A 1-year, multipart lifestyle intervention helped improve glycemic control and kidney function and reduce dependence on medication in patients with type 2 diabetes (T2D) at risk for chronic kidney disease (CKD), new data suggested. CKD is a common complication of T2D.

The intervention, delivered both individually and in groups, included a whole food, plant-based diet; progressive intermittent fasting and water fasting; targeted muscle activation; yoga; stamina-building exercises; psychological positive-mindset practice; and regular physician consultations and was conducted at the Freedom from Diabetes Clinic in India.

Stress Release Among Components

“The psychological component included stress release with journal writing and meditations. Individual counseling was given by trained psychologists,” said Nidhi Kadam, PhD, MSc, Head of Research for the Freedom from Diabetes Research Foundation in Pune, India. Kadam presented the study Monday at American College of Lifestyle Medicine (ACLM) 2025.

“While drugs are standard treatment, lifestyle interventions can improve metabolic and kidney health,” Kadam said. She said the program included having a dedicated physician for drug dose adjustments. She added that adherence to diet was the easiest part of the intervention for patients because of the preponderance of vegetarians in India; exercise was the more difficult component.

This retrospective study analyzed data from 1131 adults with T2D recruited from the Freedom from Diabetes clinic between June 2020 and March 2024. Those eligible had a urine albumin-creatinine ratio (uACR) greater than 30 mg/g and varying estimated glomerular filtration rates (eGFR).

Medical history and biochemical data were collected at baseline and after the intervention. Patients were grouped into CKD risk groups based on the KDIGO 2012 guidelines: moderate risk (uACR, 30-300 mg/g) and high risk (> 300 mg/g), with eGFR ranging from normal (≥90 mL/min/1.73m²) to severely reduced (15 mL/min/1.73m²).

The median age of participants was 56 years (63% men), and the average duration of disease was 13.8 years. BMI average was 26.7 kg/m²; A1c average was 8.2%.

At baseline, almost all patients (95%) were taking oral hypoglycemic agents, and 27% of the patients were taking insulin. Among those on comorbidity-related medications, 67% (n = 756) used statins and 77% (n = 867) took CKD-related medications.

Medication Use Decreased Post-Intervention

After the intervention, more than one fifth (22%) discontinued their statins and 50% discontinued their CKD-related medications, the researchers reported.

Additionally, A1c levels dropped from 8.2% to 6.9%, BMI decreased from 26.7 to 24.9 kg/m², uACR dropped from 73.1 to 33.9 mg/g, and eGFR improved significantly (97 vs 96 mL/min/1.73m²; P < .001 for all).

At baseline, 79% (n = 894) were at moderate CKD risk, with 52.9% transitioning to low risk (uACR < 30 mg/g with a normal eGFR) post-intervention. Among high-risk patients (21%, n = 237), 10.5% improved to low risk (P < .001). 

“Notably, 85% of those who transitioned to low risk also eliminated the need for CKD medication,” the researchers wrote. “Among the 261 patients not on CKD medication at baseline, 89% were at moderate risk and 11% were at high risk, with 55.1% improving to low-risk post-intervention (P < .001).

Kadam said her team plans to test the intervention against a control group in a coming study.

‘Amazing Results’

“This intervention, Freedom from Diabetes, happens to be a Lifestyle Medicine Certified Program, meaning they have previously published outcome data showing health improvements among their patients,” Micaela Karlsen, PhD, MSPH, senior director of research for ACLM told Medscape Medical News. “They use a comprehensive lifestyle approach of nutrition, physical activity, and psychological components, and they have amazing results, both clinically meaningful and statistically significant improvements in a variety of metrics.”

The mean drop in A1c was a big drop, Karlsen noted, and likewise, the BMI drop represents a substantial change in category from overweight to normal weight. “There were also reductions and discontinuation of CKD medication. These are the kind of outcomes that inspire both clinicians and other patients,” she said.

The authors and Karlsen reported having no relevant financial disclosures. 

Marcia Frellick is a Chicago-based healthcare journalist and a regular contributor to Medscape Medical News.