Sustained Insulin Independence Following Lifestyle Intervention in a 78-Year-Old Patient With Long-Standing Type 2 Diabetes: A Six-Year Follow-Up Case Report

Insulin dependence in elderly patients with long-standing type 2 diabetes (T2D) is common due to progressive β-cell decline, and insulin withdrawal is rarely considered. Evidence on sustained insulin discontinuation and long-term glycemic stability following intensive lifestyle interventions (ILIs) in elderly patients with long-standing T2D is limited. This case report describes a 78-year-old man with a 40-year history of T2D and 31 years of insulin therapy who achieved insulin independence after a structured ILI program. The multidisciplinary protocol incorporated a whole-food, plant-based diet, intermittent fasting, yoga, resistance training, and stress management, with medication deprescription guided by the Research Society for the Study of Diabetes in India-Endocrine Society of India (RSSDI-ESI) Therapeutic Wheel, monitored through daily remote tracking of glucose levels. Insulin was successfully tapered and discontinued within the first month of enrolment. At 10 months, weight decreased from 71.9 to 62.5 kg, body mass index (BMI) from 24.9 to 21.6 kg/m², and glycated hemoglobin (HbA1c) from 7.0% to 6.6%. Lipids and inflammation improved (triglycerides, 59 to 41 mg/dL; high-density lipoprotein cholesterol (HDL-C), 53 to 62 mg/dL; high-sensitivity C-reactive protein (hs-CRP), 0.7 to 0.3 mg/L), and renal function remained stable. At the 77-month follow-up, the patient maintained an insulin-free status on minimal oral therapy (gliclazide), with stable weight (63.5 kg) and HbA1c (6.6%). Fasting insulin (4.2 μU/mL) and C-peptide (1.36 ng/mL) levels confirmed preserved endogenous insulin secretion. This case illustrates that even elderly patients with very long-standing T2D may achieve sustained insulin withdrawal in the context of comprehensive ILI, underscoring the importance of integrating lifestyle medicine into diabetes care to reduce polypharmacy and enhance long-term outcomes.