Reversing Diabetes: The Weight that PTs Should Focus On

TLDR:

• A new RCT showed a dramatic improvement in remission rates: After 12 months, the intensive treatment group (hypoglycemic agents + high-protein diet + moderate exercise) saw 73.3% of prediabetes patients return to normoglycemia and 86.7% of T2D patients achieve diabetes remission—versus just 7.7% and 16.7% respectively in the standard treatment group

• Substantial weight loss: Participants in the intensive group lost an average of 19.3 kg, compared to only 1.5 kg in the standard group. The net difference was –17.77 kg, favoring the intensive group.

• Widespread health improvements: The intensive group also experienced larger reductions in body fat percentage, visceral fat area, and liver fat (assessed via hepatic controlled attenuation parameter), all with statistical significance compared to standard treatment

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- Nutrition interventions for chronic diseases (e.g., obesity, diabetes, cardiovascular diseases)

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Transcript:

Hey y'all, Dr. Wells here from St. Augustine Beach. I'm out by my giant Lang Lang tree here with a cool new research update. This one I think you guys will really like because it's focused on diabetes and its importance on reversing diabetes.

Yes, I said reversing diabetes. So a lot of people think about diabetes is just management but I think what we as rehab professionals need to start thinking about is how can we reverse our the diseases and particularly diabetes in some of our patients, right? This was written by Zhang et al. in BMC Medical 2025.

Effects of hypoglycemic agents with weight loss effect plus a high protein diet and moderate exercise of diabetes remission in adults with obesity and type 2 diabetes. It's a randomized controlled trial. 61 people in the group overall.

They were split into two groups. One receives standard interventions. So this is what our patients probably commonly get, right? So they get education around hey, you need to reduce your intake of sugar-sweetened beverages, eat more fruits and vegetables, and try to walk 30 minutes five times a week or moderate exercise, you know, 30 minutes five times a week.

So that was kind of the standard treatment. But then the intervention group, they receive that education and that intervention, if you will, plus they got a moderate exercise routine and a high protein diet. So when I actually looked at the diet, it wasn't really considerably high from protein.

It was actually 50% carbohydrates, 25 grams from protein, excuse me, not 50 grams, 50% from carbohydrates, 25% for protein, and 25% from fats. From macronutrient distribution, it's pretty kind of a regular diet. I wouldn't say it's high protein.

Now the exercise prescription though I think was definitely more robust. So 150 to 200 minutes of moderate aerobic exercise per week plus two to three times a week of resistance training. So you think that's definitely more robust than say 30 minutes times five.

So that's 150 minutes in the standard group. However, when you looked at the difference, 12 month follow-up, those that followed the intervention group lost 42 pounds in body weight. Moreover, those that were in that intervention group had a significant rate of remission of diabetes.

So what this means is basically those in the placebo group or the standard treatment group lost no weight. And this is what we see often in our physical therapy practices, right? It's like our patients that had diabetes, they come in with that rotator cuff repair, they come in next year and they still have lower back pain or some other issue or Achilles tendinopathy, they still have diabetes, right? They haven't changed. They're still on semi-glutides or whatever they're working on to try to get their their body weight down and their blood sugar controlled.

But at the end of the day, what we're realizing is maybe we're missing the mark in the exercise component, right? So those that lost the weight had a significant improvement in their diabetes remission. And they also had a significant improvement in weight loss. So what this means is weight loss is tied to diabetes and diabetes remission.

So as physical therapists, we're doing a disservice to just sort of give them the standard treatment. Like here you go, try to walk, try to drink less sugar beverages. So what we need to focus on is giving them that better exercise prescription that's more robust and more focused on that higher rate of aerobic exercise per week, that 150 to 200 minutes, as well as adding in some resistance training and giving them a better prescription around diet, right? So like 50, 25, 25, it's kind of a very balanced diet.

It doesn't seem that crazy and out there. To help promote that 500 calorie deficit per day to promote the weight loss to get them in remission, right? Because we know once they're out off of diabetes or their diabetes goes in remission, we know that their rates of chronic tendinopathy, their rates of of rotator cuff tears, those things go way down. So hey, if you like this, we have more content about diabetes and weight loss in our board approved nutrition courses for physical therapists.

So check it out, nutritionalphysicaltherapy.com. Sign up today and get certified as a nutritional physical therapist. Make it a great one. Bye.