Very-low-energy diet for type 2 diabetes: an underutilized therapy?

J Diabetes Complications. Jul-Aug 2014;28(4):506-10. doi: 10.1016/j.jdiacomp.2014.03.014. Epub 2014 Mar 29.

Abstract

Background: Current approaches to the management of type 2 diabetes focus on the early initiation of novel pharmacologic therapies and bariatric surgery.

Objective: The purpose of this study was to revisit the use of intensive, outpatient, behavioral weight management programs for the management of type 2 diabetes.

Design: Prospective observational study of 66 patients with type 2 diabetes and BMI ≥ 32 kg/m² who enrolled in a program designed to produce 15% weight reduction over 12 weeks using total meal replacement and low- to moderate-intensity physical activity.

Results: Patients were 53 ± 7 years of age (mean ± SD) and 53% were men. After 12 weeks, BMI fell from 40.1 ± 6.6 to 35.1 ± 6.5 kg/m². HbA1c fell from 7.4% ± 1.3% to 6.5% ± 1.2% (57.4 ± 12.3 to 47.7 ± 12.9 mmol/mol) in patients with established diabetes: 76% of patients with established diabetes and 100% of patients with newly diagnosed diabetes achieved HbA1c <7.0% (53.0 mmol/mol). Improvement in HbA1c over 12 weeks was associated with higher baseline HbA1c and greater reduction in BMI.

Conclusions: An intensive, outpatient, behavioral weight management program significantly improved HbA1c in patients with type 2 diabetes over 12 weeks. The use of such programs should be encouraged among obese patients with type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT02043457.

Keywords: Obesity; Type 2 diabetes mellitus; Very-low energy diet; Weight management.

Publication types

  • Clinical Trial
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Behavior Therapy*
  • Body Mass Index
  • Caloric Restriction*
  • Cohort Studies
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Energy Intake
  • Female
  • Foods, Specialized
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hyperglycemia / prevention & control
  • Male
  • Managed Care Programs
  • Meals
  • Michigan
  • Middle Aged
  • Motor Activity
  • Obesity / blood
  • Obesity / complications
  • Obesity / diet therapy*
  • Obesity, Morbid / blood
  • Obesity, Morbid / complications
  • Obesity, Morbid / diet therapy*
  • Weight Loss

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Associated data

  • ClinicalTrials.gov/NCT02043457