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The Prediabetes Nutritionist

Prompt Lifestyle Change After Prediabetes Diagnosis May Reverse It, Prevent Type 2  

Promptly making lifestyle changes by increasing physical activity and reducing calorie intake to achieve weight loss may reverse prediabetes and prevent its progression to type 2 diabetes, new data reveals. 

Notably, 43% of adults with a family history of type 2 diabetes making lifestyle changes within three months to eight years of developing prediabetes reverted to normal blood glucose levels and 93% prevented type 2 diabetes. 

“Our findings showed that the vast majority (~93%) of participants who received lifestyle intervention within 3 months to 8 years (mean ~4 years) of developing prediabetes did not progress to T2D [type 2 diabetes] during 5 years of follow-up,” the researchers wrote. 

The study, “Outcome of lifestyle intervention in relation to duration of pre-diabetes: the Pathobiology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC) study,” was published in BMJ Open Diabetes Research & Care

Prediabetes, characterised by impaired fasting glucose or impaired glucose tolerance, affects approximately 90 million adults in the United States and is linked to a higher risk of type 2 diabetes, heart disease, and other complications. 

Lifestyle interventions, including increased physical activity and dietary changes, can reduce the risk of progression from prediabetes to type 2 diabetes by up to 60%. However, most individuals starting lifestyle interventions are more likely to maintain prediabetes rather than revert to normal glucose levels. 

It is unclear if the likelihood of reversion to normal blood glucose levels is dependent on when lifestyle interventions begin. So, a team of scientists investigated whether people who begin lifestyle interventions soon after prediabetes diagnosis are more likely to revert to normal blood glucose levels than those beginning later. 

Participants of the study were recruited from the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study. POP-ABC participants were African American and European American adults with normal blood glucose with a family history of type 2 diabetes. These participants were followed every three months for five and a half years until they developed pre-diabetes. 

Participants who developed prediabetes were invited to begin lifestyle interventions in a secondary study – the Pathobiology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC). 

PROP-ABC participants received counselling sessions focused on increasing physical activity and reducing calorie intake for weight loss. Registered dietitians encouraged participants to perform moderate-intensity exercise for at least 180 mins per week, and, depending on their starting weight, limit calorie intake to 1200-1800 kcal daily. All participants received behavioural counselling sessions and were required to attend 20 face-to-face counselling sessions over five years. 

Participants medical history, height, weight, waist circumference, and fasting plasma glucose were monitored every six months. Body fat, lipid profile, insulin sensitivity, insulin secretion and body mass index were also measured. 

A total of 151 participants in the PROP-ABC study developed prediabetes. Of the cohort, 70% were women and 52.5% African American. The mean age and BMI of the cohort was 53 years and 30.6 kgm2.

Compared to participants with normal blood glucose, those with prediabetes had higher weight, BMI, waist circumference, body fat, fasting blood glucose, two-hour plasma glucose and glycated haemoglobin (HbA1c). Participants with prediabetes also had higher levels of triglycerides and insulin resistance than those with normal blood glucose. 

Participants with prediabetes started lifestyle interventions after an average of 4 years of diagnosis. A total of 70.6% of participants attended at least half of the counselling sessions over five years, with 42.5% attending all sessions. The participants exercised for a mean of 129 mins (71.7% of the target) per week and their energy intake decreased from 1549 kcal to 1485 kcal per day. However, fat intake decreased significantly from 56g per day to 47.4g per day. 

Over five years of the lifestyle intervention, participants with prediabetes significantly reduced body weight, waist circumference and abdominal fat. However, those in the control group increased these metrics. Participants in the intervention group also reduced their fasting blood glucose while those in the control group showed increases, -7.76 mg/dL vs 1.23 mg/dL. While two-hour plasma glucose and lipid profiles were reduced in both groups, the intervention group showed larger reductions. 

Interestingly, the researchers found a link between the duration of prediabetes before starting lifestyle intervention and change in fasting plasma glucose. Essentially, participants starting lifestyle interventions within five years of prediabetes diagnosis had greater improvements in blood sugar levels than those beginning after five years of diagnosis. 

“…we observed that prediabetes duration before lifestyle intervention was inversely related to beta-cell function. Furthermore, we observed greater decrease in FPG [fasting plasma glucose] and 2hPG [two-hour plasma glucose] when lifestyle intervention was initiated within 5 years of prediabetes diagnosis than after 5 years of diagnosis,” the researchers wrote. 

After five years of the lifestyle programme, 42.8% of participants reversed from prediabetes to normal blood glucose, 50% remained in the prediabetes range, and 7.2% progressed to type 2 diabetes. 

Those achieving normal blood glucose were more likely to have lower waist circumferences, two-hour plasma glucose and higher insulin sensitivity at the start of the lifestyle programme. Notably, while a greater proportion of European Americans achieved normal blood glucose than African Americans (47.6% vs. 37.3%), fewer African Americans progressed to type 2 diabetes, 9.52% vs. 5.33%, respectively. 

Since persistent prediabetes is associated with more complications and evidence suggests that reversal of prediabetes to normal blood glucose may reduce the risk of developing type 2 diabetes and its complications, the researchers suggest that health care professionals ensure that people with prediabetes work towards achieving remission with lifestyle interventions and medications

“Restoration of NGR [normal glucose regulation] ought to be a primary goal in people with prediabetes. Because current lifestyle intervention strategies restore NGR only in ~50% of individuals with prediabetes, opportunity exists for novel interventions, including combined lifestyle and pharmacological approaches,” they wrote. 

The researchers highlighted limitations; first, only 70.6% attended at least of the scheduled 20 sessions, and secondly, only 51% of participants achieved at least 100 mins of physical activity per week. 

“In conclusion, we have shown that starting lifestyle interventions within 3 months to 8 years of incident prediabetes was associated with robust prevention of progression to diabetes and reversal of prediabetes in high-risk AA [African American] and EA [European American] with parental T2D.”

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