INTRODUCTION

Chronic noncommunicable diseases are the leading cause of death and disease in the world¹. In Ecuador the situation is no different, according to the results of the STEPS survey on noncommunicable diseases and risk factors, conducted in 2018 to people between 18 and 69 years old, it was obtained that the percentage of people with overweight and obesity is 63.6% (95% CI: 61.8 - 65.4), of these the percentage of people with obesity reaches 25.7% (95% CI: 24.1 - 27.3), with respect to diabetes mellitus, the percentage of people with impaired fasting blood glucose (between 110 and 126 mg/dl) is 7.8% (95% CI: 6.8 - 8.9), of these the percentage of people with elevated fasting blood glucose (greater than 126 mg/dl) reaches 7.1% (95% CI: 6.1 - 8.1)².

Diabetes mellitus was the second leading cause of death in Ecuador in 2019, being directly responsible for 4,890 deaths³. The participation of this pathology in deaths in Ecuador has grown steadily and considerably in recent years (Figure 1), and may contain a significant underreporting since it is not always identified as the underlying cause of death, so the figure could be even higher.

Figure 1: Number of deaths due to Diabetes Mellitus 

There are abundant references worldwide that show that lifestyle medicine is effective in improving blood glucose levels in chronic patients with diabetes mellitus, often leading to the reversal of prediabetes or diabetes^4-6. Currently in Ecuador there is not much offer of reversal programs for chronic noncommunicable diseases, being the plan de Medicina de Estilo de Vida (MEV) of Dr. Marco Albuja, the pioneer reversal program of this type in the country, which consists of eight weeks of transition to a new lifestyle that includes plant-based diet, physical exercise, psychological support and constant clinical monitoring, and a subsequent monitoring of health conditions for at least one year.

Therefore, the objective of the present study is to determine if there are differences between the clinical characteristics before and after a diabetes reversal program in Ecuador.

METHODS

RESULTS

The final sample of the study was 8 patients,Table 1describes the characteristics of weight and biochemical tests taken before and after the program, variations are observed in all variables, such as decrease in weight (from 86.3 kg to 77.2 kg), decrease in glucose (from 143, 3 mg/dL to 102.28 mg/dL), in the case of lipids we found a decrease in cholesterol (from 209.9 mg/dL to 186.8 mg/dL) and LDL (from 134.1 mg/dL to 113.5 mg/dL), increase in HDL (from 43.6 to 47.5 mg/dl), a decrease in transaminases, as well as creatinine and urea.

Intabla 2we found that the variable glucose, uric acid, microalbuminuria, TSH and urea do not follow a normal distribution unlike the other variables.

Tabla 3shows the p-values according to the statistical tests performed to compare the values of the variables measured before and after the intervention program.

DISCUSSION

The results show that the reversal program "Lifestyle Medicine" significantly improves in 8 weeks the indicators related to the pathology of diabetes mellitus in the 8 patients analyzed, such as weight and glucose in which a significant reduction in the level of the variable is observed, and others in which the reduction is less; A similar result was found in a longitudinal study conducted in women, where a significant improvement in anthropometric measures (weight, BMI, body fat, lean mass) was obtained, but no comprehensive intervention was performed on the participants, so no metabolic data were collected, where similar results to our study could possibly be found⁸.

Likewise, most of the variables follow a normal distribution, with the exception of glucose, uric acid, microalbuminuria, TSH and urea. After performing normality tests, it is concluded that the following variables improved significantly after the "Lifestyle Medicine" reversal program: Weight, BMI, glucose, glycosylated hemoglobin, triglycerides, urea and TGP, this means that the implementation of lifestyle change programs are adequate to reduce the morbimortality of non-communicable diseases, such as diabetes mellitus, as well as to decrease its incidence, in addition these programs must have an adequate support team for the integral follow-up of the person, as pointed out in a longitudinal study conducted in adolescents with overweight or obesity, although they did not find significant results in all metabolic variables, such as cholesterol and uric acid levels, good results were obtained in the anthropometric variables⁹, as well as in a review study¹⁰which indicates that carrying out lifestyle interventions at an early age has positive long-term effects, such as greater awareness and basic knowledge on the subject, thus reducing the risk of non-communicable diseases in adulthood.

Among the limitations of the study we have the size of the sample and its selection, remember that the results obtained in this article are particular to the 8 individuals analyzed, and in order to extrapolate these results to a larger reference population it would be necessary to choose subjects at random using probability sampling techniques, choosing people of different ages, socioeconomic strata, gender, among others. This becomes difficult because it would imply having a source of funding so that the availability of economic resources does not generate a sample selection bias, in this study and in the MEV program analyzed, patients self-finance their participation.

Since there are few cases in this study, the statistical tests require a greater difference to be able to establish that this is statistically significant; the sample size may also be hiding the fact that other dimensions may show improvement in their levels, but this is not large enough to be considered significant given the greater standard error of the sample mean.

CONCLUSION

In conclusion, there is an improvement in some variables measured after taking the "Lifestyle Medicine" reversal program compared to baseline measures in the 8 patients monitored for 8 weeks. These were weight, BMI, glucose, glycosylated hemoglobin, triglycerides, urea and TGP. An intervention with more patients is recommended in order to improve the statistical significance of the tests and to have more robust conclusions that can be extrapolated to the general population