Meeting Summary of 39th International Symposium on Diabetes and Nutrition

Based on DNSG 2022 symposium highlights about “Weight Management, Micronutrients and Supplements in Diabetes”¹
This article will present some of the topics discussed in the 39th International Symposium on Diabetes and Nutrition. The highlights of this article are focused on prevention and treatment of diabetes with nutrition and lifestyle. The speakers during the symposium addressed remission of diabetes through weight loss, timely intervention in prediabetes and precision nutrition’s role in promoting cardiometabolic health.¹

1- Diabetes Weight Loss and Prediabetes Diet

Michael Lean

Michael Lean discussed how diabetes remission can be achieved through sustained weight loss using very low-energy diets (VLEDs). Given that weight gain and obesity are key drivers of type 2 diabetes (T2D), achieving and maintaining weight loss is crucial for these patients. In fact, sustained weight loss can achieve T2D remission which is defined as HbA1c <48 mmol/mol without glucose-lowering medications for 6 months.^2-5 Beyond initial weight loss, weight management is also about maintenance of weight loss and prevention of weight gain.⁵

So, what are the science-backed strategies for sustained weight loss in T2D? Lean stressed the importance of evidence-based weight-loss treatments for people living with T2D and obesity. An umbrella meta-analysis of randomized controlled trials in people with T2D showed that VLEDs (400–500 kcal/day) and LEDs (1,000–1,500 kcal/day) are more effective for weight loss than control (reduced-energy) diets.⁶ The DiRECT trial, led by Lean and Roy Taylor, placed 149 patients on a total diet replacement (825−853 kcal/day) for 3–5 months, followed by 2−8 weeks of structured food reintroduction. Antidiabetic and antihypertensive medications were stopped at the start but reintroduced if needed. Most notably, at 12 months T2D remission was achieved in 46% of the intervention group versus 4% of the control group (p<0.0001).² Lean noted that while the DiRECT trial was successful, a VLED is difficult to sustain. The key to success lies in the collaboration between diabetes and weight-loss management practitioners to help maintain weight loss results.

2- Prediabetes Diet

Jeffrey Mechanick

While Lean focused on how sustained weight loss can help T2D remission, Mechanick focused on T2D as a gradual process that starts long before diagnosis. He emphasized that T2D should be managed on a spectrum starting from prediabetes to the appearance of complications.⁷ Insulin resistance, prediabetes, T2D, and associated cardiovascular complications should be seen as a continuum rather than isolated conditions.¹ This reflects Mechanick’s chronic disease model whereby genetic, environmental, and social determinants of health contribute to a predisease stage that, if unmanaged, can progress to complications.¹⁰ Therefore, T2D interventions should focus on early prevention through early nutritional and structured lifestyle interventions. These early interventions can use diabetes-specific nutrition formulas which are supported by clinical evidence.⁸ Finally, by analyzing an individual’s food metabolome, personalized recommendations can be provided to support health at any stage of the T2D spectrum.¹

3- Precision Nutrition

Simin Liu

Mechanick emphasizes the need for structured nutrition and lifestyle interventions, but Liu takes it even further by exploring how genetics, diet, and environmental factors all come together to shape cardiometabolic health.1 Why are these factors important? Let’s look at the Women’s Health Initiative Study where despite reducing fat intake from ≥35% to 20%, coronary heart disease outcomes did not improve. This was only partly due to carbohydrate substitution, half of which was sugar.¹⁰ So, this raises an important question: Why do some dietary interventions work for certain individuals but not others? This is where Liu brings in another layer—how our genes and the environment interact with our diet to influence our health. His research shows that a one-size-fits-all approach doesn’t work, and that understanding these interactions can help create more effective nutrition plans. Liu highlights that genetic risk factors must be assessed within the environmental and nutritional context i.e. the gene-diet interaction. Using genetic analysis, it is now possible to identify some of the key regulatory drivers to explain different phenotypes in T2D.¹¹ For instance, TRPM6 and TRPM⁷ are genes that encode proteins involved in magnesium transport and were identified to be potential predictors of the risk of T2D.¹²Defining biological mechanisms and triggers, aided by biomarkers, is crucial for disease prevention.