Lifestyle medicine for type 2 diabetes: practice-based evidence for long-term efficacy of a multicomponent lifestyle intervention (Reverse Diabetes2 Now)

Abstract

Introduction: A wealth of evidence supports short-term efficacy of lifestyle interventions in type 2 diabetes (T2D). However, little is known about long-term effects of lifestyle interventions in real-life settings.

Methods: This observational, single-arm study evaluated long-term impact of 'Voeding Leeft: Reverse-Diabetes2-Now', a 6-month multicomponent lifestyle programme, on glycaemic control and glucose-lowering medication (GLmed) use, other T2D parameters and quality of life in 438 T2D participants at 6, 12, 18 and 24 months using paired sample t-tests, χ² and generalised linear models.

Results: At 24 months, 234 participants provided information on GLmed and HbA1c ('responders'). 67% of the responders used less GLmed, and 28% ceased all GLmed. Notably, 71% of insulin users at baseline (n=47 of 66 insulin users) were off insulin at 24 months. Mean HbA1c levels were similar at 24 months compared with baseline (55.6±12.8 vs. 56.3±10.5 mmol/mol, p=0.43), but more responders had HbA1c levels ≤53 mmol/mol at 24 months (53% vs 45% at baseline). Furthermore, triglyceride levels (-0.34±1.02 mmol/L, p=0.004), body weight (-7.0±6.8 kg, p<0.001), waist circumference (-7.9±8.2 cm, p<0.001), body mass index (-2.4±2.3 kg/m², p<0.001) and total cholesterol/high-density lipoprotein (HDL) ratio (-0.22±1.24, p=0.044) were lower, while HDL (+0.17 ± 0.53 mmol/L, p<0.001) and low-density lipoprotein-cholesterol levels (+0.18 ± 1.06 mmol/L, p=0.040) were slightly higher. No differences were observed in fasting glucose or total cholesterol levels. Quality of life and self-reported health significantly improved.

Conclusion: This study indicates robust, durable real-life benefits of this lifestyle group programme after up to 24 months of follow-up, particularly in terms of medication use, body weight and quality of life in T2D patients.

Keywords: diabetes mellitus; nutritional treatment.

Figure 1

Percentage of responders in various GLmed categories at baseline and at 24 months (n=234). SU, sulfonylurea.

Figure 2

Mean HbA1c levels (in mmol/mol) over time atbaseline, 6, 12, 18 and 24 months. The number of participants differs per timepoint, as these are the participants who provided data on HbA1c at both baseline and follow-up.