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Remission of Prediabetes to Normal Glucose Tolerance in Obese Adults

The use of a high protein diet instead of a high carbohydrate diet to help reverse the progression to diabetes.

The prevalence of type 2 diabetes in the USA has increased dramatically in the last decade. According to the Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report of 2014, there are currently 29.1 million people with diabetes; 21 million are diagnosed and 8.1 million undiagnosed. The prevalence of subjects with impaired glucose tolerance (IGT) or prediabetes is in excess of 86 million.[1] The Diabetes Prevention Program (DPP)[2] and ACTNOW[3] studies showed that the rate of conversion for IGT to type 2 diabetes is 7–10% per year with no significant difference in ethnicity. The primary risk factor for type 2 diabetes is obesity as 90% are either overweight or obese. As body mass index (BMI) increases from 23 to >35 kg/m2, there is a 93-fold increase in type 2 diabetes. Obesity also increases the risk of heart disease, hypertension and other metabolic diseases.  Lifestyle changes, including weight loss and exercise, reduces the risk of developing diabetes by 58%, whereas therapeutic intervention reduces the risk by 32% (metformin) and 72% (pioglitazone) in prediabetes subjects. Few studies have been carried out to show some remission of prediabetes (IGT) to normal glucose tolerance with diets and weight loss.

We have poor results and little success in diagnosing those with prediabetes and then getting them to normal blood sugars, which is an important health concern that has had little success in the past. Most people with prediabetes can prevent the progression to diabetes by just changing their diet.

This study objective was to determine the effect on remission of prediabetes with a high protein (HP) versus high carbohydrate (HC) diet, and effects on metabolic parameters, and lean and fat body mass in prediabetic, obese subjects after 6 months of dietary intervention. They recruited women and men ages 20–50 years with a BMI ≥ 30 to ≤55 kg/m2 with prediabetes for a total of 24 participants. Subjects were selected on the basis of inclusion criteria of age, BMI, fasting glucose of <126 mg/dL, 2-hour glucose level of 140–199 mg/dL during a standard oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) of 5.7–6.4%.  All meals were provided to subjects for 6 months with daily food menus for HP or HC compliance, weekly food pick-up and weight measurements. At baseline and after 6 months on the respective diets, oral glucose tolerance and meal tolerance tests were performed with glucose and insulin measurements and dual energy X-ray absorptiometry scans.

From the results, it showed that after 6 months on the HP diet, 100% of the subjects had remission of their prediabetes to normal glucose tolerance, whereas only 33.3% of subjects on the HC diet had remission of their prediabetes. The HP diet group exhibited significant improvement in (1) insulin sensitivity (p=0.001), (2) cardiovascular risk factors (p=0.04), (3) inflammatory cytokines (p=0.001), (4) oxidative stress (p=0.001), and (5) increased percent lean body mass (p=0.001) compared with the HC diet at 6 months.

There are several important findings of this study, which previously have not been reported. The HP diet resulted in 100% remission of prediabetes to normal glucose tolerance while the HC diet resulted in only 33% remission. To the best of our knowledge, this is the first lifestyle intervention study where 100% remission of prediabetes was obtained. Our results show that high efficacy can be achieved with dietary modification if parameters are rigorously controlled and monitored. The HP group had greater improvement in insulin sensitivity, greater reduction in CVR factors, oxidative stress (ROS) and inflammation than the HC diet group.  The HP diet group’s percent lean body mass (LM) increased while percent body FM was decreased; whereas, the HC diet group lost both percent LM and FM.  There was no physical activity modification during the 6 months on the diets, and since all subjects were minimally physically active, we were able to study the direct effect of the HP versus HC diets. Diet meals were given to each patient weekly at our CRC along with a survey of food consumption, which resulted in a high level of compliance (>90%; ).

Practice Pearls:

  • To the best of our knowledge, this is the first lifestyle intervention study where 100% remission of prediabetes was obtained.
  • This study demonstrates that strict adherence to dietary intervention with the HP diet is possible and results in remission of prediabetes to NGT.
  • Increase in percent lean body mass and decrease in percent fat body mass with weight loss is obtained on the HP diet, but there was a decrease in percent lean body mass and percent fat body mass with weight loss on the HC diet in IGT subjects.

References:

BMJ Open Diabetes Res Care. 2016;4(1).  (CDC) CfDC. National Diabetes Statistics Report. 2014. http://wwwcdcgov/diabetes/data/statistics/2014StatisticsReport . N Engl J Med 2011;364:1104–15. . Lancet 2012;379:2243–51.