Retrospective Evaluation of the Impact of a Multidisciplinary One-Year Online Lifestyle Intervention on Type 2 Diabetes Remission in Nonobese Indian Patients.

Background and Objective: Despite the high prevalence of T2D among nonobese Indians, there is a notable lack of comprehensive lifestyle intervention studies that target this population. This retrospective study was aimed at filling this gap by evaluating the impact of a multidisciplinary 1-year online intensive lifestyle intervention (ILI) on T2D remission in nonobese Indian patients. Methodology: Retrospective data from medical records of 1453 nonobese patients (BMI 18.5-24.9 kg/m²) (aged > 18 years) who participated in a 1-year online subscription-based ILI program at the Freedom from Diabetes Clinic, India, between June 2020 and October 2023 were extracted for analysis. The program included a plant-based diet, physical activity regimens, psychological support, and medical management. Homeostatic model assessment of insulin resistance (HOMA2-IR) and beta cell function (HOMA2%B) were calculated. Remission was defined as maintaining glycated hemoglobin (HbA1C) < 6.5%, measured at least 3 months after cessation of glucose-lowering pharmacotherapy. Results: The study included 1453 patients (72% male), with a median age of 53 years (IQR: 15), BMI of 23 kg/m² (IQR: 2.2), and diabetes duration of 10.5 years (IQR: 10.4). Postintervention, significant changes were observed, including a reduction in weight (-1.5 kg), fasting blood glucose (-13.2 mg/dL), fasting insulin (-0.4 μU/mL), HOMA2-IR (-0.07), and HbA1c (-1.2%), along with an increase in HOMA2%B (+3.1) (p < 0.05). Remission was observed in 24% of the patients. The study identified the baseline predictors of remission as being over 40 years of age at onset, having a diabetes duration of less than 6 years, maintaining good glycemic control (HbA1C ≤ 7%), and being drug-naïve. Postintervention factors, such as weight loss and improved beta cell function, were also significant predictors of remission (p < 0.05). Conclusion: These findings suggest that a multidisciplinary lifestyle intervention program can significantly improve glycemic control and promote T2D remission in nonobese Indian patients in a real-world setting, thereby highlighting the importance of early intervention and weight management in this population. Trial Registration: Clinical Trials Registry of India identifier: CTRI/2024/03/064596.