North Texas Research Forum 2026

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Division

North Texas

Hospital

Medical City Fort Worth

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2026

Keywords

diabetes, GLP-1 receptor agonists, GLP-1, intensive therapeutic lifestyle change

Disciplines

Endocrine System Diseases | Internal Medicine | Medicine and Health Sciences

Abstract

BACKGROUND: GLP-1 receptor agonists are popular for managing type 2 diabetes (T2D) and obesity but are costly and can result in side effects including weight rebound. Intensive therapeutic lifestyle change (ITLC) programs present an effective alternative, facilitating an HbA1C (A1C) less than 6.5% for 3 months without medication and long-term weight control.

CASE PRESENTATION: We present a 69-year-old Black man with T2D, hypertension, chronic kidney disease, obesity, and sleep apnea. In 2023, he was hospitalized with a blood glucose of 800 mg/dL and A1C 10.8% and discharged on insulin. And, with a BMI of 32 kg/m2 and weight of 238.6 pounds, he began treatment with semaglutide. Insulin was discontinued and the semaglutide dose was gradually increased to 2mg weekly.  In one year, his A1C improved to 6.5% and weight decreased to 227 lbs. In 2024, he enrolled in an ITLC program for T2D remission based on the LEADR (Lifestyle Empowerment Approach for Diabetes Remission) curriculum, including shared medical appointments, diabetes and nutrition coaching, exercise sessions, psychological support, and continuous glucose monitoring (CGM).

14 weeks into the ITLC program, he discontinued semaglutide with an A1C of 5.7%. He maintained an A1C of 5.8% by program's end. His A1C fluctuated  but stabilized at 5.9% one year later without medication, indicating remission. At the start of the program, his waist circumference (WC) was 42 inches, BMI 32 kg/m², and weight 220.3 lbs. After one year, his WC was 37 inches, BMI to 28.5 kg/m², and weighed 198.2 lbs. His first 14 weeks on semaglutide, he lost 10 lbs (-4.6%) and 16 lbs (-7.4%) total by the program's end. Overall, he lost 21 lbs (-10%), including 12 lbs (-5.6%) after stopping semaglutide. His body fat decreased from 59.8 lbs (27%) to 50 lbs (22%) and visceral fat area from 126.4 to 93.8. He discontinued antihypertensive medication, improved his sleep apnea, engaged in pickleball, and reported increased energy. Through the ITLC program, he achieved diabetes remission and continues to maintain it.

CONCLUSION:

This case demonstrates that comprehensive ITLC programs can promote sustained weight loss, improve metabolic parameters, enhance quality of life, reduce cardiovascular risk, deprescribe medication, and achieve diabetes remission. Similar programs could provide scalable, provider and payer-friendly models for T2D remission to decrease reliance on GLP-1RAs and lower long-term healthcare costs

Original Publisher

HCA Healthcare Graduate Medical Education

Cost Effectiveness of Lifestyle Program for Diabetes Remission in the Era of GLP-1

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