Beta Cell Restoration Through Fat Mitigation

Inclusion Criteria

• Prior completion of at least two months in a diet, exercise and lifestyle intervention program within the past two years
• Fasting plasma glucose >90 mg/dl plus 2-hour glucose ≥140 mg/dl on 75 gm OGTT plus HbA1C ≤7.0%. There is no lower limit for the A1C and no upper limit for the OGTT 2-hour glucose based on prior studies that allow us to identify people with falling β-cell function
• Age 22-65 years
• Body mass index (BMI) 30-40 kg/m2
• For participants with diabetes, known duration 5.5 mmol/l)
• Anemia (hemoglobin 3 times upper limit of normal in local clinical lab
• Excessive alcohol intake
• Suboptimally treated thyroid disease
• Conditions or behaviors likely to affect the conduct of the study
• unable or unwilling to give informed consent
• unable to adequately communicate with clinic staff
• another household member is a participant or staff member
• current or anticipated participation in another intervention research project that would interfere with any of the interventions/outcomes
• likely to move away from participating clinic in next 2 years
• current (or anticipated) pregnancy and lactation.
• major psychiatric disorder that, in the opinion of clinic staff, would impede the conduct of the study
• weight loss >5% in past three months for any reason except postpartum weight loss.
• additional conditions may serve as criteria for exclusion at the discretion of the local site