Efficacy of a patient-tailored weight-loss dietary intervention for type 2 diabetes remission

Background and aims: Remission of recently-onset type 2 diabetes (T2D) can be achieved with a sharp 10% body weight reduction. Traditional weight-loss strategies, however, are unfeasible and ineffective for most patients. Therefore, we tested the efficacy of a patient-tailored dietary intervention on weight loss and diabetes remission in patients with recently-onset T2D. Materials and methods: Patients with T2D treated with metformin or diet-only, short diabetes duration (<6 years), and obesity (BMI>30 kg/m2) were prescribed a personalized dietary intervention designed to achieve a 10% weight loss in 12-16 weeks, based on a careful assessment of the individual’s drivers of obesity and personal preferences. Glucose-lowering therapy was withdrawn at the beginning of the diet. Body weight was evaluated every 4 weeks, exploring the reasons in case of inadequate weight loss and adapting nutritional prescriptions. According to the latest consensus, diabetes remission was defined as a glycated hemoglobin (HbA1c) <48 mmol/mol after at least 3 months without therapy. Results: A total of 10 subjects completed the intervention (age 60±8 years, 50% women, BMI 34.8±4.8 kg/m2, HbA1c 47±6 mmol/mol). Dietary prescriptions included balanced energy restrictions (n=2), carbohydrate restrictions (n=4), and time restricted eating schedules (n=4), requiring little adjustments over time to achieve the target monthly weight loss. At 12-16 weeks, the individualized dietary intervention induced a marked body weight reduction in all participants (weight change -9.8±1.8%, range -6.2 to -11.8%; BMI change -3.3±0.7 kg/m2), with 7 subjects (70%) achieving the 10% target weight loss. Diabetes remission was obtained by 7 subjects (70%), while the remaining 3 subjects had HbA1c levels close to diagnostic criteria without therapy (48 to 51 mmol/mol). Body weight loss was similar between the two groups with or without diabetes remission (-10.0±1.2% vs -9.7±2.0%, p=0.76; >10% weight loss in 66.7% vs 71.4% of subjects, p>0.99). Conclusion: A patient-tailored dietary intervention has proven to be feasible and effective in achieving short-term weight loss and diabetes remission in patients with recently-onset T2D. These beneficial effects appear comparable to that of more intensive dietary strategies. Long-term assessments are ongoing.