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. 2022 May 18;16(3):342-362.
doi: 10.1177/15598276221087624. eCollection 2022 May-Jun.

Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Richard M Rosenfeld  1 , John H Kelly  2 , Monica Agarwal  3 , Karen Aspry  4 , Ted Barnett  5 , Brenda C Davis  6 , Denise Fields  7 , Trudy Gaillard  8 , Mahima Gulati  9 , George E Guthrie  10 , Denee J Moore  11 , Gunadhar Panigrahi  12 , Amy Rothberg  13 , Deepa V Sannidhi  14 , Lorraine Weatherspoon  15 , Kaitlyn Pauly  6 , Micaela C Karlsen  6
Affiliations

Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Richard M Rosenfeld et al. Am J Lifestyle Med. .

Abstract

Objective: The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used.

Methods: Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers.

Results: The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section.

Conclusion: Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.

Keywords: Delphi method; Dietary intervention; Expert consensus; Plant-based diet; Remission; Type 2 diabetes.

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Conflict of interest statement

Richard M. Rosenfeld, MD, MPH, MBA (chair/methodologist, ACLM member): 100% plant-based food, 95% whole or minimally processed; Chair, Committee on Plant-based Health and Nutrition, SUNY Downstate Health Sciences University; Sr. Liaison for Medical Society Relations at ACLM; Chief Medical Officer for American Board of Lifestyle MedicineJohn H. Kelly, MD, MPH (assistant-chair, ACLM Founding President, ACLM member): 99% plant-based food, 70% whole or minimally processed; consultant for the CHIP lifestyle program and one of the expert presenters in the programMonica Agarwal, MD, MEHP, FACE (representative, American Association of Clinical Endocrinology): 95% plant-based food, 75% whole or minimally processed; no other disclosuresKaren Aspry, MD, MS, FACC (representative, American College of Cardiology): 80% plant-based food, 90% whole or minimally processed; Associate Director, local Ornish Cardiac Rehabilitation Program; Board Member, National Lipid Association. Ted Barnett, MD, FACLM (ACLM Physicians, ACLM member): 100% plant-based food, 90% whole or minimally processed; owner of Rochester Lifestyle Medicine Group; President of Rochester Lifestyle Medicine Institute; Co-coordinator of Rochester Area Vegan Society; Member of ACLM Board of Directors Brenda C. Davis, RD (ACLM Dietitians, ACLM member): 100% plant-based food, 90% whole or minimally processed food; receives author royalties from Book Publishing Company; HCI Books Denise Fields, PharmD, BC-ADM, FASHP (ACLM Pharmacists, ACLM member): 100% plant-based food, 80% whole or minimally processed; no other disclosures Trudy Gaillard, PhD, RN, CDCES, FAHA (Representative of American Heart Association): 85% plant-based food, 15% whole or minimally processed; no other disclosures Mahima Gulati, MD, MSc (ACLM Endocrinologists, ACLM member): 100% plant-based food, 85% whole or minimally processed; no other disclosures George E. Guthrie, MD, MPH, CDE, CNS, FAAFP, FACLM (ACLM Past President, ACLM member): 94% plant-based food, 50% whole or minimally processed; no other disclosuresDenee J. Moore, MD (representative, American Academy of Family Physicians): 50% plant-based food, 90% whole or minimally processed; no other disclosures Gunadhar Panigrahi, MD, FACC (ACLM Physicians, ACLM member): 90% plant-based food, 95% whole or minimally processed; no other disclosures Amy Rothberg, MD, PhD (representative, Endocrine Society): 80% plant-based food, 80% whole or minimally processed; REWIND, INC. virtual platform created for weight control with the goal to “defeat” T2D—I provide consultancy, Nestle-provides product, for an R01/NIDDK grant Deepa V. Sannidhi, MD (ACLM Research Committee, ACLM member): 90% plant-based food, 70% whole or minimally processed; runs a shared medical appointment program for UC San Diego Health focused on the use of lifestyle for the prevention of obesity; advisory board member for Vavici, which provides a platform for physicians to offer wellness services including group visits to their patients via a membership model Lorraine Weatherspoon, PhD, RDN (representative, Academy of Nutrition and Dietetics): 60% plant-based food, 90% whole or minimally processed; no other disclosuresKaitlyn Pauly, MS, RDN (co-staff liaison, ACLM member): 98% plant-based food, 95% whole or minimally processed food; no other disclosures Micaela C. Karlsen, PhD, MSPH (primary staff liaison, ACLM member): 99% plant-based food, 80% whole or minimally processed food; Sr. Director of Research at ACLM; receives book royalties from Forks Over Knives: The Plant-Based Way to Health.

References

    1. Prevention. National Diabetes Statistics Report. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020:12-15.
    1. Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018;6(1):69-80. - PubMed
    1. Wang L, Li X, Wang Z, et al.. Trends in prevalence of diabetes and control of risk factors in diabetes among US adults, 1999-2018. JAMA. 2021;326(8):1-13. - PMC - PubMed
    1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). What is Diabetes?
    1. Association AD. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S15-S33. - PubMed

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