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

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

No power calculation reported (low): No power calculation reported

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

Regular insulin 8 units daily plus human insulin 50/50 32 units daily at baseline; complete discontinuation by one month and maintained at 77 months.

Insulin was tapered and fully stopped within one month, and the patient remained insulin-free at 77 months while continuing oral therapy.

HbA1c 7.0% at baseline and 6.6% at 77 months.

HbA1c decreased modestly from 7.0% at baseline to 6.6% at 77 months, with a lowest reported value of 6.1% at 56 months.

Fasting blood glucose 108.3 mg/dL at baseline and 85.3 mg/dL at 77 months.

Fasting glucose decreased from 108.3 mg/dL at baseline to 85.3 mg/dL at 77 months in this single case.

Weight 71.9 kg at baseline and 63.5 kg at 77 months.

Body weight decreased from 71.9 kg to 63.5 kg at 77 months, showing long-term maintenance of lower weight in this case.

QUICKI 0.31 at baseline and 0.39 at 77 months.

QUICKI increased from 0.31 to 0.39 by 77 months, suggesting improved insulin sensitivity, but this is a surrogate measure from one patient.

All fasting values remained above the ADA Level 1 hypoglycemia threshold during May-September 2019, with no rescue intervention required.

The report states there were no hypoglycemic events during insulin withdrawal, based on daily glucose monitoring.

A multicomponent lifestyle program using plant-based nutrition, intermittent fasting, physical activity, behavioral support, remote monitoring, and physician-guided medication management.

Positive: 6; Negative: 0; No effect: 0; Mixed: 0

Extracted 6 outcome signals across the study

Most reported outcomes moved in a favorable direction, but evidence comes from one uncontrolled case.

↓ Total daily insulin dose: insulin stopped within one month and remained discontinued at 77 months

↓ HbA1c: 7.0% at baseline to 6.6% at 77 months

Mostly intermediate or surrogate outcomes

The patient maintained insulin-free status for 77 months while continuing minimal oral therapy with gliclazide.

HbA1c stayed stable at 6.6% at final follow-up, with the lowest reported value of 6.1% at 56 months.

Fasting insulin and C-peptide at final follow-up suggested preserved endogenous insulin secretion.

Tripathi P, Kadam NS, Kathrikolly T, Ganla M. Sustained insulin independence following lifestyle intervention in a 78-year-old patient with long-standing type 2 diabetes: a six-year follow-up case report. Cureus. 2026;18(4):e107273. doi:10.7759/cureus.107273

Single-patient case report with no control group.

Multiple intervention components were introduced together.

The patient continued oral glucose-lowering medication, so this was insulin independence, not medication-free remission.

Findings may not generalize to frailer adults or those with lower beta-cell reserve.

A single older man with long-standing type 2 diabetes stopped insulin after a structured lifestyle program and maintained HbA1c near 6.6% for 77 months.

↓ Body weight: 71.9 kg at baseline to 63.5 kg at 77 months

Whole-food plant-based diet, physical activity, stress management, daily glucose tracking, and physician-guided medication deprescription over 77 months.

Structured intensive lifestyle intervention with physician-guided medication deprescribing

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

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

Lifestyle program helped an older man stop insulin long term

This case report describes one 78-year-old man with type 2 diabetes who followed a structured lifestyle program. He stopped insulin within one month and maintained stable blood sugar control for more than six years, but the single-patient design means the result may not apply broadly.

Insulin withdrawal was supervised with daily glucose monitoring.

The patient continued gliclazide at final follow-up.

The lifestyle program included diet, exercise, stress support, and medication management together.

A structured lifestyle program for insulin deprescribing in one older man with type 2 diabetes.

Older adults with type 2 diabetes and long-term insulin use may find this hypothesis-generating.

The case most closely applies to carefully selected patients with preserved C-peptide and close clinical supervision.

It does not prove that similar patients can safely stop insulin without medical oversight.

Intervention	Outcome	Measured Change	Study Effect
Multidisciplinary lifestyle intervention for type 2 diabetes remission (Behavioral & Lifestyle)	Body weight (Weight & Anthropometrics)	Decrease	Mixed
Multidisciplinary lifestyle intervention for type 2 diabetes remission (Behavioral & Lifestyle)	Daily insulin dose (Glycemic Control)	Decrease	Mixed
Multidisciplinary lifestyle intervention for type 2 diabetes remission (Behavioral & Lifestyle)	Fasting Plasma Glucose (Glycemic Control)	Decrease	Limited
Multidisciplinary lifestyle intervention for type 2 diabetes remission (Behavioral & Lifestyle)	HbA1c (Glycemic Control)	Decrease	Limited
Multidisciplinary lifestyle intervention for type 2 diabetes remission (Behavioral & Lifestyle)	Hypoglycemia events (Safety)	Uncertain	Limited
Multidisciplinary lifestyle intervention for type 2 diabetes remission (Behavioral & Lifestyle)	Insulin sensitivity (Metabolic Health)	Increase	Limited

Lifestyle program helped an older man stop insulin long term

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