Dietary modifications are most effective in achieving remission in adults with type 2 diabetes when they emphasize whole, plant-based foods, according to an expert consensus statement from the American College of Lifestyle Medicine.
A multidisciplinary panel of health care professionals with expertise in diabetes treatment, research, and remission developed the document using a modified Delphi process. The panel used the best available evidence to identify 69 consensus statements regarding dietary interventions in nonpregnant adults diagnosed with type 2 diabetes.
The statements should help clinicians who manage adults with type 2 diabetes reach shared decisions regarding remission as an optimal treatment outcome, the role of dietary interventions in facilitating this goal, and the specific aspects of diet and lifestyle that are most likely to result in success, the authors wrote. The expert consensus statement was endorsed by the American Association of Clinical Endocrinology, was supported by the Academy of Nutrition and Dietetics, and was cosponsored by the Endocrine Society. It was published online on May 18 by the American Journal of Lifestyle Medicine.
The panel reached consensus on a number of issues, including the following:
- Remission is a realistic and achievable goal for some adults with type 2 diabetes.
- Diet as a primary intervention can achieve remission in many adults with type 2 diabetes and is related to the intensity of the intervention (i.e., the degree of dietary restrictions imposed and the frequency and duration of patient contact or counseling).
- Diet as a primary intervention for type 2 diabetes is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products.
- Healthy, food-based dietary interventions (e.g., Mediterranean, DASH, whole-food plant-based diets) are preferable to calorie or isolated nutrient restriction (e.g., low carbohydrate, low fat, and high protein) for long-term remission of type 2 diabetes.
- The risk of adverse events, including the potential to cause or exacerbate chronic disease and to increased cardiovascular risk, should influence the choice of diet as a primary intervention for type 2 diabetes remission.
- A very-low-carbohydrate diet can be associated with significant adverse events and cardiovascular risk that make this diet inadvisable for long-term remission of type 2 diabetes.
- Dietary intervention should be combined with other lifestyle interventions, such as regular exercise, for achieving remission of type 2 diabetes.
- A whole-food, plant-based diet with intermittent fasting or time-restricted feeding could achieve remission of type 2 diabetes in some patients.
The consensus statement was limited by gaps and uncertainties in the relevant medical literature, the authors noted. Regarding potential conflicts of interest, panelists self-reported that their diets, on average, consisted of 89% plant-based foods, ranging from 50% to 100%, with most food choices described as whole or minimally processed.
“This high prevalence of healthy, plant-based eating, as well as our discussion focused on plant-forward dietary patterns, may have introduced bias in favor of this approach that impacted responses to the iterative Delphi surveys,” the authors wrote. “We have therefore disclosed this information so the reader can draw their own conclusions.”