Rosenfeld Richard M, Kelly John H, Agarwal Monica, Aspry Karen, Barnett Ted, Davis Brenda C, Fields Denise, Gaillard Trudy, Gulati Mahima, Guthrie George E, Moore Denee J, Panigrahi Gunadhar, Rothberg Amy, Sannidhi Deepa V, Weatherspoon Lorraine, Pauly Kaitlyn, Karlsen Micaela C
Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA (RMR).
Loma Linda University School of Medicine, Loma Linda, CA, USA (JHK).
Am J Lifestyle Med. 2022 May 18;16(3):342-362. doi: 10.1177/15598276221087624. eCollection 2022 May-Jun.
The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used.
Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers.
The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section.
Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.
本专家共识声明的目的是帮助临床医生将饮食作为主要干预措施，使成年2型糖尿病（T2D）患者实现病情缓解。采用了由多学科专家医疗团队达成的循证声明。
具有糖尿病治疗、研究和病情缓解方面专业知识的小组成员遵循既定方法，通过改良的德尔菲法制定共识声明。一名检索策略师系统地回顾了文献，并使用现有最佳证据撰写了关于18岁及以上确诊为T2D的成年人饮食干预的声明。对存在显著实践差异以及可能导致T2D病情缓解的主题进行了优先排序。通过迭代的在线流程，小组成员表达了对声明的认同程度，根据平均回复和异常值数量将声明分类为共识、接近共识或非共识。
专家小组确定了131条候选共识声明，重点关注以下高价值主题：（1）定义和基本概念；（2）饮食与T2D病情缓解；（3）饮食细节和饮食类型；（4）辅助和替代干预措施；（5）支持、监测和治疗依从性；（6）体重减轻；（7）支付与政策。经过4轮德尔菲调查并删除重复声明后, 69条声明符合共识标准，5条被指定为接近共识，60条被指定为无共识。此外，就以下关键问题达成了共识：（a）T2D病情缓解应定义为糖化血红蛋白（HbA1c）<6.5%，持续至少3个月，且未进行专门用于降低血糖的手术、器械或积极药物治疗；（b）饮食作为T2D的主要干预措施可使许多成年T2D患者实现病情缓解，且与干预强度有关；（c）饮食作为T2D的主要干预措施，在强调以植物性食物为主、减少肉类和其他动物产品摄入时，最有效地实现病情缓解。许多达成共识的其他声明在论文的表格展示中突出显示，并在讨论部分进行了阐述。
就69条关于饮食与T2D病情缓解、饮食细节和饮食类型、辅助和替代干预措施、支持、监测、治疗依从性、体重减轻以及支付与政策的声明达成了专家共识。临床医生可利用这些声明提高医疗质量、为政策和方案提供信息，并确定存在不确定性的领域。
