Abstract
Objectives
Although lifestyle interventions are first-line treatment for individuals living with
prediabetes and type 2 diabetes (T2D), they are rarely implemented effectively in
routine clinical care.
Methods
We present a retrospective analysis of a 12-month, single-centre, structured multidomain
lifestyle intervention clinic offered to individuals living with prediabetes and type
2 diabetes. The intervention consisted of expert-guided educational and nutritional
counselling combined with a personalized physical exercise prescription, with the
main goal of improving metabolic health and reaching remission. Anthropometric parameters,
glucose, basal insulin, glycated hemoglobin (A1C), and lipid levels were measured
at baseline and at 3, 6, and 12 months after the lifestyle intervention initiation.
Remission of prediabetes and T2D were defined as a return of A1C at 6 months to <6.5%
(or <5.7% for prediabetes) and persisting for at least 3 months in the absence of
glucose-lowering pharmacotherapy.
Results
After a multidomain, expert-guided lifestyle intervention, 117 individuals living
with prediabetes and T2D had significantly improved metabolic profiles: Mean weight
change at 12 months was −4.9 kg (95% confidence interval [CI], −4.0 to −5.7; p<0.001),
and mean change in A1C at 12 months was −0.6% (95% CI, −0.4 to −0.7; p<0.001). A substantial
proportion of individuals reached the criteria for remission (20% among participants
with prediabetes and 12% among those with T2D).
Conclusions
The results of this study suggest that prioritizing lifestyle changes in a multifaceted,
progressive, 12-month intervention in this population improves anthropometric and
insulin resistance measures, and has the potential to normalize metabolic values,
even to the point of reaching the criteria of remission.
Résumé
Objectifs
Bien que les interventions axées sur le mode de vie constituent le traitement de première
ligne des individus vivant avec le prédiabète et le diabète de type 2 (DT2), elles
sont rarement mises en œuvre de façon efficace dans le cadre des soins cliniques courants.
Méthodes
Nous présentons une étude rétrospective unicentrique d’une clinique d’interventions
axées sur le mode de vie, multidomaines et structurées, de 12 mois, offertes aux patients
vivant avec le prédiabète et le diabète de type 2. Les interventions consistaient
en la combinaison d’un counseling éducationnel et nutritionnel par un expert et d’une
prescription personnalisée ayant pour principal objectif l’amélioration de la santé
métabolique et l’obtention de la rémission. Les paramètres anthropométriques et les
concentrations de glucose, de l’insuline basale, de l’hémoglobine glyquée (A1c) et
des lipides ont été mesurés au début et 3, 6 et 12 mois après l’amorce des interventions
axées sur le mode de vie. La rémission du prédiabète et du DT2 a été définie par le
retour de l’A1c après 6 mois à < 6,5 % (ou < 5,7 % lors de prédiabète) et son maintien
durant au moins 3 mois en l’absence de pharmacothérapie hypoglycémiante.
Résultats
Après les interventions multidomaines axées sur le mode de vie par des experts, 117
individus vivant avec le prédiabète et le DT2 avaient montré une amélioration significative
de leurs profils métaboliques : le changement moyen du poids après 12 mois était −4,9
kg (intervalle de confiance [IC] à 95 %, de −4,0 à −5,7; p < 0,001), et le changement
moyen de l’A1c après 12 mois était de −0,6 % (IC à 95 %, de −0,4 à −0,7; p < 0,001).
Une proportion substantielle d’individus remplissait les critères de rémission (20
% chez les participants atteints de prédiabète et 12 % chez ceux atteints du DT2).
Conclusions
Les résultats de cette étude montrent que la priorisation des changements au mode
de vie d’une intervention multifacette progressive de 12 mois dans cette population
permet d’améliorer les mesures anthropométriques et de la résistance à l’insuline,
et a le potentiel de normaliser les valeurs métaboliques, au point même de remplir
les critères de rémission.
Keywords
Mots clés
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Article info
Publication history
Published online: November 03, 2022
Accepted:
October 23,
2022
Received in revised form:
October 12,
2022
Received:
May 11,
2022
Identification
Copyright
© 2022 Canadian Diabetes Association.
