Thesis Defence: Evaluating the impact of a community healthcare provider-led nutrition-based type 2 diabetes remission intervention on glycemic management and medication use

Yuan Ji, supervised by Dr. Jonathan Little, will defend their thesis titled “Evaluating the impact of a community healthcare provider-led nutrition-based type 2 diabetes remission intervention on glycemic management and medication use” in partial fulfillment of the requirements for the degree of Master of Science in Health and Exercise Sciences.

An abstract for Yuan Ji’s thesis is included below.

Defences are open to all members of the campus community as well as the general public. Registration is not required for in-person defences.

Abstract

Introduction: Emerging evidence indicates that remission of type 2 diabetes (T2D) is achievable through nutritional approaches. However, their effectiveness has yet to be tested in real-world settings.

Objective: To evaluate the effectiveness of a community healthcare provider-led nutrition intervention for T2D remission on glycemic management and medication use.

Methods: This quasi-experimental study was facilitated by community-registered dietitians and pharmacists. Adults with T2D self-selected to either a 12-week intensive whole-food ketogenic diet (KD, <50g of carbohydrates/day) or a low-calorie, low-carbohydrate commercial weight-loss diet (LCAL, 900-1100 kcal/day). Continuous glucose monitoring (CGM) was used to assess glycemic outcomes at baseline, weeks 1-2, and weeks 13-14. The primary outcome was change in CGM-derived average sensor glucose across the intervention period for the overall cohort. Secondary outcomes included additional CGM metrics and medication effect score (MES), which reflects glucose-lowering medication intensity. Exploratory analyses examined within-diet changes and between-group differences.

Results: The majority of participants (n=59) selected the KD compared to the LCAL diet (n=21). Overall, there were significant improvements in almost all CGM metrics, in the cohort as a whole and within each group, at both weeks 1-2 and weeks 13-14. This included reductions in average sensor glucose, coefficient of variation (CV%), SD, and time above range (TAR), along with significant increases in time in range (TIR) and time in tight range (TITR) (all p<0.01). Time below range (TBR) remained unchanged throughout the intervention. In exploratory between-group analyses, the only significant difference detected was for TITR, which was higher in the LCAL group at both CGM timepoints. Glucose-lowering medications decreased significantly, with MES reduced by -0.7 (arbitrary units; 95% CI, -0.9, -0.5) at 12 weeks for the overall cohort. Total daily energy intake decreased significantly in the LCAL group at week 12 compared with baseline (p=0.012) but did not change significantly in the KD group (p>0.05). Carbohydrate intake decreased significantly in both groups (both p<0.05).

Conclusions: A community healthcare provider-led nutrition-based T2D remission intervention led to significant improvements in CGM-derived glycemic outcomes and reduced medication burden over 12 weeks, supporting the feasibility of community-based nutritional strategies for T2D management.