Understanding Artificial Pancreas Systems: Results from a 24-Month Trial

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Non-randomized (moderate): Randomization not used or not reported

No control group (high): Single-arm or uncontrolled design

Open-label or unblinded (moderate): No blinding reported

High risk of bias (high): Overall bias rated high

{"intervention_arm_id":"arm_1","reference_arm_ids":[],"comparison_type":"pre_post"}

HbA1c reduction: -15.3% (remission) vs -12.4% (non-remission), Group x Time p<0.001

HbA1c decreased by 15.3% in the remission group compared to 12.4% in the non-remission group (p<0.001 for group x time interaction). Overall cohort improved from 7.5% to 6.4% (median values).

Weight change: -8.5% (remission) vs -5.2% (non-remission), Group x Time p<0.001

Body weight decreased by 8.5% in the remission group compared to 5.2% in the non-remission group (p<0.001 for group x time interaction). Weight loss >10% was the strongest predictor of remission (AOR 4.1).

BMI change: -8.6% (remission) vs -5.2% (non-remission), Group x Time p<0.001

BMI decreased by 8.6% in the remission group compared to 5.2% in the non-remission group (p<0.001 for group x time interaction). Overall cohort improved from 27.0 to 25.2 kg/m².

FBG change: -13.2% (remission) vs -8.8% (non-remission), Group effect p<0.001

Fasting blood glucose decreased by 13.2% in the remission group compared to 8.8% in the non-remission group (p values <0.001 for time and group effects).

Fasting insulin change: -26.6% (remission) vs -11.4% (non-remission), Group x Time p<0.001

Fasting insulin decreased by 26.6% in the remission group compared to 11.4% in the non-remission group (p<0.001 for group x time interaction).

HOMA-IR change: -37.3% (remission) vs -19.7% (non-remission), Group x Time p=0.013

HOMA-IR decreased by 37.3% in the remission group compared to 19.7% in the non-remission group (p=0.013 for group x time interaction). Post-intervention HOMA-IR <2.5 was a significant predictor of remission (AOR 4.0).

HOMA-beta change: +3.3% overall (95% CI 0.05-7.30), p=0.317

HOMA-beta showed no significant change overall (3.3%, 95% CI 0.05-7.30, p=0.317). The remission group had higher baseline HOMA-beta (71.0 vs 44.9) indicating better preserved beta-cell function at baseline, but no significant group x time interaction (p=0.710).

Remission rate: 31.2% overall, 83% drug-naive, 24.2% on OHAs

31.2% of participants (744/2384) achieved diabetes remission, defined as maintaining HbA1c <6.5% without glucose-lowering medications for at least 3 months. Among drug-naive participants, remission was 83%. Among those on OHAs, 24.2% achieved remission.

A comprehensive one-year online lifestyle program culturally adapted for Indian adults with type 2 diabetes, combining plant-based diet, intermittent fasting, juice fasting, physical activity, psychological support, and physician-guided medication management delivered via a dedicated mobile application with a six-member care team.

Positive: 8; Negative: 0; No effect: 0; Mixed: 0

Direction counts recalculated from intervention outcomes due to mismatch with AI-provided counts.

Extracted 8 outcome signals across the study

31.2% remission rate demonstrates clinically meaningful benefit across multiple metabolic outcomes (weight, HbA1c, insulin resistance, beta-cell function) with statistical significance

Direction counts were recalculated from extracted outcomes because the AI-provided totals did not match.

↑ 31.2% of participants achieved diabetes remission after the 1-year program

Mostly intermediate or surrogate outcomes

Intensive lifestyle intervention led to clinically meaningful diabetes remission in nearly one-third of Indian adults with T2D

Shorter diabetes duration and drug-naive status were strong baseline predictors of remission

Weight loss >10% and lower post-intervention insulin resistance were key modifiable predictors

Tripathi P, Kadam N, Kathrikolly T, et al. Type 2 diabetes remission and its predictors in an Indian cohort: A retrospective analysis of an intensive lifestyle intervention program. PLoS One. 2025;20(10):e0333114. doi:10.1371/journal.pone.0333114

Retrospective design without a control group limits causal inference

Participants had higher socioeconomic status, limiting generalizability

Self-reported weight and height may introduce measurement bias

No long-term follow-up to assess sustainability of remission

An intensive lifestyle program combining plant-based diet, exercise, and stress management helped 31% of Indian adults with type 2 diabetes achieve remission, with better results in those with shorter disease duration.

↑ Drug-naive patients had 83% remission vs 24% in those on medications

↑ Weight loss >10% was the strongest predictor of remission (AOR 4.1)

Participants received 63 calls annually on average and attended monthly online group sessions. Daily self-monitoring of blood glucose via mobile app, medication adjustments by physicians based on real-time glucose trends.

Intensive lifestyle intervention (online, one-year)

No control group (high): No parallel control group reported

Includes self-reported outcomes (moderate): Self-reported outcomes used

Limited safety reporting (moderate): Safety reporting depth: not_reported

Intensive lifestyle program helps reverse type 2 diabetes in Indian adults, especially when started early

This study followed 2,384 Indian adults with type 2 diabetes through a one-year online lifestyle program. About 31% achieved diabetes remission, keeping their HbA1c below 6.5% without medication. Success was more likely in people who were younger, had diabetes for less than 6 years, lost more than 10% of their body weight, and had not yet started diabetes medications.

The program was subscription-based, which may have selected for motivated individuals

Remission was defined at one year; long-term sustainability is not yet known

Participants had online access and digital literacy, which may not be universal in India

Juice fasting as a predictor needs further research to confirm its independent role

Medication tapering followed clinical judgment, which may have varied between physicians

Intensive lifestyle intervention for type 2 diabetes remission in India

Indian adults with type 2 diabetes, especially those with shorter disease duration

People with type 2 diabetes who have not started glucose-lowering medications

Adults with T2D and BMI ≥23 kg/m² willing to follow a structured lifestyle program

Intensive lifestyle program helps reverse type 2 diabetes in Indian adults, especially when started early

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