Tripathi Pramod, Kadam Nidhi, Tiwari Diptika, Vyawahare Anagha, Sharma Baby, Kathrikolly Thejas, Kuppusamy Maheshkumar, Vijayakumar Venugopal
Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India.
Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, Arumbakkam, Chennai, Tamil Nadu, India.
PLoS One. 2024 May 3;19(5):e0302777. doi: 10.1371/journal.pone.0302777. eCollection 2024.
Achieving diabetes remission (HbA1c<48mmol/mol without the use of anti-diabetic medication for 3 months) might not assure restoration of a normal glycemic profile [fasting blood sugar level <5.6 mmol/L and Post-Prandial (PP) blood glucose <7.8mmol/L]. The study investigates the factors associated with OGTT clearance in patients under type 2 diabetes remission. Four hundred participants who achieved remission during a one-year online structured lifestyle modification program, which included a plant-based diet, physical activity, psychological support, and medical management (between January 2021 and June 2022), and appeared for the OGTT were included in the study. OGTT clearance was defined by fasting blood glucose < 5.6 mmol/L and 2-hour post-prandial blood glucose <7.8 mmol/L post-consumption of 75g glucose solution. Of the 400 participants, 207 (52%) cleared OGTT and 175 (44%) had impaired glucose tolerance (IGT). A shorter diabetes duration (<5 years) was significantly associated with OGTT clearance (p<0.05). Pre-intervention use of glucose-lowering drugs showed no association with OGTT clearance (p<0.1). Post-intervention, the OGTT-cleared group showed significantly higher weight loss (p<0.05) and a decrease in HbA1c compared to the IGT group (p<0.05). Improvement in Insulin resistance and β-cell function was also higher in the OGTT-cleared group compared to the IGT group (p<0.05). In conclusion, clearing the OGTT is a possibility for those achieving remission through lifestyle interventions. Higher weight loss, a shorter duration of diabetes, and improvement in insulin resistance were significantly associated with OGTT clearance in participants in remission. Future randomized controlled trials with longer follow-ups may help substantiate our findings.
实现糖尿病缓解（糖化血红蛋白<48mmol/mol，且3个月未使用抗糖尿病药物）可能无法确保恢复正常血糖谱[空腹血糖水平<5.6 mmol/L，餐后血糖<7.8mmol/L]。本研究调查了2型糖尿病缓解期患者口服葡萄糖耐量试验（OGTT）清除的相关因素。在一项为期一年的在线结构化生活方式改善计划（包括植物性饮食、体育活动、心理支持和医疗管理，时间为2021年1月至2022年6月）中实现缓解且参加了OGTT的400名参与者被纳入研究。OGTT清除的定义为：在饮用75g葡萄糖溶液后，空腹血糖<5.6 mmol/L，餐后2小时血糖<7.8 mmol/L。400名参与者中，207名（52%）OGTT清除，175名（44%）糖耐量受损（IGT）。糖尿病病程较短（<5年）与OGTT清除显著相关（p<0.05）。干预前使用降糖药物与OGTT清除无关联（p<0.1）。干预后，与IGT组相比，OGTT清除组体重减轻显著更高（p<0.05），糖化血红蛋白降低（p<0.05）。与IGT组相比，OGTT清除组胰岛素抵抗和β细胞功能改善也更高（p<0.05）。总之，对于通过生活方式干预实现缓解的患者，OGTT清除是有可能的。体重减轻更多、糖尿病病程较短以及胰岛素抵抗改善与缓解期参与者的OGTT清除显著相关。未来进行更长随访的随机对照试验可能有助于证实我们的发现。
