Evaluation of a local healthy moderate carbohydrate (LHMC) diet and structured exercise for diabetes remission in early type 2 diabetes mellitus: A nutrition intervention study from India

Abstract

Background

Lifestyle interventions can promote type 2 diabetes mellitus (T2D) remission, but prospective evidence on culturally adapted Indian Local Healthy Moderate Carbohydrate (LHMC) diets are limited.

Objective

To assess remission and metabolic changes associated with a tailored LHMC diet combined with structured physical activity in adults with early T2D.

Methods

This prospective, single-arm interventional study included adults with T2D duration ≤2 years from two centres in Maharashtra, India (n = 87). The 6-month intervention comprised a culturally adapted, LHMC diet and daily structured exercise. Glucose-lowering medications were discontinued at intervention initiation. The primary endpoint was diabetes remission, defined as HbA1c of <6.5% measured at least 3 months after stopping glucose lowering medications. Secondary outcomes included anthropometry, biochemical and continuous glucose monitoring (CGM) measures; diet and exercise adherence were monitored.

Results

Seventy-five participants completed the 6-months intervention, with an estimated remission rate of 60.9% under the missing-at-random assumption. Clinically meaningful improvements were observed in weight, waist circumference, HbA1c, and lipid profile. Higher exercise adherence was independently associated with remission, in the context of baseline reduction of approximately 500 kcal/day. CGM metrics were more favourable in the remission group.

Conclusion

In this single-arm cohort of adults with early T2D, a culturally tailored LHMC diet combined with consistent exercise was associated with a 60.9% remission rate and improvements in metabolic parameters. The absence of a comparator limits causal inference; therefore, findings are hypothesis-generating and warrant confirmation in controlled studies. The results support the potential of scalable, region-specific lifestyle interventions in routine care.

Clinical trial registry number and website

This study is registered with Clinical Trial Registry of India. (CTRI Reg. Date 18/08/2023 CTRI Reg. No. CTRI/2023/08/056,621).

Statement of novelty

This work is the first to demonstrate more than 60% diabetes remission rates in recent-onset T2D using a culturally tailored, moderate calorie (around 1200 kcals) moderate-carbohydrate Indian diet and a simple, scalable walking-based regimen, rather than very low-calorie or highly restrictive diets that dominate existing remission trials. It is also novel in prospectively evaluating exercise adherence alongside CGM-derived metrics as practical, significantly associated predictors of remission in a real-world setting, despite not being prespecified.