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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.
Diabet Med. 2003 Apr;20(4):319-24
Dhindsa P, Scott AR, Donnelly R.
School of Medical & Surgical Sciences, University of Nottingham, and Jenny O'Neil Diabetes Centre, Southern Derbyshire Acute Hospitals, NHS Trust, Derby, UK.
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/m2, 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/m2, respectively, with favourable reductions in serum total cholesterol (5.9-4.9 mm), blood pressure (10/6 mmHg) and fructosamine (386 +/- 73-346 +/- 49 microm) (equates to an HbA1c 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/m2. 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.
Very-low-calorie-diets: is there a place for them in the management of the obese diabetic?
Diabetes Metab 2000 Jun;26 Suppl 3:46-51
Monnier L; Colette C; Percheron C; Boniface H.
Service des Maladies Metaboliques, Hopital Lapeyronie, Montpellier.
It is well-recognized that standard caloric restrictions (1500 kcal/day) are usually poorly effective in achieving weight losses in overweight type 2 diabetic patients. For that reason very-low-calorie-diets (VLCDs) were developed as a mean for initiating or accelerating weight reduction. Short-term studies indicate that VLCDs result generally in weight losses that are three times greater than those obtained with standard low-calorie-diets. Fasting blood glucose values are improving in parallel to weight losses and in many patients the improvement in glycemic control is better than that expected from the magnitude of weight losses. However the results are rather disappointing after several months or years of follow-up. For example it has been demonstrated that weight regain can be observed as soon as the patient is shifted to a refeeding or maintenance dietary program at the end of the VLCD period. Long-term results on glycemic control and body weight reduction are generally similar with standard low-calorie-diets and with VLCDs, the final results depending on the magnitude of weight loss whatever the prescribed diet. At short-term the VLCDs can be helpful first for initiating weight losses and second for sensitizing the patient to the potential benefits of complying to dietary measures.
Aggressive weight reduction treatment in the management of type 2 diabetes.
Diabetes Metab 1998 Apr;24(2):116-23
Scheen AJ. Department of Medicine,
CHU Sart Tilman, Belgium.
Most patients with Type 2 diabetes are significantly overweight, and diet-induced weight loss can provide marked improvement in their glycaemic control. As conventional therapy combining diet and exercise usually has a poor long-term success rate, more aggressive weight reduction programmes have been proposed for the treatment of severely obese diabetic patients, including very-low-calorie diets, anti-obesity drugs and bariatric surgery. Very-low-calorie diets usually have a remarkable short-term effect, and energy restriction and weight reduction are positive factors for the glycaemic control of obese diabetic subjects. However, the long-term efficacy of these methods remains doubtful since weight regain is a common phenomenon. Although anti-obesity (anorectic) drugs may help patients to follow a restricted diet and lose weight, their overall efficacy on body weight and glycaemia is generally modest, and their long-term safety still questionable. Interestingly, serotoninergic anorectic agents have been shown to improve both the insulin sensitivity and glycaemic control of obese diabetic patients independently of weight loss. Bariatric surgery may be helpful in well-selected patients. The correction of weight excess after successful gastroplasty fully reverses the abnormalities of insulin secretion, clearance and action on glucose metabolism present in markedly obese non-diabetic patients, and allows interruption or reduction of insulin therapy and antidiabetic oral agents in most obese diabetic patients. In conclusion, weight loss is a major goal in treating obese patients with Type 2 diabetes, and aggressive weight reduction programmes may be used in selected patients refractory to conventional diet and drug treatment. However, long-term prospective studies are needed for more precise determination of the role of such a strategy in the overall management of obese diabetic patients.
Improved metabolic control after supplemented fasting in overweight type 2 diabetic patients.
Acta Med Scand. 1984;216(1):67-74.
Vessby B, Boberg M, Karlstrom B, Lithell H, Werner I.
Twenty obese type II diabetes patients were treated in a metabolic ward during 4 weeks with a very low calorie regimen (200 kcal/day). They were given dietary advice and reexamined 3 months after discharge. Mean body weight decreased by 10 kg during fasting, blood glucose was normalized, urinary glucose disappeared and the K-value at i.v. glucose tolerance test increased. Fasting serum insulin concentrations decreased by 54%. Serum triglycerides (TG) decreased by 65%, serum cholesterol (Chol) by 28% and high density lipoprotein (HDL) Chol by 14%. Three months later, only serum TG remained significantly decreased (-47%) while HDL Chol was significantly higher than on admission (+11%). Fasting blood glucose remained significantly lower (-25%) with a low urinary glucose excretion. Supplemented fasting appears to be a safe and useful tool in the treatment of obese type 2 diabetics. It causes, at least during a limited follow-up period, a significant improvement in glucose control and lipoprotein metabolism in spite of a concomitant reduction of the antidiabetic medication.
Maturity-onset diabetes mellitus--toward a physiological appropriate management.
Med Hypotheses. 1981 Oct;7(10):1265-85.
McCarty MF.
"Eumetabolic" therapies of diabetes are defined as those which promote and potentiate a normal physiological pattern of insulin activity--in contrast to the less subtle effects of exogenous insulin or sulfonylureas. Effective eumetabolic therapy would provide better metabolic control and reduce the risk of secondary complications, would be more convenient to administer, and would be especially appropriate for preventive use in the early stages of diabetes. Possible components of a eumetabolic therapy include: aspirin, as a potentiator of glucose-stimulated insulin secretion; GTF, to directly enhance the efficacy of insulin; weight loss, exercise, and fasting, to help reduce tissue resistance to insulin; mitochondrial "metavitamins", to optimize the oxidative disposal of excess substrate; a high-fiber, low-fat diet, which appears superior to traditional diabetic diets as a promoter of glucose tolerance. Following a prolonged fast, obese diabetics show substantial improvement in most parameters of insulin function--an effect which is to some degree independent of weight loss; long-term remission of diabetes may be possible if the benefits of therapeutic fasting are conserved by appropriate eumetabolic measures.
Insulinemia in the obese before and after fasting therapy
Journ Annu Diabetol Hotel Dieu. 1969;10:287-92.
[Article in French]
Gueris J, Segrestaa JM, Lamotte M.
EXPERIMENTAL EVIDENCE:
Dietary restriction and glucose regulation in aging rhesus monkeys: a follow-up report at 8.5 yr.
Am J Physiol Endocrinol Metab 2001 Oct;281(4):E757-65
Gresl TA, Colman RJ, Roecker EB, Havighurst TC, Huang Z, Allison DB, Bergman RN, Kemnitz JW.
Wisconsin Regional Primate Research Center, Madison 53715, USA.
In a longitudinal study of the effects of moderate (70%) dietary restriction (DR) on aging, plasma glucose and insulin concentrations were measured from semiannual, frequently sampled intravenous glucose tolerance tests (FSIGTT) in 30 adult male rhesus monkeys. FSIGTT data were analyzed with Bergman's minimal model, and analysis of covariance revealed that restricted (R) monkeys exhibited increased insulin sensitivity (S(I), P < 0.001) and plasma glucose disappearance rate (K(G), P = 0.015), and reduced fasting plasma insulin (I(b), P < 0.001) and insulin response to glucose (AIR(G), P = 0.023) compared with control (C; ad libitum-fed) monkeys. DR reduced the baseline fasting hyperinsulinemia of two R monkeys, whereas four C monkeys have maintained from baseline, or subsequently developed, fasting hyperinsulinemia; one has progressed to diabetes. Compared with only the normoinsulinemic C monkeys, R monkeys exhibited similarly improved FSIGTT and minimal-model parameters. Thus chronic DR not only has protected against the development of insulin resistance in aging rhesus monkeys, but has also improved glucoregulatory parameters compared with those of otherwise normoinsulinemic monkeys.
Intermittent feeding and fasting reduces diabetes incidence in BB rats.
Autoimmunity 1999;30(4):243-50
Pedersen CR; Hagemann I; Bock T; Buschard K.
Bartholin Instituttet, Kommunehospitalet, Copenhagen, Denmark.
Food intake may be one of several factors which influence the risk of development of insulin dependent diabetes mellitus, but the influence of the pattern of food supply has not been studied previously. The aim of the present study was to investigate the effect of intermittent feeding and fasting upon diabetes in BB rats. This study included three groups. Group 1 served as control and included 77 animals, 79% became diabetic. In groups 2 and 3, after weaning, food but not water was withdrawn from the animals: 24 h twice a week in group 2; 24 h every second day in group 3. Group 2 included 40 BB rats, 50% (p < 0.004) became diabetic. Group 3 included 44 BB rats, 52% (p < 0.01) became diabetic. No differences were seen between sexes. Degree of insulitis was not influenced by changed food supply. Regarding blood glucose, no influence was seen among diabetic animals, among non-diabetic animals changed food supply reduced blood glucose values obtained at the end of the study. Intermittent feeding and fasting tended to reduce mean age at the time of diagnosis of diabetes, significance was reached only in female animals from group 3 compared to group 1. Body weight was obtained weekly. Intermittent feeding and fasting caused a reduced weight gain in group 2 as well as in group 3 compared to control animals; however, most pronounced in group 3 and also more pronounced among males compared to females. For pre-diabetic and non-diabetic animals comparable influence on body weight was seen. The main conclusion in the study is that intermittent feeding and fasting reduced diabetes incidence.
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