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Durrer, Cody

University of British Columbia

Introduction: Targeted nutritional approaches for treating type 2 diabetes (T2D) have garnered attention due to the increasing evidence base suggesting they can induce T2D reversal/remission. While physicians are typically at the centre of diabetes care, pharmacists are more accessible and patients with T2D make more visits to their pharmacist than primary care physician. Given their accessibility and expertise in medication management, community pharmacists may be ideally positioned to safely and effectively deliver nutrition interventions targeted at reducing diabetes medication use and promoting T2D remission. Aim and methods: The aim of the Pharmacist-led therapeutic carbohydrate restriction (Pharm-TCR) as a treatment strategy for T2D trial was to determine if a 12-week very-low carbohydrate, low-calorie diet - led by community pharmacists - could reduce the need for glucose-lowering medications and facilitate improvements in cardiometabolic health when compared to guideline-based treatment-as-usual (TAU). Second, we tested the hypothesis that fasting markers of beta-cell stress/function, liver adiposity, and liver function are improved following the Pharm-TCR intervention. Thus, a pragmatic community-based RCT following a parallel-group design was conducted through 12 community pharmacies throughout British Columbia, Canada (Paper 1: trial protocol). Results: Following the 12-week intervention, 35.7% of participants in the Pharm-TCR group were completely off all glucose-lowering medications compared to 0% in the TAU group (difference = 35.7%, [CI₉₅ 25.9 to 44.8%], p<0.0001). Among other cardiometabolic improvements, there were substantial improvements in A1c (-1.4% [CI₉₅ -1.8 to -1.0%]), body weight (-12.0 kg [CI₉₅ -13.6 to -10.4 kg]), and systolic blood pressure (-13 mmHg [CI₉₅ -17 to -8]) (Paper 2). We also observed improvements indices of liver adiposity, and liver function related to T2D (Paper 3; secondary/exploratory outcomes). Conclusions: The Pharm-TCR intervention led to a reduced need for glucose-lowering medications, improved glycemic control, weight loss, and reduced blood pressure compared to usual care. In addition, we observed improvements in markers of T2D pathophysiology, indicating that the Pharm-TCR intervention positively affected the underlying drivers of the disease. Overall, the Pharm-TCR intervention was effective in treating T2D and can be viewed as a pragmatic and viable strategy for implementing a nutritional intervention in the community for people with T2D.

Text

2021-08-19

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/79346

Kinesiology

University of British Columbia

UBCO

http://creativecommons.org/licenses/by-nc-nd/4.0/