Achieving Diabetes Remission Through Lifestyle Intervention: Preliminary Results From A Scoping Review Of The Literature And Implications For Africa

Background: Africa is experiencing the most rapid rise of type 2 diabetes (T2D) in the world. In addition, Africa has the highest proportion of undiagnosed cases. If people with T2D are undiagnosed, then complications progress, outcomes are poor, and social and financial costs escalate. Our goal with this review is to determine whether Life-Style Intervention (LSI) as primary treatment can lead to remission of T2D. LSI generally includes some combination of dietary change, weight loss, exercise, and counseling. If LSI alone leads to high rates of T2D remission, this will provide both the impetus and justification for investing scarce health care resources in programs which would convert undiagnosed T2D into diagnosed T2D. Methods: PubMed, Embase, Cochrane and CINAHL were searched between September 1 st and September 13 th , 2021 for studies that assessed whether LSI, as the only treatment would lead to remission in either newly diagnosed or established T2D. Results: The search identified 1162 articles. After removal of duplicates (n=291), 871 are being screened for eligibility. To date, data have been extracted from 11 of the articles which met the inclusion criteria. None of the 11 studies were conducted in Africa. Three of the 11 studies reported on newly diagnosed T2D cases. All three were successful in achieving a high rate of T2D remission with LSI. Strategies which were successful in converting T2D to prediabetes included: (1) a caloric decrease of only 500 less than predicted maintenance; (2) a low carbohydrate diet; and (3) a 10% loss in baseline weight. Exercise and counseling regimens varied widely between the three trials. The eight articles which enrolled patients with known T2D focused largely on very low calorie diets and intensive psychologic support and counseling. Factors in these studies which were associated with success were: T2D duration less than 5 years, weight loss of >10% in the first year, and higher insulin concentrations at baseline. Conclusion: Literature review, even if scant, will provide currently known best practices. They will help us move forward in the design of culturally sensitive lifestyle interventions that would be acceptable to African participants and economically attractive to government and health care agencies.