A new study aims to find out exactly how certain diets and exercise can help people with type 2 diabetes manage their condition, and even take them into remission. Søren Gregersen, Clinical Professor at Steno Diabetes Center Aarhus (SDCA), is leading the ambitious project, which will run over six years and involve 1,500 participants. The Novo Nordisk Foundation is funding the study – called ON LiMiT (Optimal Non-pharmacological Lifestyle Modifications Among Patients with T2DM) – with a grant of up to DKK 102 million.
Here, Arne Astrup, Senior Vice President in Obesity and Nutritional Sciences at the Foundation, explains more about the project and the impacts he hopes it could have on the lives of people around the world with type 2 diabetes.
There’s already lots of research into diabetes management, especially here in Denmark. What is particularly exciting or different about this project?
“There’s been a growing recognition over the last years that most new cases of type 2 diabetes are caused primarily by overweight and obesity – and that if you lose weight as a person with type 2 diabetes, you can actually go into remission. If you maintain that weight loss, the disease could go away completely.
The official recommendations for management of type 2 diabetes tend to focus on using low-calorie diet formula to achieve that goal, but there’s also been lots of research to suggest that specific diets and exercise regimes can play a key role. However, most studies have had a short duration and only looked at a small number of patients, so the results are not robust enough to influence the official guidelines.
That was the starting point for ON LiMiT, which has a far bigger scope than anything done before in this area. If the results are as exciting as we hope, it could become a landmark study.”
What do you think might be discovered and what could the benefits be?
“For a long time, the official diet recommendations for people with type 2 diabetes have been counterproductive, prioritising starchy carbohydrates that we now know can cause elevated blood sugar levels and weight gain in people who are insulin resistant, that is, people with type 2 diabetes or pre-diabetes. Only in the last years has this recommendation gradually been modified, but there is still no clear advice about the optimal diet.
We hope that ON LiMiT will produce robust results that can lead to changes in the official recommendations, both here in Denmark and globally. If that happens, a huge number of people could benefit. In Denmark alone, there are 322,000 people diagnosed with type 2 diabetes, and the numbers are growing rapidly, both here and in many other parts of the world.
Crucially, this study will also hopefully reveal how various foods and types of exercise affect individuals in different ways, enabling medical practitioners to better tailor treatment plans for their patients. Some will benefit far more from specific dietary changes than from taking a weight loss drug, while others might find that a low dose of a drug combined with a particular diet has the biggest impact.”
There’s already plenty of information out there on how to live a healthy life, and yet many of us don’t follow it. Even if the study does result in excellent new guidance on the best diets and exercise regimes for people with type 2 diabetes, what makes you think they will follow it?
“I believe that the element of personalisation is key – that is, when people can immediately see and understand how a particular behaviour impacts their health. In this case, it could be using an app to see the effect on your blood sugar level of eating a piece of cake or doing a fitness class. There are already lots of diet and exercise tools out there, but we need some that are targeted for this group.
ON LiMiT will help develop much-needed new knowledge about the specific behaviours that can enable weight loss in different people, but also about how to support those people to maintain the good behaviours over the two years of the study period. This knowledge can then be used to help develop the tools that are needed.”
What makes SDCA the right organisation to lead this study?
“Simply put, they have the right expertise, experience, and infrastructure to run a study like this. At SDCA, they’ve already engaged substantially in diet studies and run similar ones to ON LiMiT in type 1 diabetes. They also have access to patients through their collaborations with general practitioners, and a reputation that makes it attractive for people to get involved.“
Why is the Foundation funding this area of research and what are the future plans?
“We want to improve the lives of people who are diagnosed with or at risk of developing cardiometabolic diseases, the leading cause of death worldwide. As part of that mission, we’re funding significant research into the effect of factors such as diet, exercise, and sleep on metabolism and weight, with the goal of finding new ways to help prevent, manage or even cure diseases such as diabetes. ON LiMiT is just one among several studies we’re funding in this area.
Some research now also suggests that dietary changes could help reduce the need for blood pressure medications, which are currently taken by hundreds of thousands of people in Denmark alone. This could be an area of research for the Foundation to look at in the future.”
