Type 2 diabetes remission and its predictors in an Indian cohort: A retrospective analysis of an intensive lifestyle intervention program

Predictors of type 2 diabetes (T2D) remission following intensive lifestyle intervention (ILI) are poorly characterized, especially in high-risk populations, such as India. This study aimed to identify the key predictors of T2D remission after an ILI in an Indian population. This retrospective analysis included 2384 patients with T2D (age 30-75 years; body mass index (BMI) ≥23 kg/m² enrolled in an online one-year ILI program at the Freedom from Diabetes Clinic, India, between May 2021 and August 2023. The intervention included personalized plant-based diet, physical activity, stress management, and medical support. Remission was defined as maintaining glycated hemoglobin (HbA1c) < 48 mmol/mol (6.5%) for ≥3 months without glucose-lowering medications. Anthropometric and biochemical data were extracted from clinical records. Predictors were assessed using logistic regression analysis. Post- intervention, 744 patients (31.2%) achieved remission The remission group showed significantly greater improvements in weight (-8.5% vs. -5.2%), BMI (-8.6% vs. -5.2%), HbA1c (-15.3% vs. -12.4%), fasting insulin (-26.6% vs. -11.4%), and homeostatic model assessment of insulin resistance (HOMA-IR) (-37.3% vs. -19.7%), than the non-remission group (p <0.05). The predictors of remission included age (≤50 years), higher BMI (≥25 kg/m²), drug-naïve status, shorter disease duration (≤6 years), juice fasting, baseline HbA1c <7%, weight loss >10%, and post-intervention HOMA-IR <2.5 (p <0.05). Our findings demonstrate that a significant proportion of individuals with T2D can achieve remission through a comprehensive culturally adapted lifestyle program. The identification of both baseline and post-intervention predictors underscores the importance of early, personalized, and holistic care in diabetes management.