Freedom from Diabetes
Research Foundation

Diabetes remission is defined as Hba1c < 6.5 without medications for at least 3 months. This possibility and arena of diabetes remission research is growing at a rapid and exciting pace as more and more diabetics seek deeper solutions across the world.

We at the Freedom from Diabetes Research Foundation are committed to identifying, implementing and publishing holistic and sustainable methods for reversing diabetes, its complications (related to eyes, heart, kidneys, nerves, etc) and related metabolic disorders (related to obesity, high cholesterol, hypertension, hypothyroid, PCOD, etc)

Scientific Publications


PUBLISHED RESEARCH

  • Lifestyle Intervention for Diabetes Remission: A Paradigm Shift in Diabetes Care and Management

    Authors: Pramod Tripathi, Thejas R Kathrikolly
    Journal: Current Diabetes Reviews, Online Ahead of Print

    Remission is often considered the ultimate goal in Type 2 Diabetes (T2D) management and care. Although metabolic surgery is the conventional choice to achieve remission, substantial evidence suggests the possibility of T2D remission through lifestyle interventions. In this context, the current perspective explores recent scientific advancements in lifestyle intervention for diabetes remission and also emphasises its clinical applicability as a pragmatic approach to diabetes management. The perspective further provides additional evidence on remission from the authors' own research findings in the Indian population. We propose that a holistic lifestyle intervention approach - individualised diet plan, exercise protocol, and psychological intervention - may be a benchmark protocol to achieve T2D remission.

  • Long‑term remission of type 2 diabetes through intense lifestyle modification program–A case series

    Authors: Pramod Tripathi, Nidhi Kadam Anagha Vyawahare Maheshkumar Kuppusamy Venugopal Vijayakumar
    Journal of Family Medicine and Primary Care, September 2023, Vol. 12

    Type 2 diabetes (T2D) remission is being widely accepted and documented as feasible through calorie restriction and bariatric surgery.
    Recent studies with lifestyle changes have also shown T2D remission; however, long‑term remission through lifestyle modifications is not yet established. Though glycated hemoglobin (HbA1c) is a universally accepted indicator of glycemic status, oral glucose tolerance test (OGTT) would be a more robust marker in understanding whether the metabolic abnormalities in glucose metabolism have undergone complete remission as well. We present a case series of four patients enrolled in the Holistic Transformation Program, a lifestyle modification program, between 2016 and 2018. The intervention was a combination of a vegan diet, structured exercises, and stress management delivered over 12 months. All four patients successfully achieved T2D remission and cleared OGTT consecutively for a minimum period of 3 years. Our findings suggest that long‑term T2D remission may be possible through lifestyle modification.

  • Type 2 Diabetes Remission Through Intense Lifestyle Modification with Three-Year Follow-Up of an Elderly Male on High Insulin Dosage: A Case Report

    Authors: Pramod Tripathi, Nidhi Kadam Anagha Vyawahare Venugopal Vijayakumar Maheshkumar Kuppusamy
    Integrative Medicine (Encinitas), September 2023, Vol. 22, No. 4

    An elderly obese male patient (60 yrs.) diagnosed Type 2 Diabetes (T2D) presented to our clinic. He was on 94 units of insulin and oral hypoglycemic agents during his initial consultation visit. After obtaining informed consent, he was enrolled into intense lifestyle modification program for a duration of six months, with a three-year follow-up after the intervention. The patient underwent complete remission losing 13 kg of body weight and also successfully clearing oral glucose tolerance tests (OGTT) for three consecutive years. We present three unique features in the current case report:
    (1) Elderly age of the patient
    (2) OGTT clearance along with normalisation of HbA1c, and
    (3) High initial insulin dosage at baseline.
    A few of the common positive predictors of T2D remission documented in earlier studies include younger age and minimal or low doses of insulin. The current case study shows that older age and higher dosage of insulin, it is possible to undergo complete T2D remission along with OGTT clearance through intense holistic lifestyle modification.

    Future experimental studies with adequate sample sizes would help substantiate our observation.

  • Extent of Diabetic Nephropathy Reversal in Type 2 Diabetes Mellitus Patients by following the Freedom from Diabetes Protocol

    Authors: Pramod Tripathi, Mamata Hiremath, Anagha Vyawahare, Anay Dudhbhate
    Indian Journal of Public Health Research & Development, August 2020, Vol. 11, No. 8

    Introduction The purpose of the study is to test the efficacy of Freedom from Diabetes (FFD) protocol on diabetic nephropathy patients.

    Methods Out of 776 participants enrolled, 302 had diabetic nephropathy. Selected participants were given a specially modified plant based diet along with lymphatic movement, anti-gravity exercises and relevant supplements to reverse the effects of nephropathy. Baseline characteristics, anthropometric measurements and biochemical parameters were measured on visit 1 and visit 2.

    Results - After 6 months, there was a significant reduction in urinary microalbumin and serum creatinine levels which was accompanied by improvement in glycemic control. Anthropometric measurements like body weight and BMI also showed a significant improvement.

    Conclusion - This study states that FFD protocol (specifically adapted plant-based diet along with lymphatic movement and anti-gravity exercises) with relevant supplements helps in improving diabetic nephropathy status.

  • Reversal of Metabolic Syndrome With Plant Based Diet And Exercise: Case Report

    Authors: Pramod Tripathi, Mamata Hiremath, Anagha Vyawahare
    Journal: Ayushdhara, March - April 2020, Vol 7, Issue 2

    This study aimed to investigate the effectiveness of a specified diet pattern and exercise like lymphatic and strength-building exercises (FFD protocol) to enhance weight and fat loss. A 45-year-old male with a history of obesity and diabetes mellitus (DM) enrolled in the study. The patient followed a specified diet along with lymphatic and strength-building exercises. Follow up was done for 6 months where, baseline characteristics, anthropometric measurements and biochemical parameters were measured in visit 1 and visit 2. The patient was off DM medication in 10 days. In first follow up (3 months) weight, BMI, waist circumference and body fat was significantly reduced. Whereas skeletal muscle mass was increased. A drop in HbA1C, fasting insulin, fasting blood sugar level and postprandial blood sugar levels were observed. In comparison to first follow up the second follow up after 6 months, shows substantial changes in the basal parameters. A drastic decline in HbA1c was reported from 6.1% to 5.5%. The FFD program comprehensively targets diabetes, ultimately clearing GTT the harbinger of the defeat of diabetes and visceral obesity, thereby successfully reversing the cluster of components of this morbid syndrome.

Scientific Conferences


INTERNATIONAL

  • IDF 2023 | International Diabetes Federation | Virtual | 4th - 7th December 2023

    Efficacy of a Lifestyle Intervention program in improving mental health among Patients with Type 2 Diabetes in India
    Authors: Ms. Baby Sharma, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare, Dr. Diptika Tiwari, Dr. Thejas Kathrikolly, Dr. Mayurika Das Biswas

    Insulin resistance and sensitivity in context of dyslipidaemia in non-obese type 2 diabetes patients
    Authors: Dr. Diptika Tiwari, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare, Ms. Baby Sharma, Dr. Thejas Kathrikolly, Dr. Malhar Ganla, Dr. Banshi Saboo

    Lifestyle Intervention for Dyslipidemia in Type 2 Diabetes: Insights from an ongoing Diabetes Management Program
    Authors: Dr. Thejas Kathrikolly, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare, Ms. Baby Sharma, Dr. Diptika Tiwari

  • SICEM 2023 | Seoul International Congress of Endocrinology and Metabolism | Seoul, Republic of Korea | 26th - 28th October 2023

    Is Return to a Normal Glycaemic Profile a Possibility in Patients with Type 2 Diabetes Undergoing Remission through a Lifestyle Intervention Program?
    Authors: Dr. Pramod Tripathi, Dr. Nidhi Kadam, Dr. Diptika Tiwari, Mrs. Anagha Vyawahare, Ms. Baby Sharma, Dr. Thejas Kathrikolly, Dr. Malhar Ganla

    Comorbidities and glycemic control challenges in type 2 diabetes: a baseline profile of patients attending a diabetes management program
    Authors: Dr. Nidhi Kadam, Dr. Pramod Tripathi, Dr. Thejas Kathrikolly, Dr. Diptika Tiwari, Mrs. Anagha Vyawahare, Ms. Baby Sharma, Dr. Malhar Ganla

    Weight loss-induced type 2 diabetes remission in the non-obese Indian population through a customized lifestyle intervention program
    Authors: Dr. Pramod Tripathi, Mrs. Anagha Vyawahare, Dr. Nidhi Kadam, Dr. Diptika Tiwari, Ms. Baby Sharma, Dr. Thejas Kathrikolly, Dr. Malhar Ganla

    Subgroups of Type 2 Diabetes and their Association with Weight Loss-induced Remission through Lifestyle Intervention in Indian Population
    Authors: Dr. Pramod Tripathi, Mrs. Anagha Vyawahare, Dr. Nidhi Kadam, Dr. Diptika Tiwari, Ms. Baby Sharma, Dr. Thejas Kathrikolly, Dr. Malhar Ganla

  • EASD Hamburg 2023 | European Association for the Study of Diabetes | Hamburg, Germany | 2-6th October 2023

    Possibility of Clearing Oral Glucose Tolerance Test in Type 2 Diabetes Patients Who Underwent Complete Diabetes Remission

    Authors Dr. Pramod Tripathi, Dr. Malhar Ganla, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare, Ms Baby Sharma, Dr. Banshi Saboo

    Background/objective: Type 2 diabetes (T2D) remission through calorie and carbohydrate restriction has been reported. We conducted a pilot trial to observe whether oral Glucose tolerance test (OGTT) clearance is possible in T2D patients who underwent remission through a lifestyle modification program.

    Methods: A total of 3689 patients who had previously undergone remission through our one-year lifestyle modification program in Pune city, India, were asked to enroll for the OGTT; 1121 (all still in remission) accepted the invitation and enrolled (June 2022). Remission was defined as HbA1c<48mmol /mol for a minimum of three months without glucose-lowering medication. Of 1121, 400 participants completed a 3-month training (where foods with increasing glycemic load were introduced every week while monitoring the blood sugar levels (BSL)). Subsequently, they appeared for OGTT (75g) from October-November 2022.

    Results Of the 400 participants, 207 (51.7%) cleared OGTT [Fasting BSL(FBSL)<=100, 2-hrs postprandial (PP2) <140], 175 (43.7%) cleared IGT-Impaired Glucose Tolerance (FBSL<126, PP2<200), while 18 (4.5%) did not clear. The median BMI at the time of appearing for OGTT was 22.8 kg/m2. Those clearing OGTT had significantly higher weight loss during the program than those clearing IGT (10 kg vs 6.4 kg) and had a shorter duration of diabetes (5 years vs 6.9 years) (p<0.05). Medication status at the start of the intervention (OHA, Insulin, both, and no medication) did not affect the possibility of clearing OGTT (p>0.1).

    Conclusion Complete remission of type 2 diabetes to the point of achieving a non-diabetes glycemic profile irrespective of initial medication status is possible through lifestyle intervention if weight loss is achieved and maintained. The long-term sustainability of lifestyle interventions in achieving remission needs to be explored through a larger cohort study with a control group.

  • ADA San Diego 2023 | American Diabetes Association | San Diego (CA), USA | 23rd-26th June 2023
  • IDF Lisbon 2022 | International Diabetes Federation | Lisbon, Portugal | 5-8th December 2022

    Indian scenario of Diabetes Remission: Interim results of an ongoing cohort study on Type 2 Diabetes remission

    Authors Dr. Pramod Tripathi, Dr. Milanjeet Kaur, Dr. Nidhi Kadam

    Background: Type 2 diabetes (T2DM) remission is widely reported across the world. However, there are no large-scale cohort studies, especially in Indian population.

    Aim: To evaluate the effectiveness of a structured community-based lifestyle modification program- ‘Freedom from diabetes holistic transformation program (FFD-HTP) on T2DM remission in Indian population.

    Materials and methods: Patients with diagnosed T2DM (HbA1C > 6.5 or on conventional diabetes medication) above 18 years of age were included in a one-year intense lifestyle modification program, ‘FFD-HTP’. The intervention includes dietary modifications (high protein, low carbohydrate vegan diet, with low glycemic fruits and vegetables), personalized exercise plan (anti-gravity, yoga poses, cardio workout), and stress management support (psychological counselling, mindfulness meditation), with regular monitoring through a personal mentor. HbA1C and other biochemical parameters were measured at baseline, every three months, and after completion of the study, while fasting and post prandial blood glucose levels were measured daily. Complete T2DM remission was defined as maintaining HbA1c<6.5 for at least 3 months without use of anti-diabetic medication.

    Results: A total of 3,103 patients were screened between December 2020 and March 2021. Of these, 1,127 (699 males) met the inclusion criteria. Mean age was 51.7±10.4 years with mean duration of diabetes 10.4±7.6 years. After one-year intervention, 416 patients (36.9%) achieved T2DM remission. Patients were divided into four groups: Groups A (on oral hypoglycemic agents [OHA], n=829), B (on both insulin and OHA, n=219), C (only on insulin, n=4), and D (not on any anti-diabetic medication, n=75), respectively. In group A 41.7% (n=346) patients, group B 5.9% (n=13) patients, and group D 76% (n=57) patients achieved complete remission, with no remission in group C.

    Conclusion: Our findings tentatively suggest that FFD-HTP is beneficial in achieving T2DM remission in Indian population. A one-year post-intervention follow-up is underway to understand the long-term effects of the intervention.

  • PSAD-RAPID Copenhagen 2022 | PsychoSocial Aspects of Diabetes' Annual Scientific Meeting | Copenhagen, Denmark | 29th November- 1st December 2022

    Impact of Intensive Lifestyle Intervention On Depression And Anxiety In Patients With Type 2 Diabetes – A Way Forward

    Authors: Snehal Kulkarni, Dr. Nidhi Kadam, Dr. Pramod Tripathi, Baby Sharma

    Background: Type 2 diabetes (T2DM) is a chronic metabolic disorder that has a significant impact on mental health of an individual. In turn, depression and anxiety result in poor disease outcome and early mortality in patients with T2DM.

    Objective: The study aimed to assess the effect of holistic lifestyle intervention in improving depression and anxiety in patients with T2DM.

    Materials and Methods: In this quasi-experimental study, baseline data on 250 T2DM patients enrolled in a one-year online holistic lifestyle intervention programme at the Freedom from Diabetes Clinic (Pune, India) between May-August 2021 was collected. Data on anthropometric parameters and medical history was collected along with response to validated Patient Health Questionnaire (PHQ-9) (scoring 0-27) and Generalized Anxiety Disorder Assessment (GAD-7) scale (scoring 0-21). The intervention comprised of customized vegan diet and exercise protocol along with following activities to improve mental health: meditation, diary writing, goal setting, and one-on-one psychological counselling sessions. At the completion of 6 months of intervention, the patients were re-administered the questionnaires to see the effect in improving the PHQ-9 and GAD-7 scores. Since the intervention is for one year, data collection is ongoing.

    Results: At baseline, the prevalence of depression and anxiety (score>10) was 13% and 15% which reduced to 9.3% and 8.9% post-intervention, respectively. Post intervention, depression (3.30+4.35) and anxiety scores (3.27+4.21) were statistically lower than baseline (4.28+4.49 & 4.59+5.16) (Z= -3.73; -4.25, p<0.05) , respectively (using Wilcoxon signed rank test). Of the 32 patients with depression and 38 patients with anxiety at baseline, those who regularly attended the inner transformation phase and one-on-one psychological counselling session /s, 10 showed an improvement in depression scores and 20 showed improvement in anxiety scores.

    Conclusion: Our findings suggest that incorporating a psychological component to lifestyle interventions may help improve mental health in patients with T2DM.

NATIONAL

  • DIABETES INDIA 2024 | 14th World Congress Of Diabetes India | Bhubaneswar, Odisha | 25th - 28th, January, 2024

    1. Holistic Lifestyle Intervention for Prediabetes Management: A Year-long Study on Weight Loss, Glycaemic Control, and Lipid Improvements in an Indian Population
    Authors: Dr. Diptika Tiwari, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Dr. Banshi Saboo

    2. Exploring Lifestyle Modification for Dyslipidemia Management in Type-2 Diabetes: Early Insights from an Ongoing Diabetes Reversal Program in India.
    Authors: Dr. Pramod Tripathi, Dr. Thejas Kathrikolly, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare, Ms. Baby Sharma, Dr. Diptika Tiwari, Dr. Banshi Saboo

  • Vishwa Swasthyam ICIGH (International Conference on Integrative Global Health) | Mumbai, India | 4th – 6th January 2024

    Holistic Lifestyle Intervention In Prediabetes Management And Restoring Wellness
    Authors: Mrs. Tanmayi Naik, Dr. Pramod Tripathi, Dr. Diptika Tiwari, Mrs. Anagha Vyawahare, Ms. Baby Sharma, Dr. Thejas Kathrikolly, Dr. Malhar Ganla, Dr. Nidhi Kadam

  • RSSDI Chennai 2023 | Research Society of the Study of Diabetes in India | Mumbai, India | 16th - 19th November 2023

    P21: Enhancing Type 2 Diabetes Classification Strategies: Data-Driven Comparative Insights from Cluster Analysis and Sub-Phenotyping
    Authors: Mrs. Anagha Vyawahare, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Dr. Diptika Tiwari, Ms. Baby Sharma, Dr. Thejas Kathrikolly, Dr. Malhar Ganla

    P22: Prevalence and Predictors of Anxiety and Depression among Individuals with Type 2 Diabetes in India
    Authors: Ms. Baby Sharma, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare, Dr. Diptika Tiwari, Dr. Thejas Kathrikolly, Dr. Mayurika Das Biswas

    P83: Impact of lifestyle intervention on glycemic control and remission in type 2 diabetes patients with normal BMI
    Authors: Dr. Pramod Tripathi, Dr. Nidhi Kadam, Dr. Amruta Prabhu, Mrs. Anagha Vyawahare, Dr. Thejas Kathrikolly, Ms. Baby Sharma, Dr. Diptika Tiwari, Dr. Malhar Ganla

    To read our abstracts, click here

  • ISLM | International Conference on Lifestyle Medicine | Chennai, India | 4th - 5th November 2023

    Impact of Lifestyle Medicine on Type 2 Diabetes Remission in Indian population
    Authors: Dr.Pramod Tripathi, Dr.Nidhi Kadam, Dr Kiran Vaswani, Dr.Thejas Kathrikolly

  • NAMSCON Bengaluru | 63rd Annual Conference of the National Academy of Medical Sciences | Bengaluru, India | 6th-8th October 2023

    Holistic Tele-Counselling combined with visual feedback through a smartphone application to improve self-management in Type 2 Diabetes Mellitus patients between the age group of 40-79 years

    Authors: Dr. Anuja Butaney, Dr. Pramod Tripathi, Dr. Diptika Tiwari, Dr.Nidhi Kadam
  • DiaCareCon Ahmedabad | Annual Conference of DiaCare | Ahmedabad, India | 30th September-1st October 2023

    1. Interplay between ABC Goals, Insulin Resistance Indices, Beta-Cell Function, and Dyslipidemia in Patients with Type 2 Diabetes

    Authors: Diptika Tiwari, Pramod Tripathi, Nidhi Kadam, Thejas Kathrikolly, Anagha Vyawahare, Baby Sharma, Malhar Ganla

    Background: The ABC goals (HbA1c <7%, blood pressure < 140/90 mmHg, and LDL-C <100 mg/dl) serve as crucial benchmarks for the management of type 2 diabetes (T2D) as well as associated comorbidities.

    Objective: The study aimed to explore the interrelationship between ABC goals, insulin resistance (IR), beta-cell function (BCF), and dyslipidemia in T2D patients.

    Method: We retrospectively analysed the baseline data of clinically diagnosed T2D patients (not on Insulin) attending a one-year online lifestyle intervention programme for diabetes management at the Freedom from Diabetes Clinic, India. The data included medical history, anthropometric, and biochemical parameters. Homeostasis model assessments of insulin resistance (HOMA-IR), beta-cell function (HOMA-β), and quantitative insulin-sensitivity check index (QUICKI) were calculated.

    Results: Data on 681 patients on medications for diabetes, dyslipidemia, and hypertension were analysed. Of the total, 22.3%, 44.9%, and 26.9% of patients achieved all three, two, or one ABC goals, respectively; 5.9% of patients did not achieve any of the ABC goals. Patients who met all three goals showed significantly lower insulin resistance, higher sensitivity (HOMA-IR, median 2.1; QUICKI, median 0.34), higher BCF (median 62.9), and healthier lipid profiles than those who did not achieve all three goals (p<0.05). Patients achieving only two goals showed significantly healthier lipid profiles (p<0.05) compared to those who either met a single goal or did not meet any goal. A significantly higher number of elderly patients achieved ABC goals compared to those below 50 years of age (p<0.05). No significant association was observed between diabetes duration and ABC goal achievement (p>0.1).

    Conclusion: Achieving the ABC goals may be challenging for T2D patients due to IR and altered BCF. Further research to explore this relationship may aid in effective diabetes management and better patient outcomes.



    2. Lifestyle Intervention for Promoting Weight Loss, Diabetes Management, and Remission in Obese Type-2- Diabetes Patients

    Authors: Thejas Kathrikolly, Pramod Tripathi, Nidhi Kadam

    Background: Obesity and type 2 diabetes (T2D) pose a multifaceted public health challenge. Lifestyle intervention to achieve diabetes remission among obese T2D patients is an area of ongoing investigation.

    Objective: This study aimed to investigate the effectiveness of a comprehensive lifestyle intervention program in promoting weight loss, diabetes management and remission among obese patients with T2D.

    Methods: Data were collected on obese (BMI>30 kg/m2) T2D-diagnosed patients (>18 years) (n=470) enrolled in a one-year lifestyle modification program at Freedom from Diabetes Clinic, Pune between April to December 2021. The intervention included a plant-based diet, physical activity, psychological support, and medical management. Baseline and endline anthropometric and biochemical parameters (lipid profiles and glycemic indices) were analyzed. Remission was defined as maintaining HbA1c < 6.5% for a minimum of 3 months without the use of anti-diabetic medication.

    Results: Post-intervention, a significant reduction in body weight (91 kgs to 84 kgs, p<0.05) and improvement in glycemic control (HbA1c reduced from 7.7% to 6.6%, p < 0.05) were observed. Further, 50% of patients showed significant improvement in BMI; 46% shifted to the overweight category (BMI 25-30 kg/m2) while 4% shifted to the normal BMI category (BMI<25 kg/m2). Additionally, 37% of the population achieved remission with higher rates of remission (46%) associated with more than 5 kgs weight loss (p<0.05). Furthermore, significant improvements in triglycerides and HOMA-IR values (p<0.05) were also observed.

    Conclusions: Significant improvement in weight loss and glycemic control observed in the study underscores the efficacy of a comprehensive lifestyle intervention in facilitating remission in obese individuals with T2D. These findings emphasize the importance of lifestyle modifications as a reliable approach for the effective management of T2D among obese individuals.



  • IDEC Pune 2023 | International Diabetes Experts Consortium | Pune, India | 30th June- 2nd July 2023

    Possibility of Oral Glucose Tolerance Test (OGTT) Clearance in Type 2 Diabetes Patients who underwent Complete Diabetes Remission

    Authors: Dr. Surbhi Khatod, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Dr. Diptika Tiwari

    Improvement In Anxiety and Depression in Patients With Type 2 Diabetes Through Customized Lifestyle Intervention

    Authors: Dr. Pournima Kulkarni, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Baby Sharma
  • D-TechCon New Delhi 2023 | World Congress of Diabetes Technology & Therapeutics | New Delhi, India | 5-7th May 2023

    Prevalence and Determinants of Anxiety and Depression in Patients with Type 2 Diabetes in India

    Authors: Dr. Pournima Kulkarni, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Baby Sharma
  • Diabetes India Indore 2023 | Diabetes India | Indore, India | 5-7th April 2023

    1. Characteristics of Type 2 Diabetes Remission in Non-Obese Indian Population

    Authors: Dr. Nidhi Kadam, Dr. Pramod Tripathi, Mrs. Anagha Vyawahare, Dr. Malhar Ganla

    Background & Aim: Weight loss-induced Type 2 Diabetes (T2D) remission is widely reported in overweight and obese but not in those with normal BMI. Indians are known to have higher body fat at normal BMI. The study aimed to evaluate the effectiveness of a one-year lifestyle modification program on weight-loss-induced T2D remission in non-obese Indian population.

    Materials and methods: We retrospectively analyzed data on anthropometric and biochemical parameters of T2D patients (with prior informed consent) with normal BMI (18.5 to 25 kg/m2) enrolled in an online one-year diabetes management program. The intervention included a customized plant-based diet, exercises, stress management, and medical support. Remission was defined as HbA1c<48 mmol /mol for a minimum of 3 months without the use of anti-diabetic medications.

    Results: The mean age, duration of diabetes, and BMI at baseline were 41.8±12 years, 10.6±11.9 years, and 22.8±2.3 kg/m2, respectively (n=515). Post-intervention, mean weight, fasting blood glucose, fasting insulin, and HbA1c decreased significantly (p<0.05). Remission was seen in 69 (13.3%) patients. Higher remission was seen in those with>5% weight loss and diabetes duration <6 years (36.2%) followed by those with <5% weight loss and <6 years of diabetes duration (26.8%). Those with >6 years of diabetes duration showed lower remission irrespective of the weight loss.

    Conclusion: Our findings suggest that patients with normal BMI with recently diagnosed T2D can also achieve remission through lifestyle management with a weight loss of at least 5%. However, the rate of remission is lower in patients with normal BMI compared to that reported in overweight and obese patients in previous studies in the Indian population.



    2. Sustained Type 2 Diabetes Remission through Lifestyle Modification in a Geriatric Patient: A case report with 3-year follow-up

    Authors: Dr. Thejas Kathrikolly, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare

    Background: The common factors influencing Type 2 diabetes (T2D) remission include the recent diagnosis, lower age, and minimal dosage of medicines. The current case study reports sustained T2D remission post-one-year lifestyle intervention program in an elderly male on a high dose of insulin.

    Case presentation: An elderly male patient (60 years) with obesity (BMI 31.7 kg/m2) and diagnosed with T2D (3.4 years back) enrolled for a one-year lifestyle intervention program at our diabetes management clinic. At the first consult, he was on 94 units of insulin and oral hypoglycemic agents with an HbA1c of 8.7%. Other significant history included microalbuminuria (106 µg/ml). The intervention included a customized plant-based diet, exercises, stress management, and medical support. At the end of the program, he had a weight loss of 13 kg, stopped both insulin and OHAs, showed significant improvement in HbA1c (4.9% without medication) and urine microalbumin (3.2 µg/ml), and successfully cleared the 75g oral glucose tolerance test (OGTT). He continues to be in remission and has cleared the OGTT for 3 consecutive years.

    Conclusion: We present three unique features in the current case report: (1) The elderly age of the patient and high insulin dosage, (2) OGTT clearance along with normalization of HbA1c, and (3) reversal of associated co-morbidity. The current case study shows that despite older age and higher dosage of insulin, the patient achieved complete T2D remission through sustained weight loss by following our lifestyle modification program. Future experimental studies with adequate sample sizes would help substantiate our observation.



    3. A Case Report on Remission of Long-Standing Type 2 Diabetes through Lifestyle Modification in a Geriatric Patient

    Authors: Diptika Tiwari, Dr. Pramod Tripathi, Dr. Nidhi Kadam, Mrs. Anagha Vyawahare

    Background: Weight loss through lifestyle modifications is known to induce Type 2 diabetes (T2D) remission; however, in recently diagnosed younger populations. Here we report the complete remission (defined as maintaining HbA1c <6.5% for at least three months without the use of diabetes medication) in an elderly patient with a 30-year history of T2D, through customized lifestyle modification.

    Case Presentation: In December 2019, a 66-year-old male patient diagnosed with T2D (HbA1c 7.7%) and on both insulin and oral hypoglycemic agents (OHA) presented to our clinic. Other medical history included hypertension, hyperlipidemia, and multiple surgeries. Family history revealed that the patient’s mother had T2D. He enrolled in our one-year lifestyle modification program which included a customized plant-based diet, exercises, stress management, and medical management support. The patient underwent complete remission with a reduction in HbA1C (5.3%), fasting insulin (8.62 μU/ml), fasting blood sugar (85mg/dl), postprandial blood sugar (104mg/dl), and homeostatic model assessment of insulin resistance (HOMA-IR) (6.22 to 1.81) at the end of the program. He also successfully cleared the 75g oral glucose tolerance test (OGTT). The patient continues to be in remission based on his last follow-up visit in May 2022 (HbA1C 5.3%). Informed consent was obtained from the patient for reporting the case study.

    Conclusion: We present three unique features in the current case report: 1) The patient’s advanced age, 2) longer duration of diabetes, and 3) HbA1c normalization with OGTT clearance. Younger age and lower diabetes duration are common positive predictors of T2D remission documented in earlier studies. The current case study shows that despite older age and longer T2D duration, it is possible to undergo complete remission along with OGTT clearance through lifestyle modification. Future planned studies with adequate sample sizes would help substantiate our findings.



    4. Prevalence and Determinants of Anxiety and Depression in Patients with Type 2 Diabetes in India

    Authors: Dr. Nidhi Kadam, Dr. Pramod Tripathi1, Mrs. Anagha Vyawahare1, Baby Sharma

    Background & Aim: Type 2 diabetes (T2D) is a chronic metabolic disorder that has a significant impact on the mental health of an individual, which in turn results in increased morbidity and mortality. Aim of the present study was to assess the prevalence of anxiety and depression and its determinants in patients with T2D attending a diabetes management clinic in India.

    Materials and Methods: Patients enrolling for a one-year online diabetes management program in India between July 2021 and September 2022 were invited to participate in this cross-sectional study. Data on medical history, anthropometry, and biochemical parameters were collected. The validated Patient Health Questionnaire (PHQ-9) (scoring 0-27) and Generalized Anxiety Disorder Assessment (GAD-7) scale (scoring 0-21) were used to assess depression and anxiety, respectively. Statistical analyses were performed using SPSS 21. P-value<0.05 was considered statistically significant.

    Results: A total of 2730 (34.5% females) patients with T2D agreed to participate (gave informed consent) and completed the questionnaires. The mean age and duration of diabetes were 49.9±10.2 and 10.0±7.0 years, respectively. The prevalence of moderate to severe depression and anxiety was 20.3% and 17.3%, respectively. Both depression and anxiety were significantly higher in females, those who were overweight and obese, those who were less than 50 years of age, had recently been diagnosed (<6 years), those with poor glycemic control (HbA1c> 8%), and those on insulin (p<0.05). Conclusion: Gender, higher BMI, lower age, recent diagnosis, use of insulin, and poor glycemic control were factors affecting both anxiety and depression in T2D patients in India. The high prevalence of both depression and anxiety suggests the inclusion of psychological aspects in the management of T2D in the Indian population.

  • RSSDI Chennai 2022 | Research Society of the Study of Diabetes in India | Chennai, India | 6-9th October 2022

    Effectiveness of a customized lifestyle modification program on Type II Diabetes Remission: Indian Scenario

    Authors: Dr. Pramod Tripathi, Dr. Nidhi Kadam, Snehal Kulkarni
  • FEMPEDICON, Nashik | Indian Academy of Pediatrics | Nashik, India | 30-31st July 2022

    Effectiveness of a structured community-based lifestyle modification on Remission of Type II Diabetes: Indian Scenario

    Authors: Dr. Kiran Vaswani, Dr. Nidhi Kadam, Dr. Milanjeet Kaur Raizada, Dr. Pramod Tripathi

YEAR-WISE DOCUMENTATION OF GTT CLEARED PARTICIPANTS


Glucose Tolerance Test (GTT) involves consuming 15 tsp (75 grams) of glucose in a fasting state. This is followed by checking Blood Sugar Level (BSL) tests, taken after one and two hours respectively. Only those whose BSL counts fall within normal ranges are declared successful. All diabetics usually fail this test. Infact, this test is used to diagnose diabetes and pre-diabetes. Many medical professionals consider it to be one of the ultimate test of reversal.

Over the years the number of FFD participants who have successfully cleared this test has grown tremendously, after becoming free of medications and coming into remission (Hba1c < 6.5 without medications for 3 months).

In 2015, we had around 15 GTT cleared participants; By 2021 that number had blossomed to 350+. So far, over 600+ participants have cleared GTT and 400+ have cleared IGT. Conventional thinking may maintain that diabetes is irreversible, but we know this is not true through this real-world experience. It’s a great achievement for anyone who has suffered from diabetes, to stop medications, to experience remission and then clear this tough test and it definitely is a cause of celebration. Summary of the year-wise results are given in the graph below:

GTT Year on Year Graph

Every year since 2015, we have been celebrating this achievement of our participants through a unique Festival of Freedom called Muktotsav. This is an annual event when our champions step into the well-deserved limelight. They are felicitated and awarded for their achievements. Not just those who have reversed their diabetes, and passed the GTT, but other champions too. For instance, people who have lost the maximum weight, or stopped their medicine in the shortest time. There are also award categories for freedom from hypertension, cholesterol medications, most deserving athletes, healthy couples and families, etc. The successes of our participants validate our efforts and our belief that Diabetes Can Be Reversed. This event greatly encourages other diabetics, from all over the world, to strive towards their own reversal and freedom!

Muktotsav has attracted several celebrity guests. In 2020, Muktotsav had internationally celebrated diabetes reversal pioneer, Dr. Neal Barnard as Chief Guest. In 2021, acclaimed researcher in the field of diabetes remission, Dr. Roy Taylor graced the event as the Chief guest along with Dr. Bhushan Patwardhan (Former Vice Chairman- UGC and Chairman- Indian Council of Social Science Research).

To know more about the people who have achieved this stupendous success, the celebrations and awards, please click on the year wise links below: