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Personalized nutritional therapy promotes diabetes remission

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Leipzig, Germany — for newly diagnosed patients type 2 diabetes, nutritional therapy is very effective in achieving remission. “The greater the weight loss, the more likely it is that blood sugar levels will normalize,” said Dr. Diana Rubin at the autumn press conference of the German Diabetes Association (DDG). Rubin is conference president and chief physician at the Center for Nutritional Medicine and Diabetes at the Vivantes Humboldt Hospital and Spandau Hospital in Berlin, Germany.

Due to the development of modern medicine, nutritional therapy has been increasingly relegated to the background over the past 50 years. But nutritional therapy and weight loss can effectively delay diabetes for years, Rubin said. The patient is healthy without being cured.

Nevertheless, remission is rarely permanent. Most patients develop type 2 diabetes again after 5 years.

personalized nutritional therapy

It is not just medical developments that have relegated nutritional therapy to the background. Another factor is that statutory health insurance companies do not cover individual nutrition counseling as standard, Rubin said.

The latest research in nutritional therapy shows that people with diabetes need to receive individualized treatment. However, this idea is not considered in current diabetes training programs, which are the only nutritional treatments covered by statutory health insurance companies.

Instead, nutritional information is primarily communicated through group training sessions. Individuals do not necessarily find each other again. Additionally, these sessions are rarely led by nutrition experts. “As is often the case with group training sessions like this, using a ‘one size fits all’ approach is rarely helpful,” Rubin said.

The DiRECT study, which helped patients lose 15 kg and achieved an almost 90% remission rate, is an example of how nutritional therapy can be highly effective. This is especially true if the goals and methods are determined on an individual basis and there is frequent contact with the therapist. German and international guidelines, including his 2022 DDG Best Practice Guide, emphasize the importance of individualized nutritional therapy.

Telemedicine promotes adherence

“It’s really important to consider the current living situation of the people involved,” Rubin says. “It is important to set small goals that can also be implemented in everyday life.” This can only be achieved with professional face-to-face consultation. “Then it will also be realistic to achieve this goal: to lose 10% to 15% of your body weight and maintain this loss,” she said. “Long-term monitoring is required to maintain this weight.”

Weight loss methods should generally be determined by the person’s preferences, as diet and environment are personal. Examples include reducing carbohydrate and fat intake, intermittent fasting, and using meal replacement drinks.

New data also shows that digital apps available on prescription (DiGA) can help support. This idea is reflected in DDG’s Nutritional Best Practice Guide for People with Type 2 Diabetes.

“Research shows that adherence is highly dependent on the amount of contact with the therapist and the long-term nature of the treatment,” Rubin said. She mentioned the need for long-term monitoring that can repeatedly remind patients of their treatment goals. “In this regard, I see a lot of potential in digital apps and telemedicine that cater to short-term contacts with concerned parties.”

A 2015 meta-analysis of 92 studies found that A1c For people with type 1 or type 2 diabetes when using telehealth nutrition therapy. Rubin frequently prescribes her DiGA. obesity“Just being aware of that makes it easier for many patients to reach their goals.”

Rubin also recommends connecting with sports groups and self-help groups. “Maintaining weight is a long-term project.”

Abdominal fat is decisive

Prediabetes is a precursor to type 2 diabetes and is associated with an increased risk of heart attack, kidney and eye disease, and many types of cancer. Until now, doctors have tried to delay the onset of type 2 diabetes by helping prediabetic patients lose weight. However, scientists from the German Diabetes Research Center have shown in a prediabetes lifestyle intervention study that abdominal fat plays an important role in remitting prediabetes.

1,105 prediabetic patients participated in a one-year program that involved healthy eating and increased physical activity. We found that when all subjects lost at least 5% of their body weight, some subjects achieved remission and others did not.

People who achieved remission had better symptoms insulin I became more sensitive and the visceral fat in my abdomen further decreased. Abdominal visceral fat can influence insulin sensitivity, particularly through inflammatory responses in adipose tissue.

Reducing abdominal visceral fat is clearly very important to achieve remission of prediabetes. Participants in this study who achieved remission had a significantly reduced risk of type 2 diabetes for up to two years after completing the program. They had improved kidney function and better blood vessel status.

Waist circumference

New results show that a 5% reduction in body weight and waist circumference of about 4 cm for women and 7 cm for men increases the chance of remission.

“Based on new data, remission should become the new treatment goal for prediabetic patients. This has the potential to change clinical practice and minimize complication rates for both male and female patients. ” says author Dr. Rainer Jampertz von Schwarzenberg. Researchers at Tübingen University Hospital in Germany.

Prediabetic remission can be considered if fasting blood glucose is less than 100 mg/dL (5.6 mmol/L), 2-hour blood glucose is less than 140 mg/dL (7.8 mmol/L), and A1c is less than 5.7%. can. New findings show that the more weight you lose, the better your chances of remission. Waist circumference should be reduced by about 4 cm for women and about 7 cm for men.

Jamperz von Schwarzenberg and his colleagues want to investigate whether this strategy is cost-effective and can secure payer support.

This article has been translated from German version of Medscape.

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