Diet and exercise could pave the way for diabetes remission

A research team from the University of Alberta is aiming to find out whether a combination of diet and exercise could stop the progression of type 2 diabetes for some people—or even put the disease into remission.

Led by professor Norm Boulé and Ph.D. student Jordan Rees, researchers from the Faculty of Kinesiology, Sport, and Recreation are investigating the potential for diabetes remission. Their preliminary findings suggest some patients can stabilize blood sugar levels without medications, following an intensive lifestyle intervention.

"The majority of people with diabetes in Alberta have type 2 diabetes," says Boulé, who is a member of the Alberta Diabetes Institute. "Concerningly, type 2 diabetes, once primarily seen in older adults, is now being diagnosed in younger individuals. This is what is exciting about this study. Early intervention is paramount, given the more aggressive progression observed in younger patients," he adds.

Though type 2 diabetes has historically been viewed as a manageable yet progressive disease, the interplay of social, economic and environmental influences has led to its alarming surge in Alberta.

According to recent statistics, diabetes rates in Alberta have almost doubled in just a decade. As of 2022, this means that 8% of the population—or more than 403,000 Albertans—are living with either type 1 or type 2 diabetes, and 90 to 95% of those diagnosed with the disease will have type 2.

While usually associated with cancer, the term "remission" has slowly been integrated into the diabetes research lexicon. Even though diabetes is normally viewed as a progressively worsening condition, there's a growing body of evidence suggesting it might be possible to halt type 2 diabetes or even put it into remission.

One of the benchmarks in this area of research is the Diabetes Remission Clinical Trial (DiRECT) from the U.K., which saw participants undergo a 12- to 20-week, low-energy meal replacement diet.

"Astonishingly, after one year, 46% of participants were in remission, and after two years, that figure was still at 36%," Boulé says.

The DiRECT trial focused mainly on diet without incorporating a structured exercise regime.

"Such diets do lead to significant weight loss, but it's crucial to understand that not all weight loss is beneficial," says Boulé. He explains that these diets often result in the loss of muscle mass, which is undesirable, especially for older people.

"Cardiovascular health of participants on these diets didn't improve as much as expected."

Study blends diet and exercise

Boulé's ongoing research aims to enhance the benefits of the low-energy diet approach by adding an exercise component. Adding exercise into the mix can be a game-changer—and it's not just about burning calories, he emphasizes.

"Maintaining and building muscles is crucial for storing glucose, and with the aging process leading to natural muscle reduction, an exercise regimen is essential," says Boulé.

Rees adds that a major benefit to participants is the one-on-one interactions they experience, including counseling from dietitians.

"In a health care system often overwhelmed, clients have told me they appreciate the close attention to their concerns," she says.

Another bonus for clients is they are fitted with a continuous glucose monitor. "This technology, often visible as a small sensor on the arm, provides a detailed view of glucose levels throughout the day, allowing for more precise understanding of glucose changes with the diet and exercise plans," Boulé explains.

This study is particular about its participants, to ensure it reaches those who could benefit the most and produces the most reliable results, says Boulé.

"Although not every participant may achieve long-term remission, even a short-term delay in the progression of diabetes may lead to sustained health benefits."

And while this study is a great start, he believes occasional "resets" might be needed as glucose levels start to creep up over the years.

One size doesn't fit all

Boulé emphasizes some patients respond better than others to treatments, and not achieving remission doesn't equate to not putting in enough effort. "The disease has multiple facets, and different interventions may be needed for different individuals."

It's crucial to consult with health-care professionals to understand whether aiming for remission is suitable.

There are also societal factors, such as colonialism and racism, that can affect diabetes rates and care, so an approach that addresses these issues is essential, Boulé stresses.

"It's crucial not to view remission as a measure of success or failure. Instead, the focus should be on individualized care, and ensuring everyone has access to the best possible treatments and resources."

If you're 18–45 years old, recently diagnosed with type 2 diabetes and meet specific criteria, consider participating in this groundbreaking research. You can sign up at Be The Cure.

Provided by University of Alberta