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Very Low-Calorie Diets and Diabetes
Very low-calorie diets (VLCD) are hypocaloric dietary regimens of approximately 400–800 kcal/day that result in 20–30% reductions in body weight, sometimes in just 12–16 weeks. A body of evidence demonstrates that adherence to VLCD in adults with type 2 diabetes (T2D) can result in marked improvements to glycemic control and even full T2D remission, challenging the convention that T2D is a lifelong disease. Although these data are promising, the majority of VLCD studies have focused on weight loss and not T2D remission as a primary endpoint.
Type 2 diabetes (T2D) and its comorbidities have reached epidemic proportions globally , largely driven by high rates of obesity in adults and children. With less than 2% of cases of T2D entering spontaneous remission , the current clinical paradigm is that T2D is irreversible. Although current standard clinical care is effective in maintaining normoglycemia in T2D , long-term studies show that intensive glycemic control is not sufficient in halting T2D progression and decline in pancreatic β-cell function, or in mitigating the risk of cardiovascular disease . Weight loss is the primary approach for nutritional management of T2D , and evidence shows that, compared to standard care, intensive multicomponent lifestyle interventions, including behavior change, physical activity and dietary energy restriction produce superior weight loss and improvement to glycemic control .
Dietary energy restriction approaches for management and treatment of T2D have largely focused on weight reduction through the use of either low-calorie diets (LCD) (1200–1500 kcal/day) , or very low-calorie diets (VLCD) (approximately 400–800 kcal/day) . VLCD approaches have shown to be the most effective in producing rapid weight loss, improvement to pancreatic insulin secretory capacity, and reduction of hemoglobin A1c (HbA1c) to pre-diabetic and non-diabetic levels, sometimes within days . However, despite this body of evidence , the long-term efficacy of VLCD for reversing T2D remains unclear, as many of these studies have been of short duration (< 12 weeks), did not have T2D remission as a primary endpoint, and varied greatly in their VLCD protocols, follow up duration, and definitions of T2D remission.
A recent body of evidence has demonstrated that with VLCD approaches, clinically defined and sustained (6–24 months) , show that a VLCD intervention led to significant reductions in body weight and sustained T2D remission in 45–60% of subjects after 12 months, and in 35% of individuals at 24 months . However, data also showed that approximately 30% of individuals with relatively longer duration T2D (3.8 years since diagnosis) did not achieve remission despite significant weight loss (i.e., non-responders) . Also, consistent with numerous VLCD weight loss studies , approximately 25% of individuals who achieved remission from T2D, regained a significant proportion of their lost weight and had their T2D relapse at 24 months .
Collectively, these data demonstrate that it remains unclear what the efficacy and durability of T2D remission is, using VLCD approaches, and, equally important, a better understanding is needed of which individuals with T2D would most likely respond and benefit from VLCD approaches for T2D remission.
This narrative review will provide an overview of the studies which share similar VLCD approaches that specifically sought to measure T2D as a primary endpoint. This narrative review will also address who is likely to benefit, what the risks are, and how a VLCD approach compares to other less restrictive hypocaloric diets on remission of T2D.
2. Effect of Very Low-Calorie Diets on Remission of T2D
3. Comparison between a Very Low-Calorie Diet and a Low-Calorie Diet for T2D Remission
4. Degree of Weight Loss Necessary for T2D Remission
The entry is from 10.3390/nu13062086
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