LCMD for Type 2 Diabetes Remission: Evaluation of Effectiveness and Exploration of Individual Differences

Type 2 diabetes (T2DM) has become a major public health problem, and effective prevention and treatment strategies are urgently needed. Recently, the understanding of T2DM has shifted to "a disease that can be remission." Achieving remission, defined as HbA1c<6.5% without using glucose-lowering medications, has become a new treatment goal for T2DM. Evidence suggests that a low-calorie diet is an effective approach to induce remission. Our previous research (NCT05472272) also demonstrated that a low-calorie diet can achieve remission in Chinese T2DM patients.

However, adverse effects during the intervention, such as fatigue, appetite, and constipation, have become significant barriers to successful remission. These symptoms often result in poor adherence to the intervention plan and, consequently, failure to achieve remission. In traditional Chinese medicine (TCM), fatigue and constipation are typical symptoms of "Qi Vacuity", while hunger is more associated with "Yin Vacuity". "Herb is the food" is a unique concept in TCM. Integrating TCM herbs into a low-calorie diet may help alleviate these adverse effects and improve the likelihood of achieving diabetes remission.

This project aims to investigate the efficacy of a Low-Calorie Medicine Diet (LCMD) in achieving remission of T2DM among overweight/obese individuals through a randomized controlled trial. The investigators will also explore individual differences in achieving remission and elucidate the underlying biological mechanisms, focusing on the brain-gut-microbiota axis. By integrating theories from nutrition and TCM dietetics, this project seeks to provide a novel, evidence-based approach to the management of T2DM in Chinese populations.

Inclusion criteria

• Physician-diagnosed T2DM
• The history of T2DM less than 6 years
• Most recent HbA1c higher than 6.5%
• Body mass index: 24-45 kg/m2
• Fasting C-p ≥1.1 ng/ml
• Inability to provide informed consent

Exclusion criteria

• Type 1 diabetes, type 2 diabetes currently treated with insulin, or HbA1c ≥12%
• Cardiovascular events within 6 months before trial
• Current use of anti-obesity medications, eating disorders, dieting behaviors, or weight loss >5 kg within 6 months before trial
• Chronic kidney disease stage 3b or above (eGFR <30 mL/min/1.73m²)
• Any condition causing fluid overload, such as heart failure or liver cirrhosis
• Previously diagnosed psychiatric disorders (e.g., schizophrenia, post-traumatic stress disorder, obsessive-compulsive disorder), uncontrolled depression, or epilepsy
• Severe arthritis or active gout
• Active gallstone disease or known as asymptomatic gallstones
• Concurrent enrollment in another clinical trial
• Pregnancy, lactation, or planned conception during the study
• Substance abuse
• Known malignancy
• Comorbidities increasing dietary intervention risk (e.g., biliary disorders)
• Long-term use of antibiotics, corticosteroids, NSAIDs, or PPIs
• Chronic gastrointestinal disorders affecting gut microbiota (e.g., ulcerative colitis)
• Severe hepatic impairment (ALT >2.5× ULN)
• Inability to provide informed consent