patients were treatment-free at the end of the intervention with an Hb1Ac < 6.5%. All individuals who achieved remission had 0 or 1 class of hypoglycemic agent at baseline, whereas 60% of those who failed to achieve remission in 6 months had 2 to 4 classes of hypoglycemic agents. Of those who did not achieve remission, 81% had sufficient improvement to reduce their medication and they will be followed up at 9 and 12 months to assess whether they achieve remission criteria. The average reduction in visceral fat was 26% in both the remission and non-remission groups, suggesting a potential for remission even in those with more advanced disease initially. Of the 13 participants who achieved remission, 9 had diabetes for 6 years or less, whereas 4 had diabetes for 10 to 25 years. Four participants showed poor adherence to the recommendations and did not improve their metabolic parameters. The main difficulty encountered was a sense of loss of control related to food intake (craving).

Conclusion: In conclusion, a strong interest in the possibility of T2D remission was observed in the population approached. Dietary re-education and a exercise training program is effective for T2D remission, but 6 months is too short to achieve remission when 2 or more hypoglycemic agents are required at baseline. When adherence is a challenge, screening for and managing cravings should be considered. Larger clinical studies are needed to confirm the results.