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Metabolic and cardiovascular effects of very‐low‐calorie diet therapy in obese patients with Type 2 diabetes in secondary failure: outcomes after 1 year
Author(s) -
Dhindsa P.,
Scott A. R.,
Donnelly R.
Publication year - 2003
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2003.00937.x
Subject(s) - medicine , very low calorie diet , weight loss , type 2 diabetes , body mass index , insulin , diabetes mellitus , obesity , surgery , endocrinology
Aims To evaluate the short‐term and 1‐year outcomes of an intensive very‐low‐calorie diet (VLCD) on metabolic and cardiovascular variables in obese patients with Type 2 diabetes (T2DM) and symptomatic hyperglycaemia despite combination oral anti‐diabetic therapy ± insulin, and to assess patient acceptability and the feasibility of administering VLCD treatment to this subgroup of patients in a routine practice setting. Methods Forty obese patients with T2DM (22 M, mean age 52 years, body mass index (BMI) 40 kg/m 2 , duration of T2DM 6.1 years) and symptomatic hyperglycaemia despite combination oral therapy ( n = 26) or insulin + metformin ( n = 14) received 8 weeks of VLCD therapy (750 kcal/day) followed by standard diet and exercise advice at 2–3‐month intervals up to 1 year. Insulin was discontinued at the start of the VLCD, and anti‐diabetic therapy was adjusted individually throughout the study, including (re)commencement of insulin as required. Results Immediate improvements in symptoms and early weight loss reinforced good compliance and patient satisfaction. After 8 weeks of VLCD, body weight and BMI had fallen significantly: 119 ± 19–107 ± 18 kg and 40.6–36.6 kg/m 2 , respectively, with favourable reductions in serum total cholesterol (5.9–4.9 m m ), blood pressure (10/6 mmHg) and fructosamine (386 ± 73–346 ± 49 µ m ) (equates to an HbA 1c reduction of approximately 1%). Sustained improvements were evident after 1 year, with minimal weight regain, e.g. mean body weight 109 ± 18 kg and BMI 37 ± 4 kg/m 2 . Glycaemic control tended to deteriorate after 1 year. Conclusions The absence of a control group is a major limitation, but the results indicate that 8 weeks of VLCD treatment may be effective and well tolerated in symptomatic obese patients with T2DM in secondary failure, producing sustained cardiovascular and metabolic improvements after 1 year. VLCD therapy is a treatment option that deserves greater consideration in this difficult‐to‐treat patient population.