{ "question": [ "Can lifestyle changes reverse type 2 diabetes?" ], "answer": [ "Lifestyle changes, including diet modification and increased physical activity, can help prevent and manage type 2 diabetes. They can improve insulin sensitivity, control blood glucose levels, and promote weight loss, which are all beneficial in managing the disease. However, they may not completely reverse the disease, especially in advanced stages." ], "contexts": [ [ "Accumulating evidence strongly demonstrates that the majority of type 2 diabetes cases can be prevented through diet and lifestyle modification.However, the adoption of a healthy diet and lifestyle requires not only individual behavioral changes, but also changes in our food, built, and social environments.Public health strategies that target the obesogenic environment are critical.Translating clinical and epidemiologic findings into practice requires fundamental shifts in public policies and health systems.To curb the diabetes epidemic, primary prevention through the promotion of a healthy diet and lifestyle should be a global public policy priority.Together, these clinical trials demonstrate that diet and lifestyle modification is highly effective in preventing type 2 diabetes in different ethnic and racial groups.There is an urgent need to translate the findings from these trials into clinical and public health practice.Emphasis should be placed on early adoption of healthy habits in pediatric populations because these practices track through to adulthood.PREVENTABILITY OF TYPESeveral randomized clinical trials have demonstrated that diabetes is preventable.One of the first diabetes prevention trials was conducted in Daqing, China (58).After 6 years of active intervention, risk was reduced by 31, 46, and 42% in the diet-only, exercise-only, and diet-plus-exercise groups, respectively, compared with the control group.In a subsequent 14-year follow-up study, the intervention groups were combined and compared with control subjects to assess how long the benefits of lifestyle change can extend beyond the period of active intervention (59).Compared with control subjects, individuals in the combined lifestyle intervention group had a 51% lower risk of diabetes during the active intervention period, and a 43% lower risk over a 20-year follow-up.", "An obvious conclusion is a manipulation of lifestyle provides an opportunity to reverse the diabetes trend.Stated another way, we cannot change our genetic make-up, but we can alter environmental factors.Indeed, many studies have shown that diet and exercise slow the onset of diabetes in persons with IGT (2,17,18).Also, low glycemic index diets have been shown to promote weight loss along with having metabolic benefits in persons with type 2 diabetes (19).The difficulty, of course, is trying to get people to change their habits.One can predict that returning to healthy lifestyles would reverse the rising incidence of type 2 diabetes.Unfortunately, that is not a practical solution.Instead, the current approach is to better understand the pathogenesis of type 2 diabetes, hopefully followed by the development of pharmaceuticals that reverse the key pathogenic elements.We entered the 1990s knowing that type 2 diabetes was characterized by the classic triad of b-cell dysfunction, excess glucose production from the liver, and insulin resistance defined as impaired insulin-mediated glucose clearance into skeletal muscle (8).However, knowledge at that time provided no physiological connection between these organs.Another conundrum was how excess adiposity, i.e., being fat, caused insulin resistance, which again is a defect in skeletal muscle physiology.", "Evidence from randomized controlled trailsThe effi cacy of lifestyle changes in obesity and T2DM prevention has been established in numerous randomized controlled trails (RCTs).Several of them may, however, be considered of major importance due to their large sample sizes (i.e., 458-3234 individuals) and long-term duration (i.e., 3-6 years).The Chinese Da Qing diabetes prevention study was the fi rst to investigate the eff ect of 6-year lifestyle change on body weight and diabetes incidence in individuals with impaired glucose tolerance (IGT) ( Pan et al., 1997 ).Pan and co-workers (1997) reported 42 % reduction in diabetes incidence, although no signifi cant diff erence in body weight was present.Similar results were found in the Finnish Diabetes Prevention Study (DPS) and the US Diabetes Prevention Program (DPP).DPS and DPP independently reported reduction in diabetes incidence of 58 % accompanied by significant reduction in body weight (5-7 %) as a result of the lifestyle modifi cation ( Knowler et al., 2002 ;Tuomilehto et al., 2001 ).These fi ndings were also confi rmed in Japanese and Indian populations, reporting 67.4 % and 28.5 % reduction in diabetes incidence, respectively ( Kosaka et 2011) reported signifi cant reduction in body weight and diabetes incidence at 1, as well as, at 3 years during a lifestyle modifi cation program carried out in a primary healthcare setting among subjects with IGT.All large-scale interventions have been successful in preventing T2DM during the active intervention period.Remarkably when the eff ectiveness of the lifestyle modifi cation programs was assessed on the long-term after discontinuation of the intervention, diabetes risk still remained substantially reduced.In the Finnish DPS, for instance, at extended follow-up 3 years after the 4-year intervention period a substantial reduction in body weight and T2DM incidence was still present ( Lindstrom et al., This document was downloaded for personal use only.Unauthorized distribution is strictly prohibited.As already pointed out in several of the T2DM prevention studies the reduction in diabetes risk has been paralleled by substantial weight loss and weight reduction has been considered to have major importance for diabetes prevention ( Knowler et 1998 ).Hence, lifestyle modifi cation seems to have an eff ect on T2DM not only through reduction in body weight, but also through improvement in insulin sensitivity, blood glucose control and lipid profi le.Whereas there is convincing evidence that lifestyle changes can prevent T2DM in randomized controlled studies, so far little is known whether a lifestyle intervention could also modify cardiovascular morbidity and mortality.The 20-year follow-up results from the Chinese Da Qing diabetes prevention study showed a non-signifi cant 17 % reduction in cardiovascular mortality in the combined (diet and/or PA) intervention group vs. controls ( Li et al., 2008 ).Similarly, lifestyle intervention in the Finnish DPS was not found to reduce signifi cantly cardiovascular mortality during the fi rst 10 years of follow-up ( Uusitupa et al., 2009 ).However, this study was not initially designed to examine the eff ect of lifestyle intervention on total mortality or cardiovascular morbidity, and therefore the statistical power may not have been suffi cient to detect small diff erences in cardiovascular events between the 2 groups.Besides, a longer follow-up period might be needed to answer this question.In the Malm Preventive trial with a 12-year follow-up of men with IGT total and cardiovascular mortality were lower among participants in the lifestyle intervention group, however, these results should be considered with caution due to the non-randomized design of the study ( Eriksson and Lindgarde, 1998 ).Recent fi ndings of bariatric surgery treatment of very obese subjects showed that weight loss indeed may reduce not only T2DM risk but also total mortality ( Sjstrm et al., 2007 ).Further investigations are needed to clarify whether prevention of T2DM by lifestyle modifi cation is associated with cardiovascular disease prevention; until then decisions have to be made on the basis of the best available information.al., 2002 ;Kosaka et al., 2005 ;Lindstrom et al., 2003 ;Tuomilehto et al., 2001 ).In some studies although no or just minor weight loss was achieved, diabetes incidence was also reduced( Pan etal., 1997 ; Ramachandran et al., 2006 ).In addition, on the long term weight was partially or totally regained in all of the studies ( Knowler et al., 2009 ; Li et al., 2008 ; Lindstrom et al., 2006 ; Lindstrom et al., 2003 ).Despite this regain T2DM risk remained low or decreased further, thus the eff ect of lifestyle is unlikely to be solely due to body weight reduction.In support of this notion Pan et al. (1997) reported comparable decrease in T2DM incidence in the intervention group of Da Qing among overweight and lean individuals.In conclusion, evidence from epidemiological studies and RCTs demonstrate that lifestyle modifi cation comprising higher levels of PA and prudent food consumption may be eff ective in obesity and T2DM prevention.The positive eff ect of lifestyle on body weight seems somewhat transient, whereas the eff ect on T2DM is sustained for longer periods.Furthermore, lifestyle modifi cation appears to have an eff ect on diabetes risk independently of body weight and even of weight loss.", "Because lifestyle changes to reduce bodyweight have always been an important therapy for type 2 diabetes, investigators of Look AHEAD trial 156 examined the eff ect of weight reduction (achieved by an intensive lifestyle intervention) on cardiovascular events.Despite diff erential weight loss for more than 10 years and improvements in many cardiovascular risk factors (including blood pressure and lipids), lifestyle change did not reduce cardiovascular events compared with diabetes support and education (control group).This fi nding might have been because large proportions of participants in both groups received medical treatment for these risk factors.However, participants in the group receiving Glucokinase Reduce hepatic production of glucoseTable 1: Selected therapeutic targets of largely untested mechanisms for type 2 diabetesintensive lifestyle intervention who had a history of a cardiovascular event at baseline had a tendency for an increased risk of a subsequent cardiovascular event; 156 a similar fi nding was reported in ACCORD. 144Several other fi ndings from Look AHEAD are worthy of comment.First, participants in the weight-loss group were more likely to achieve either partial or complete remission of diabetes, 157 had better glucose control needing fewer glucose-lowering drugs (including insulin), and were more likely to achieve a glycated haemoglobin A 1c measurement of less than 7% (53 mmol/mol) than were those in the control group. 158However, despite weight loss and addition of drugs, patients in the treatment group had similar progression of diabetes to that of the control group-ie, with continuous increases in glycated haemoglobin A 1c . 156Second, lifestyle change slowed progression of nephropathy.Third, other health outcomes associated with better quality of life-eg, sleep apnoea 159 and mobility 160 -improved.Thus, intensive lifestyle change in patients with type 2 diabetes has benefi ts, but unfortunately not for cardiovascular outcomes, which remain the major cause of premature mortality in type 2 diabetes.", "INTRODUCTIONIntensive lifestyle interventions (eg, promoting increased physical activity and weight loss) can be effective in decreasing the incidence of type 2 diabetes mellitus (T2DM). 1 However, healthcare resources are limited, and participants in interventions to prevent diabetes should be prioritized.Identification of individuals at high risk of T2DM could facilitate the targeting of prevention efforts to those who could benefit from them and reduce the cost of preventing T2DM.", "GENETIC FACTORS AND LIFESTYLE interact in the development of type 2 diabetes.Physical activity, favorable dietary changes, and weight reduction were essential components of a success-ful lifestyle intervention in two large randomized controlled trials on the prevention of type 2 diabetes in high-risk individuals with impaired glucose tolerance (IGT), including the Finnish Diabetes Prevention Study (DPS) (44) and the Diabetes Prevention Program (DPP) (22).In the DPS, increased physical activity was associated with a decreased risk of type 2 diabetes independently of changes in diet and body weight.The individuals who increased their physical activity most (i.e., were in the upper third of the change) were 66% less likely to develop type 2 diabetes than those in the lower third (24).Type 2 diabetes can be prevented or delayed by lifestyle modification, including increased physical activity, beneficial dietary changes, and weight reduction (22,44).However, only Model adjusted for age, gender, group, baseline value of moderate-to-vigorous physical activity, and baseline values and changes in body weight and in intakes of energy and energy-adjusted saturated fat and fiber. *The median (range) of each tertile of change in moderate-to-vigorous physical activity is shown.Adjusted interaction between moderate-to-vigorous physical activity (3 groups) and the polymorphism (2 groups) on the risk of developing type 2 diabetes.a few studies have investigated the effects of such lifestyle interventions on insulin sensitivity and insulin secretion in persons with IGT (21,46).On the basis of the 4-yr follow-up study of the DPS with repeated frequently sampled intravenous glucose tolerance test (FSIGT), insulin sensitivity improved along with lifestyle changes, while insulin secretion remained virtually unchanged (46).Most other data also indicate that physical activity, diet, and weight loss primarily increase insulin sensitivity.Insulin resistance and the associated glycemic stress may exhaust -cells and impair their function.Regular physical activity may diminish glycemic stress by improving insulin sensitivity of target tissues (18).While the mechanisms of improved -cell function in response to lifestyle interventions are still largely unknown, several studies suggest that physical activity (5,11), diet (19,26), weight loss (45), or their combination (21) may directly improve the first-phase insulin secretion that is an indicator of the -cell function.", "Several studies have shown that treatment with lifestyle change or medication can reduce the progression from prediabetes to diabetes (98,99).Furthermore, a clinical benefit of early therapy has been demonstrated (100,101), with reductions in retinopathy and cardiovascular and allcause mortality (102).This evidence suggests that identifying prediabetes at an early stage and keeping glucose levels close to normal could change the natural history of the disease (93).", "Lifestyle modification including exercise, nutrition and behavioral changes is the cornerstone to prevent and treat type 2 diabetes.Oral antidiabetic medicationeither as single agent or combination therapyis frequently required to maintain metabolic control, as assessed by monitoring of glycated hemoglobin A 1C (HbA 1C ) levels.Eventually, a significant proportion of patients with type 2 diabetes require the exogenous administration of insulin [40].", "Lifestyle changes9][120][121] Intervention studies involving diet alone to treat patients with youngonset type 2 diabetes have been limited.In a study 120 of 20 obese children and adolescents (mean age 145 years) with type 2 diabetes, improvements in weight (BMI was reduced from 435 to 393 kg/m), insulin sensitivity, and HbA 1c concentration were seen after following a very low calorie diet (<800 kcal per day) for a 2 month period.These improvements were, however, not maintained after cessation of the diet.", "Diet and lifestyle factorsDiet and lifestyle modification is an important aspect of T2DM prevention.Major clinical trials have demonstrated that intensive lifestyle interventions can lower the incidence of diabetes mellitus by 58% compared with control groups 55 .Trials have also shown that these interventions are more effective than pharmacological interventions 55 .Landmark clinical trials, such as the Diabetes Prevention Program in multi-ethnic Americans 55 , the Finnish Diabetes Prevention Study 56 and the Da Qing IGT and Diabetes Study in China 57 , have demonstrated that many cases of T2DM could be prevented through lifestyle interventions focused on increasing physical activity and adopting a healthy diet.Nevertheless, when lifestyle interventions are not feasible, pharmacological therapy can be considered as a strategy to prevent the development of T2DM.For example, metformin reduced the incidence of T2DM by 31% over an average follow-up period of 2.8 years among high-risk individuals from the USA who did not have diabetes mellitus 55 .Similarly, metformin reduced T2DM risk in clinical trials in India and China 58 .T2DM managementModification of lifestyle, including weight loss, increasing physical activity and adopting a healthy diet, remains one of the first-line strategies for the management of T2DM.In the Look AHEAD (Action for Health in Diabetes) trial in the USA 133 , a 4-year intensive lifestyle intervention through caloric restriction and increased physical activity achieved increased weight loss, improved cardiometabolic risk profiles and a reduced requirement for medication to control CVD risk factors compared with the control group (who had diabetes mellitus and received support and education about lifestyle modifications) 134 .However, after a median follow-up period of 9.6 years, the trial was terminated because the intervention did not reduce the rate of CVD events 134 .", "Multiple interventions in adults with T2D have been evaluated for risk reduction and prevention, both in the short and the long term.A recent systematic review (69) reported that after active interventions lasting from 6 months to .6 years, relative risk reduction achieved from lifestyle interventions (39%) was similar to that attained from use of drugs (36%); however, only lifestyle interventions had a sustained reduction in risk once the intervention period had ended.Analysis of the postintervention follow-up period (;7 years) revealed a risk reduction of 28% with lifestyle modification compared with a nonsignificant risk reduction of 5% from drug interventions." ] ], "task_id": [ "F0CC742EA104CB2C8B8BCA9CB6EB78F0" ] }