Plant-Based Diet Shows Potential in Active Diabetes Remission

Diabetes remission is defined as maintaining a hemoglobin A_1c (HbA_1c) level of less than 6.5% for at least 3 months without the use of glucose-lowering medications. Although traditional type 2 diabetes (T2D) management has focused on pharmacological progression to slow the disease, new clinical evidence suggests that intensive lifestyle interventions (ILIs) can effectively achieve remission, particularly in patients diagnosed within the last 6 years.^1,2

In the REmission of diabetes using a PlAnt-based weight loss InteRvention (REPAIR) trial, investigators studied how a structured, plant-based approach can address the dual epidemics of obesity and diabetes in a multiethnic population.^1,2

“Dietary and clinical practice guidelines have recently shifted to recommending various plant-based dietary patterns for obesity, diabetes, and cardiovascular disease management,” the study investigators said.¹ “Given the evidence for plant-based dietary patterns in diabetes prevention and management and their potential to provide metabolic benefits beyond weight loss, there is an opportunity to assess the effect of a plant-based ILI for diabetes remission since all previous studies on ILIs have used dairy-based meal replacements and mainly omnivorous dietary patterns.”

The Shift Toward Clinical Remission

Plant-based diets can address impairment of insulin sensitivity and beta-cell function by reducing calorie density while providing high fiber and water content, which naturally supports weight loss and satiety. The paradigm of T2D care is shifting from lifelong symptom management toward the goal of reversing the underlying metabolic dysfunction. Historically, bariatric surgery and low-calorie diets with meal replacements have been the primary methods for reaching this target.^1-3

Beyond simple caloric restriction, animal-derived products contain heme iron, which acts as a pro-oxidant that can damage insulin-producing pancreatic cells. Furthermore, animal proteins are rich in branched-chain amino acids that are associated with insulin resistance, whereas plant-derived polyphenols can inhibit pathways that promote obesity and metabolic dysfunction. By replacing animal fats with unsaturated fats and increasing prebiotic intake, these diets also improve the gut microbiome, leading to reduced systemic inflammation and enhanced glucose homeostasis.^2,3

In the REPAIR trial, investigators introduced a 2-phase plant-based ILI designed to achieve weight loss of 15% or more, which is recognized as a threshold for metabolic recovery.¹

The intervention began with a 12-week total diet replacement (TDR) phase using plant-based shakes, followed by a 40-week maintenance phase centered on the Portfolio Diet, a pattern rich in plant proteins, nuts, and viscous fibers. Unlike previous trials that relied on dairy-based meal replacements, this research explores the additional metabolic benefits of plant-source foods that may improve health outcomes independent of weight loss.¹

“The REPAIR trial will generate the first high-quality Canadian evidence on a plant-based ILI for diabetes remission, weight loss, and additional cardiometabolic benefits and provide insights into behavioral strategies for sustaining remission,” the study authors said.¹ “These findings provide Canadian context to inform national nutrition and health policy, clinical guidelines and provide a readily implementable clinical public health solution using plant-based ILIs to address the burden of obesity and diabetes and downstream complications in Canada and beyond.”

The Pharmacist’s Role in Diabetes Care

For pharmacists and clinical teams, the rapid physiological response to these interventions requires vigilant medication monitoring and de-prescribing. Research from the American College of Lifestyle Medicine indicates that transitioning to a whole-food, plant-based diet can cause immediate drops in blood glucose and blood pressure, creating a risk of hypoglycemia or hypotension if medications are not adjusted promptly.^1,2

In the REPAIR trial, study physicians follow established protocols to stop or reduce antihyperglycemic and antihypertensive therapies at the baseline visit to account for these swift changes. Pharmacists are essential in this ecosystem, as they must identify patients who may need urgent dosage reductions to avoid adverse events while they adhere to intensive therapeutic lifestyle changes.^1,2

It is crucial for health care providers to distinguish between different types of plant-based patterns, as not all are equally beneficial. A healthy plant-based diet focused on minimally processed foods—such as fruits, vegetables, and whole grains—is associated with a 15% lower risk of diabetes. Conversely, an unhealthy plant-based diet heavy in refined grains, sweets, and sugar-sweetened beverages shows no such protective association.³

Pharmacists can support patients by emphasizing that the omission of red meat is a significant driver of reduced diabetes risk, whereas avoiding other animal products like dairy or eggs appears to have a more neutral effect on average. The integration of innovative plant-based foods, such as meat and dairy alternatives, can also help lower barriers for patients who are transitioning away from a traditional Western diet.^1,3

READ MORE: Diabetes Resource Center

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REFERENCES

1. McKay B, El Chaar D, Paquette M, et al. Rationale and design of a parallel randomised trial of a plant-based intensive lifestyle intervention for diabetes remission: The REmission of diabetes using a PlAnt-based weight loss InteRvention (REPAIR) trial. Diabetes Obes Metab. Published online February 2, 2026. doi:10.1111/dom.70510

2. American College of Lifestyle Medicine. The benefits of plant-based nutrition: Treatment and prevention of type 2 diabetes. March 31, 2023. Accessed February 2, 2026. https://lifestylemedicine.org/benefits-plant-based-nutrition-type2-diabetes/

3. Mozaffarian D. Plant-Based Diets and Diabetes Risk: Which Foods, What Mechanisms?. Diabetes Care. 2024;47(5):787-789. doi:10.2337/dci24-0011