Article Review: Whole-food, plant-based intervention for improving Type 2 Diabetes

A recent article published in September of 2024 compared the improvements of glycemic control and reduction in medication need using a plant-based diet intervention compared to the standard medical care. With more than 10% of adults world-wide having diabetes and the rising costs of medications for diabetes treatment, this study hits home to many people. Diet is one of the leading risk factors in diabetes, so can it also be one of the leading treatments?

Research has previously proven that the very low calorie diet can reduce HbA1c significantly (by 0.9%) and 46% of participants in early-stage T2DM had remission (compared to only 4% receiving the standard care treatment). The problem is, very low calorie diets are extremely difficult to adhere to and have health risks including headaches, dizziness, muscle cramps, and bone loss. Therefore, this study looked at using a whole-food, plant-based diet with emphasis on whole vegetables, fruits, legumes, whole grains, nuts, and seeds.

The study was a randomized control trial that compared a group being treated with whole-food, plant based diet and moderate exercise to a group receiving the standard care of glucose-lowering medications without diet or exercise changes. The plant-based group had strict guidelines to follow.

Week 1-12: received prepared meals and attended group exercise sessions and group instructional classes on nutrition, cooking, exercising, and managing stress. Hours of attendance decreased as the weeks went on to wean the intensity of support (Wk 1-2: 15-21hr/wk. Wk 3-6: 8-10hr/wk. Wk 7-12: 4-5hr/wk), the number of meals received also decreased as time went on (Wk 1-2: 12 meals/wk. Wk 3-6: 2 meals/wk. Wk 7-12: 1 meal/wk).

Week 13-24: followed the intervention on their own.

The diet was 35gm of fiber daily, low fat (20-25% of total calories with <7% from saturated fats), moderate protein (10-15% of total calories), and low sodium (<2400mg/day). The 1-2 weeks the majority of meals were provided and had little to no animal products in them as well as minimal ground grains and refined carbohydrates. In weeks 3-12 they could consume small amounts of animal products and processed foods, but the goal was 75-100% of energy was from whole, unprocessed plant foods.

The exercise was moderate-intensity aerobic and resistance exercise for 60min/day the first 1-2 weeks and then 30-60min/day for weeks 3-24. They also suggested to walk 10-20 minutes before breakfast and after lunch and dinner.

The research found that 8% of the plant-based group had remission while 0% of the standard medical care group had remission. In total 63% of the plant-based group lowered their baseline medication dose versus only 24% in the standard care group. Weight and waist circumference were also more improved in the plant-based group, however the changes to fasting glucose levels were decreased within the first 2 weeks of intervention suggesting that the improvements were from diet and exercise, not specifically weight loss.

The study really showed that quality over quantity is important. It also lends to the food is medicine framework. Although diabetes medications have an important role in type 2 diabetes treatment, some great changes can be made by changing diet and exercise.

References:

Hanick CJ, Peterson CM, Davis BC, Sabaté J, Kelly JH Jr. A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial. Diabetologia. 2025 Feb;68(2):308-319. doi: 10.1007/s00125-024-06272-8. Epub 2024 Sep 21. Erratum in: Diabetologia. 2025 Feb;68(2):471. doi: 10.1007/s00125-024-06332-z. PMID: 39305340; PMCID: PMC11732952.