Diabetes Reversal Program

The diabetes reversal program is a diabetes reversal intervention based on low carbohydrates. It’s main target population are people living with overweight, pre-diabetes, and type 2 diabetes.

This intervention encourages participants to achieve changes in their lifestyle that address not only carbohydrate intake but also focus on healthy fats and proteins, as well as incorporating increased physical activity into their daily routine.

Phases of the Diabetes Reversal Program

The intervention is structured in 4 phases:

Phase 1: Initial consultation and evaluation by a clinician

Patients are seen following a specific protocol, current health status, including diabetes and comorbidities (other illness), medications, and physical and metabolic parameters (blood pressure, BMI, Self-monitored Blood Glucose (SMBG), HbA1c, lipids, liver function, thyroid function, and renal function) are documented.

The laboratory tests provided should be done not more than a month before this consult. A thorough diet history is also taken. Individuals are provided with tailored advice on reducing their carbohydrate intake, with an emphasis on adapting traditional dishes to reduce sugar and starchy carbohydrates and on discouraging processed foods.

Patient’s readiness to make these lifestyle changes is also assessed and those that indicate that they are ready will be invited to attend a lifestyle management program.

Their medication will be adjusted where appropriate to reduce hyperinsulinemia and the risk of hypoglycemia and to facilitate weight loss. They will be advised to undertake limited structured self-monitoring of blood glucose (about 6 tests per week).

Phase 2: Lifestyle management program (6 weeks during months 1-3)

Patients are invited to attend a weekly lifestyle management program for six weeks that will reinforce dietary messages, provide peer support, and encourage increased physical activity within their lifestyles.

The diabetes reversal program is developed according to the principles of social learning theory, whereby individuals learn from their own experiences and observations, particularly in a group setting.

We run the program several times a year so that no one has to wait more than a few weeks to enroll. Participants are encouraged to attend all six sessions. Each session will accommodate up to 15 patients in a group setting and be facilitated by staff with expertise in nutrition, behavior change, and psychology, as well as diabetes management.

Each session follows a detailed written curriculum, backed up by written material for participants. Sessions are facilitated to encourage active engagement and discussion between participants. Each week will focus on a specific theme and participants are asked to complete related tasks during the following week, adapted to meet their own goals.

Each session is facilitated by a qualified clinician and nutritionist. During the 6 sessions, the clinician will review the participants and make any necessary adjustments to medication as needed.

Phase 3: Lifestyle update groups (every 2 months, month 5, 7, 9, 11)

Having completed the six-week program, patients are enrolled in group updates every two months to help them consolidate lifestyle changes, review their goals, and seek additional support in achieving them as required.

Each participant is invited to four update sessions, and each one will recap part of the content of sessions 1-6 above, with extended time to review the progress to date of each participant and supporting them in overcoming any obstacles to achieving their goals.

Phase 4: Follow-up consultation with a clinician (every two months, month 4, 6, 8, 10, and 12)

The aim is to review progress in changing diet and physical activity, reducing body weight, and improving blood glucose levels. Blood will be taken for HbA1c at months 3, 6, 9, and 12. Medication (for diabetes, blood pressure, and lipids) will be adjusted as appropriate.

Patients can be referred back to the group lifestyle program if appropriate. In patients who are able to come off all diabetes medication and whose HbA1c is <6% (42mmol/L), a glucose tolerance test will be performed as part of the final assessment at one year to document the extent of reversal (e.g. to IGT or normal).

The following table shows the complete programme over one year, with details of data collected at each time point.

Month	Visit type	Month	Visit type
1	Initial assessment by doctor and data collection*	8	Review by doctor and data collection
2-3	Course over six weeks	9	Group update
4	Review by doctor and data collection	10	Review by doctor and data collection
5	Group update**	11	Group update
6	Review by doctor and data collection	12	Final Review by doctor and data collection
7	Group update

**Bodyweight, waist circumference, blood pressure, and HbA1c measured at each doctor review; Problem Areas in Diabetes (PAID), lipids, renal, liver, and thyroid function at baseline, six and twelve months.

**Group updates reinforced main messages and provided support to participants in problem-solving and in maintaining lifestyle changes.