Exclusion criteria were a diagnosis of type 1 diabetes, use of an insulin pump, serious comorbidities, for example, a severe form of chronic obstructive pulmonary disease (COPD) (Gold III or IV), bariatric surgery, eating disorders, heart failure (class 2–4), or kidney failure (estimatedglomerular filtration rate (eGFR)/modification of diet in renal disease (MDRD), eGFR/MDRD <45 unit). Inclusion criteria were diagnosis of T2D mellitus, age 18–75 years, body mass index (BMI) 25–41 kg/m 2, ability to speak Dutch fluently and motivation to take part in a lifestyle intervention programme. Patients were included using a stepped-wedge design with approximately 20 patients per group starting each month per location (a so-called convenience sample). Informed consent was provided by both the patient and their general practitioner (GP). Patients who completed the ‘Reverse Diabetes2’ programme (see below) between February 2015 and March 2016 were enrolled in this observational study. 29 The study hypothesis was that T2D patients would significantly reduce their Hb1Ac levels and use of glucose lowering medication in response to the 6-month multicomponent multidisciplinary programme. In addition, the programme uses a dynamic ‘proof of practice’ approach 28 and therefore is continuously updated as insights on T2D develop over time. This includes providing skills rather than just knowledge of nutrition and lifestyle, in its individual approach using biometric feedback, and its use of a group-based approach. The novelty of this programme lies in its multicomponent character. This programme is called ‘Reverse Diabetes2’ ( In Dutch ‘Keer Diabetes2 Om’) and has been developed by the Foundation Nutrition Alive ( In Dutch ‘Voeding Leeft’). The objective of this study was therefore to pilot a newly developed 6-month multicomponent programme providing intensive counselling on nutrition and lifestyle, a digital coaching and education platform, physician-guided medication management and cooking classes. Indeed, studies in primary care settings that show the efficacy of lifestyle interventions are relatively scarce. 24–26Ĭommon arguments against lifestyle management as part of standard clinical practice includes that a lack of patient motivation hampers the sustainability of any potential results, that it would be impractical, and that effectiveness in primary care is not supported by evidence. The studies that have been performed showed long-term improvements. General lifestyle intervention studies, including nutrition, physical activity and stress reduction, in T2D are even rarer. 9 18 21–23 Moreover, none of these studies assessed T2D medication use as a primary outcome. 11–14 A major limitation of the latter two options is that they are based on data from studies with a number of shortcomings, for example, being relatively short in duration, 12 15 performed in relatively small populations, 10–13 not leading to long-term changes or reversal of T2D, 16–20 and/or that long term adherence to these strategies is relatively low. Interventions to reverse T2D so far were based on (1) bariatric surgery, 7 8 (2) very low-calorie diets 9 10 or (3) nutritional ketosis. Sustained remission of T2D comes with improved physical health and well-being of the patient, fewer comorbidities and a considerable reduction in medical costs. 6 The latter could also be called drug-free remission of T2D.
5 T2D is potentially reversible, as reflected by normalised Hb1Ac levels and a reduction and/or elimination of T2D medication. 3 4 Therefore, it would be logical to give nutrition and lifestyle a prominent place in T2D prevention and treatment. 2 Among lifestyle factors, metabolically unhealthy eating habits play a key role in the aetiology and progression of T2D.
1 It is probable that lifestyle-related factors are the dominant cause, together with the ageing of the population and a genetic predisposition. The prevalence of type 2 diabetes (T2D) has seen an exponential rise during the last decades.
0 kommentar(er)
