Immediate and long-term effects of a very-low-calorie diet on diabetes remission and glycemic control in obese Thai patients with type 2 diabetes mellitus

Mongkontida Umphonsathien, Pornsawan Prutanopajai, Juntagan Aiam-O-Ran, Titiprang Thararoop, Apaporn Karin, Chanida Kanjanapha, Wiroj Jiamjarasrangsi, Weerapan Khovidhunkit, Mongkontida Umphonsathien, Pornsawan Prutanopajai, Juntagan Aiam-O-Ran, Titiprang Thararoop, Apaporn Karin, Chanida Kanjanapha, Wiroj Jiamjarasrangsi, Weerapan Khovidhunkit

Abstract

Aim: A very-low-calorie diet (VLCD) can reverse the underlying defects of type 2 diabetes mellitus (DM) in obese subjects. We determined the efficacy, safety, and durability of VLCD in Thai patients with DM and obesity.

Methods: Twenty Thai patients with DM and obesity were enrolled. After a 2-week trial, VLCD (600 kcal/day) was continued for 8 weeks, followed by a 4-week transition period. Data on diabetes remission (fasting plasma glucose level <126 mg/dl and HbA1c <6.5% without the use of glucose-lowering medications), glycemic control, metabolic parameters, and quality of life (QOL) were collected along with indices of insulin resistance (IR) and beta cell function. Glycemic control 12 months after discontinuation of VLCD was also examined.

Results: Among 19 patients (age 48 ± 2 years, BMI 27.7 kg/m2) who completed the study, rapid improvement in glycemic control was observed in the first 2 weeks of VLCD. At both 8 and 12 weeks, diabetes remission was achieved in 79%. Significant weight loss was accompanied by a significant reduction in IR and an increase in beta cell function, starting at 4 weeks of VLCD. QOL also significantly increased. At 12 months after VLCD, however, DM remission was achieved in approximately 30%.

Conclusion: Very-low-calorie diet was effective and safe in inducing short-term diabetes remission in Thai subjects by ameliorating beta cell function and IR. Optimal long-term glycemic control was potentially durable as one-third of subjects remained without diabetes medication 12 months after VLCD.

Keywords: caloric restriction; obesity; quality of life; very‐low‐calorie diet.

Conflict of interest statement

JA, AK, CK, and WJ declare that they have no conflict of interest. WK received lecture fees from Astra Zeneca, Sanofi Aventis, Novo Nordisk, and Biopharm. MU, PP, TT, and WK coauthored a Thai pocketbook with copyrights on low‐calorie menus.

Figures

Figure 1
Figure 1
Study protocol. The study consisted of three periods. In the run‐in period (weeks −2 to 0), subjects were tried on a VLCD (600 kcal/day [2,512 KJ/day]) 10 days/2 weeks. In the caloric restriction period (weeks 0–8), subjects received a VLCD (600 kcal/day [2,512 KJ/day]) every day. In the transition period (weeks 8–12), subjects received higher caloric intake in a stepwise fashion from 800 kcal/day [3,349 KJ/day] on week 9 to 1,500 kcal/day [6,280 KJ/day] on week 12. An OGTT, blood chemistry, anthropometric measurements, and evaluation of QOL were assessed as indicated
Figure 2
Figure 2
CONSORT flow diagram
Figure 3
Figure 3
(a) Changes in fasting plasma glucose (FPG), 2‐hr plasma glucose after an OGTT (PPG), and (b) HbA1c during the study periods. (a) Fasting plasma glucose (closed circles) and 2‐hr plasma glucose after an OGTT (open circles) were measured at weeks −2, 0, 4, 8, and 12. (b) HbA1c was determined at weeks −2, 0, 4, 8, and 12. *: p < 0.01, **: p < 0.001 compared to values at week −2
Figure 4
Figure 4
The percentage of remission of diabetes mellitus at different time points. Remission of diabetes mellitus, defined as a FPG level 1c <6.5% (48 mmol/mol) without the use of glucose‐lowering medications, was determined at weeks 4, 8, and 12

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