Freedom from Diabetes
Research Foundation

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.

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.

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.

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.

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.

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.