Intermittent very low-calorie diet lowers glucose levels in adults with obesity, diabetes
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Adults with obesity and type 2 diabetes improved glucose levels after eating a very low-calorie diet either 2 or 4 days per week, according to study findings published in the Journal of Diabetes Investigation.
“An intermittent very low-calorie diet, either 2 days per week or 4 days per week, is effective in achieving glycemic control in patients with type 2 diabetes and obesity,” Weerapan Khovidhunki, MD, PhD, and Mongkontida Umphonsathien, MD, of the division of endocrinology and metabolism at Chulalongkorn University and the Excellence Center in Diabetes, Hormone and Metabolism at King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, told Healio. “A significant portion of patients with type 2 diabetes and obesity, almost 30% in the study, achieve diabetes remission without need for diabetes medication from an intermittent very low-calorie diet.”
Khovidhunki, Umphonsathien and colleagues conducted a randomized controlled trial of adults aged 30 to 60 years diagnosed with type 2 diabetes within the past 10 years (mean duration 4.9 years) with a BMI of at least 23 kg/m2 (mean 30.1 kg/m2) and an HbA1c between 6.5% and 10% (mean 7.4%). Participants ate a very low-calorie diet of 600 kcal per day for 10 days during a 2-week run in period. After the run-in period, participants were randomly assigned to a very low-calorie diet for 2 days a week (n = 14), a very low-calorie diet for 4 days a week (n = 14) or a control group eating a normal diet of 1,500 kcal to 2,000 kcal per day and receiving normal diabetes care (n = 12). The study period was 18 weeks. Primary study outcomes were changes in glucose levels and HbA1c and the rate of diabetes remission in each group. Secondary outcomes included insulin secretion, insulin sensitivity, anthropometric parameters, cardiovascular risk factors and quality of life. Outcome data were collected at baseline and weeks 2, 10 and 20.
After 20 weeks, the 4-day very low-calorie diet group had a 39.7 mg/dL reduction in fasting plasma glucose, and the 2-day very low-calorie diet group had a FPG reduction of 25.1 mg/dL, compared with a 7.9 mg/dL reduction in the control group. Mean HbA1c dropped by 1.2% in the 4-day very low-calorie diet group and 0.7% in the 2-day very low-calorie diet group after 20 weeks, whereas the control group had a 0.1% reduction. Diabetes remission without need for glucose-lowering medication was observed in 29% of participants in both very low-calorie diet groups compared with no participants in the control group.
“The rate of diabetes remission in individuals using a very low-calorie diet 2 days per week was comparable to that of 4 days per week, suggesting that this modality of treatment might have great clinical implications for patients with type 2 diabetes and obesity,” the researchers wrote.
Both very low-calorie diet groups had improvements in insulin resistance at 20 weeks compared with controls, although the difference was not significant between 2-day and 4-day diet groups. All three groups had reductions in body weight and BMI, with no significant difference between them. Mean serum triglyceride levels were lower in both very low-calorie diet groups at weeks 10 and 20. Both very low-calorie diet groups had improvements in quality of life at 10 weeks, and the 4-day very low-calorie diet group had a higher quality of life score at week 20.
Khovidhunki and Umphonsathien said further studies should examine how a very low-calorie diet can help preserve diabetes remission over a longer period of time.
For more information:
Weerapan Khovidhunki, MD, PhD, can be reached at wkhovid@gmail.com.
Mongkontida Umphonsathien, MD, can be reached at muijai@hotmail.com.
Perspective
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Given the global rise in the prevalence of type 2 diabetes, designing effective and personalized strategies to remit type 2 diabetes is a translational research imperative. The pilot study by Khovidhunki and Umphonsathien highlights an innovative potential approach, combining very low-calorie diets with intermittent fasting. Previous studies of intermittent fasting have shown similar weight reduction as daily calorie restriction; therefore, it is not surprising to see that use of a very low-calorie diet with intermittent fasting produces an effective weight loss response in the short term. Interestingly, improved glycemic control then follows, suggesting that as long as there is sufficient weight loss, the strategy used to achieve it may be secondary. This points to the main value of intermittent fasting — it provides patients with another dietary strategy that can be adjusted to fit their own behavioral framework and social circumstances, leading to potentially greater consistency of implementation.
While intriguing, there is still much to learn, including can patients easily alternate medication regimens that match fasting days and non-fasting days, and do these results extend over a longer period of time, especially once patients are in weight maintenance? This pilot trial, however, suggests this line of research is worth pursuing.
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