Grant: Team Grant: UK-Canada Diabetes Research Team Grants

Eating more than we need and not being physically active enough can lead to a form of diabetes called type 2 diabetes (T2D). Now we have evidence that in people with T2D, with a very strict and strong approach to reducing how much we eat, we can even reverse T2D in some people. The approach involves a low calorie diet including special shakes for a few weeks, that usually leads to losing a lot of weight. Afterwards, normal foods are brought back, through a careful eating plan. In the weeks that follow, though, you go back to shakes, if you start gaining weight. In a British study, more than one third of people who started this approach no longer had diabetes. We plan to test what happens when we combine this diet approach with an equally strong exercise program. The exercise program will involve going to a gym three times a week to work with an exercise specialist. She will help participants learn to exercise on a treadmill and to work with weights, weight machines, and resistance bands to build up muscle. After some weeks, participants will exercise at the gym on their own or at home, but they will stay in contact with the exercise specialist who will track their activity and heart rate remotely. If the exercise amount goes down, they will be brought back to the gym for supervision. With the 'flip of a coin,' we will assign some participants to their usual care; others to the low calorie diet and their usual activity; and others to the low calorie diet and the exercise program. In this study, we will see if the low calorie diet group and the low calorie diet & exercise group both do better than the usual care group in terms of 'reversing' their diabetes at 24 weeks from starting. We will also look at other important aspects of health in study participants such as how stiff their hearts are, how fit they are, and what their mood is like. We will see if they like the different ways of trying to reverse diabetes.