14 Prevention and Remission of Diabetes

We at Apex are committed to the cause of preventing all the forms of Diabetes and even aim for Remission of Diabetes. Over the past few decades, despite substantial advances in managing Diabetes and its complications, managing Diabetes still remains a major challenge all over the world.

It is now becoming apparent that controlling fasting plasma glucose, post prandial hyperglycemia and reducing insulin resistance by medication is simply not sufficient. Diabetes is a multi factorial chronic and progressive disease in people with a genetic predisposition, or more often due to an epigenetic change (inappropriate gene expression) induced by unhealthy dietary habits, sedentary lifestyle, stress and environmental factors. Apart from the insulin producing pancreatic beta cells many other organs like the intestines, liver, brain, thyroid gland, adipose tissue and the immune system as well as the innumerable signalling systems, including leptin and ghrelin are involved in the development and progression of diabetes.

Hypothalamus controls food intake and satiety

Polyphenols clearly appear to modulate neuropeptides involved in food intake and satiety [7].

The human diet and lifestyles have changed drastically over the past 100 years. Advanced Glycation End products (AGEs), and glycated or oxidized lipids and proteins from endogenous and exogenous sources, trigger a state of chronic inflammation. This state of chronic inflammation is further aggravated by mental stress, environmental pollution and epigenetic changes.

In the case of Type 1 diabetes (T1D), this chronic inflammation leads to insulitis and auto immune destruction of the insulin producing beta cells. The situation is aggravated by insulin resistance and hormonal imbalances.

In the case of Type 2 diabetes (T2DM), the chronic inflammation, increasing blood glucose levels and insulin resistance (defects in insulin receptor function, intracellular glucose transport and insulin signalling) lead to glycotoxicity.

Type 3 c Diabetes (T3cDM) also known as Pancreatogenic Diabetes is now being increasingly recognised. Damage to the pancreas disrupts the complex interplay of nutrient digestion, absorption, and utilization at different levels. Endocrine dysfunction represents deficiency of Insulin, Glucagon, Pancreatic Polypeptide PP and Incretin hormones.

However, there is encouraging news for all those who wish to prevent and aim for Remission of Diabetes. Recent developments in the field of stem cell therapy have shown that replenishing pancreatic beta cells leads to remission of diabetes. Further, major lifestyle intervention trials have demonstrated that exercise and diet can prevent and even cause remission of diabetes.

The Finnish Diabetes Prevention Study (DPS) of 3.2 years duration was one the first controlled, randomized studies to show that type 2 diabetes is preventable with lifestyle intervention. The risk of diabetes was reduced by 58% by the intensive lifestyle intervention. (Tuomilehto J et al, N Engl J Med, Vol.344,No.18;1343-50)

The results of the above Finnish Study have been reproduced by the Diabetes Prevention Program DPP ( 2.8 years) in which lifestyle intervention showed a similar 58% reduction and was superior to Metformin
(DPPRGroup, N Engl J Med, Vol.346,No.6:393-403).

The IDPP – Indian Diabetes Prevention Program (3 years) showed that consistent lifestyle modification or therapeutic intervention with Metformin could prevent or delay progression of impaired glucose tolerance (IGT) to Diabetes (Ambady Ramchandran et al, Diabetes Care Vol.30. No.10; 2548-2552).

A very encouraging study for Prevention and Remissions of Diabetes PROD is a recent, relatively shorter, 16 weeks lifestyle intervention study. (McInnes N et al, J Clin Endocrinol Metab 102: 1596–1605, 2017).

The authors conclude that “A short course of intensive lifestyle and drug therapy achieves on-treatment normoglycemia and promotes sustained weight loss. It may also achieve prolonged, drug-free diabetes remission and strongly supports ongoing studies of novel medical regimens targeting remission.”
At 8 weeks, 50.0% of the 8-week intervention group achieved normoglycemia.(vs 3.6% in controls)
At 16 weeks, 70.4% in the 16-week group achieved normoglycemia (vs 3.6% in controls)
Twelve weeks after completion of the intervention, 21.4% of the 8-week group and 40.7% of the 16-week group met HbA1C criteria for complete or partial diabetes remission.

One of the most encouraging studies is a multi modal lifestyle intervention study done by Dr. Parimal Swamy and Dr. Vishal Kastwar. The findings were presented in the 7th World Congress of Diabetes India 2017.

The unique feature of this multi modal intervention is Biofeedback Assisted Breathing Exercises (BABE), Emotional Brain Training (EBT) and 3 sessions of short duration compound exercises lasting for around 10 minutes each. The intervention was for 12 weeks in 24 T2DM patients, with duration of diabetes ranging from 1 to 10 years.

Substantial improvements were seen in body mass index -BMI, systolic and diastolic blood pressure, HbA1c, and glycemic control (the study may be published soon).

For further details please contact Dr. Parimal Swamy, email – drparimals@gmail.com

There are over 40 clinical trials of natural substances which act on the root causes and pathways leading to diabetes. Many of them are part of our food chain and can safely help in Prevention and Remission of Diabetes.

In addition to diet and exercise, these natural substances are capable of Awakening or Activating the Endogenous Antioxidant, Defense and Repair systems. They also inhibit chronic inflammation, they ‘Awaken the Power Within’, to prevent and combat Diabetes, Hypertension and various chronic inflammatory diseases

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