Training and a low-calorie diet have led to remission in half of the cases of early-onset type 2 diabetes, a disease on the rise in young people.
A winning and deadly combination that combines a low-calorie diet with a structured physical exercise program has knocked out (or into remission, with terms more suited to medical language) early-onset type 2 diabetes in half of the participants in a clinical trial.
The important result, presented at the annual congress of the European Association for the Study of Diabetes (EASD) in Milan and published in Lancet Regional Health Americascharts a path to address a rapidly increasing form of diabetes that is more dangerous and aggressive than type 2 diabetes diagnosed at an older age.
Patients to be followed carefully
Type 2 diabetes, which in the past mainly affected middle-aged and elderly adults, is progressively spreading in young people under 40 (in whom it is defined as early onset). Over the last 30 years, the number of people under 40 affected by this subtype of diabetes has grown significantly and very rapidly: from 2013 to 2021 alone, cases worldwide went from 63 million to 260 million.
Compared to the form of type 2 diabetes that affects the elderly, the early-onset form is more aggressive and linked to a greater risk of complications such as kidney and cardiovascular diseases. One reason is that more prolonged exposure to excessively high blood sugar multiplies the risk of diabetes-related disorders and shortens life expectancy.
Strict diet and exercise
Scientists from three centers in Canada and the United Kingdom followed adults aged between 18 and 45 with this form of diabetes, suffering from obesity and not on insulin therapy. The 96 participants were randomly assigned to either the diet and exercise group or the standard care group, and the results of the treatments were evaluated blindly – that is, by scientists who did not know which of the two groups they had each been assigned to.
For the first 12 weeks, half of the participants followed an 800-900 kcal daily diet, combined with supervised physical exercise (aerobic and resistance) twice a week and independent training once a week. For another 12 weeks, participants followed a maintenance diet and trained without supervision.
At the beginning of the treatment, the volunteers stopped, under careful medical supervision and as long as they did not show renal damage, all hypoglycemic and hypotensive drugs. They had to consume two liters of calorie-free liquids per day and, after the first two weeks of meal replacements, calibrated for weight loss, they were able to introduce normal foods with a greater variety of proteins, non-starchy vegetables and fruit, while maintaining the same caloric intake.
Remission in half of cases
After 24 weeks, 27 out of 50 participants on diet and exercise achieved remission from type 2 diabetes: 54% of participants, compared to 4% of the control group. Those in the intervention group were 21 times more likely to achieve remission than those in the control group. Participants in the active intervention group lost an average of 8.4 kg over the time of the study, from an average weight of 100.7 kg.
The study is significant because it targets a growing clinical population and because, compared to previous studies that focused on diet alone, this one focused on muscle mass preservation during the intensive phase of weight loss.
“Preserving muscle mass during weight loss aimed at remission could have important implications for long-term metabolic health, physical function and the course of the disease,” explain the authors of the study.
