Tramsforming Diabetes Care With Lifestyle Medicine

Learning Objectives

1.Diabetes remission as the goal of T2D treatment 

2.Introduction to Lifestyle Medicine 

3.To understand the physiology of insulin sensitivity and insulin resistance 

4.Plant based diet and its role in reversing insulin resistance and remission of diabetes 

5.Implementation of Lifestyle Medicine in a public primary healthcare 

Abstract

The world is facing a diabetes tsunami. According to the International Diabetes Foundation, worldwide 589 million people have diabetes and it is expected that by 2050 this is expected to increase to 853 million. Alarmingly 1 in 2 adults with diabetes are undiagnosed.  Diabetes is a chronic inflammatory disease and the most common type of diabetes is Type 2 Diabetes (T2DM)which is characterized by progressive decline in beta-cell function associated with insulin resistance in muscle and adipose tissue. Diet that is high in simple carbohydrates, sugar, saturated fats and animal protein with very low intake of fruits, vegetables plant protein and fiber increase inflammation, oxidative stress, ectopic fats leading to lipotoxicity and gut dysbiosis. This in turn leads to insulin resistance and T2DM. Traditionally the goal of  treatment of T2DM has been regulating blood glucose and preventing the development of complications. However this narrative changed with Buchwald’s publication on post bariatric surgery patients where it was found that it was possible for T2DM to completely resolve in obese patients. This lead to the development of the new guidelines in the management of T2DM that included remission as a primary goal of treatment for T2DM. Research indicates that remission is possible without surgical or pharmacological  intervention. The best known evidence indicates that a sufficient energy deficit is necessary until an adequate reduction in intracellular hepatic and pancreatic fat occurs and this can induce insulin sensitivity and subsequently lead to remission. Intensive lifestyle modification that include a predominantly whole food plant based diet and physical activity amongst others is able to achieve a sufficient energy deficit and adequately reduce intracellular hepatic and pancreatic fat. Intensive lifestyle modification as an intervention in patients with T2DM has shown significant clinical improvements in these patients. In order to change the trajectory of the T2DM pandemic that is plaquing the world it is imperative to embed lifestyle medicine in primary public healthcare. The successful WHOMinistry Of Health Malaysia Lifestyle Medicine For Remission Of Diabetes pilot project to incorporate Lifestyle Medicine into primary public healthcare is a model that can be replicated and upscaled in our quest to stem the diabetes tsunami.