Effect of Low Calorie Diet and Controlled Fasting on Insulin Sensitivity and Glucose Metabolism in Obese Patients With Type 1 Diabetes Mellitus (original) (raw)
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Hippokratia, 2012
Weight loss improves the metabolic syndrome (MetS) features and related clinical abnormalities in obese subjects. The aim of this study was to assess the effects of a non-surgical therapeutic program on the MetS in severely obese patients. Sixty-four extremely obese patients were involved in the therapeutic program, which consisted of two alternating phases: the three-week therapeutic fasting or semi-fasting in hospital conditions and the low calorie diet with dosed physical activity in outpatient conditions. At the baseline we measured: anthropometric parameters, blood pressure and lipid profile. Subjects underwent an oral glucose tolerance test and insulin resistance/sensitivity was evaluated by the homeostasis model assessment and the oral glucose insulin sensitivity. After weight reduction by at least 10%, all mentioned assessments were repeated. None of the patients had significant adverse effects. Forty-one patients aged 43.0±11.5 years completed the study. The mean weight los...
Clinical Nutrition, 2005
Background & Aims: Starvation decreases insulin sensitivity and glucose tolerance in both lean and obese (OB) non-diabetic subjects. Influence of drastic calorie reduction on insulin resistance in patient with type 2 diabetes (T2DM) is not known. Methods: We enrolled 10 T2DM (diabetes duration 11.177.9 years) and 10 OB age and weight-matched subjects and performed isoglycaemic hyperinsulinaemic clamp (two 120 min phases of 60 and 120 mIU min À1 m À2 i.v. insulin) with indirect calorimetry at baseline and after 60 h of fasting. Results: After starvation insulin-mediated glucose disposal decreased significantly in both hyperinsulinaemic phases in T2DM (phase 1: from 46728 to 33717, Po0:04; phase 2 from 122747 to 80730 mg kg À1 min À1 , Po0:01) as well as in OB (phase 1: from 94752 to 52724, Po0:04; phase 2: from 131746 to 106743 mg kg À1 min, Po0:01). Both oxidative and non-oxidative components of glucose disposal tended to be reduced after fasting. A change of insulin sensitivity was found to be highly dependent upon pre-starvation conditions: more insulin resistant subjects tended to maintain (or modestly improve) insulin resistance whilst subjects with better insulin sensitivity tended to worse it. Conclusion: Insulin sensitivity worsens similarly in both T2DM and OB subjects during 60-h fast. The change is probably predictable according to pre-starvation insulin sensitivity.
Diabetes Research and Clinical Practice, 1989
We put 12 obese subjects on a very-low-calorie diet (VLCD) and observed how their weight loss affected their glucose tolerance. Seven had non-insulin-dependent diabetes and five did not. They consumed 1000 kcal/day for at least 1 week, then 420 k&/day for 4 weeks, and 1000 kcal/day thereafter. VLCD improved glucose tolerance and insulin response to a glucose load in the diabetics and did not affect these parameters in the non-diabetics. It did not change insulin responsiveness to intravenous glucagon in either group. Both groups showed improved insulin resistance, as measured by an insulin suppression test. Regression analysis showed that insulin resistance correlates well with obesity and glycemic control. Weight reduction did not change hepatic insulin extraction. Thus, the improvement in glucose tolerance by some of the diabetics seems to have arisen from improvements in their insulin resistance and insulin response to a glucose load. Insulin resistance improved because of weight reduction and subsequent improvements in glycemic control.
Dietary Fat and Carbohydrates Differentially Alter Insulin Sensitivity During Caloric Restriction
Gastroenterology, 2009
Reeds, Dominic N.; Finck, Brian N.; Mayurranjan, Mitra S.; Patterson, Bruce W.; and Klein, Samuel, "Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction". Gastroenterology, 136, 5, 1552Gastroenterology, 136, 5, -1560Gastroenterology, 136, 5, . 2009. Paper 21.
The American Journal of Clinical Nutrition
Background: Alterations in glucose metabolism during early fasting may be an important trigger of the hormonal and metabolic responses to fasting. Objective: The purpose of this study was to determine whether glucose metabolism in response to brief starvation differs in lean and abdominally obese women. Design: We evaluated whole-body glucose metabolism by use of stable-isotope tracer methods and glucose uptake in subcutaneous abdominal adipose tissue by use of arteriovenous balance in 7 lean [58 ± 2 kg; body mass index (BMI; in kg/m 2): 21 ± 5] and 6 abdominally obese (96 ± 2 kg; BMI: 36 ± 1) women after 14 and 22 h of fasting. Results: Between 14 and 22 h of fasting, whole-body glucose production and disposal declined in both groups (P < 0.05), but the reduction was 50% greater in lean than in obese women (P < 0.05). The decline in glucose uptake at 22 h of fasting was also lower in obese (0.11 ± 0.04 mol • 100 g Ϫ1 • min Ϫ1) than in lean (0.26 ± 0.03 mol • 100 g Ϫ1 • min Ϫ1) women (P < 0.05). Decreases in plasma insulin and leptin concentrations between 14 and 22 h of fasting were also lower in obese than in lean women (insulin: 20 ± 3% and 32 ± 5%; leptin: 18 ± 3% and 37 ± 6%; both P < 0.05). Conclusions: The normal decline in glucose production and uptake that occurs during early fasting is blunted in women with abdominal obesity. These alterations in glucose metabolism are associated with a blunted decline in circulating concentrations of both insulin and leptin, which may explain some of the differences in the metabolic response to fasting observed between lean and abdominally obese persons.
Current Nutrition Reports, 2021
Purpose of Review A number of recent studies have suggested that intermittent fasting is as effective as traditional calorie restriction (CR) for weight loss and for cardioprotection. However, it is still unclear whether IF improves diabetes risk indicators as does CR. This review provides an overview of various patterns of intermittent fasting and shows the effect of intermittent fasting on human anthropometric such as excess body weight and biochemical parameters for example high glucose and fasting insulin, which are risk factors for diabetes. Recent Findings There is a growing body of evidence pointing to the benefits of intermittent fasting for glucose and insulin homeostasis, but this should be confirmed by further studies in population groups with (or at high risk) type II diabetes and insulin resistance. Long-term studies are also needed that could reveal potential negative health effects that some studies report. Summary Eleven studies in overweight/obese adult people that ...
Effect of Fasting on Metabolic Syndrome in Type II Diabetic Patients
2014
Aims: Effects of fasting on diabetic patients has been considered more in recent years. This study was done to investigate the changes in body weight, blood pressure and biochemical parameters in fasting people. Materials & Methods: In July and August (Ramadan) 2012, 75 diabetic patients from Kenareh village, Iran, were selected by census method and finally the results of 60 patients were enrolled. 15 days before Ramadan, triglyceride, fasting blood glucose, systolic and diastolic blood pressure in the sitting position, weight, height, body mass index and age of samples were calculated and recorded. At this stage, all samples in terms of the occurrence of any possible complications related to the fasting i.e. hypoglycemia, hyperglycemia and diabetic ketoacidosis were also examined. Correlation of each parameter was evaluated with age using Pearson correlation test and with gender using two-sample T-test. Findings: During Ramadan, weight, systolic blood pressure, triglycerides, blood...
Metabolism, 2011
Objective-To examine the effects of diet macronutrient composition on insulin sensitivity, fasting glucose, and β-cell response to glucose. Materials/Methods-Participants were 42 normal glucose tolerant (NGT, fasting glucose <100 mg/dL) and 27 impaired fasting glucose (IFG) healthy, overweight/obese (BMI 32.5 ±4.2 kg/m 2), men and women. For 8 weeks, participants were provided with eucaloric diets, either highercarbohydrate/lower-fat (55% carbohydrate, 18% protein, 27% fat) or lower-carbohydrate/higherfat (43🔞39). Insulin sensitivity and β-cell response to glucose (basal, PhiB; dynamic, PhiD; and static, PhiS) were calculated by mathematical modeling using glucose, insulin, and C-peptide data obtained during a liquid meal tolerance test. Results-After 8 weeks, NGT on the higher-carbohydrate/lower-fat diet had higher insulin sensitivity than NGT on the lower-carbohydrate/higher fat diet; this pattern was not observed among IFG. After 8 weeks, IFG on the higher-carbohydrate/lower-fat diet had lower fasting glucose and higher PhiD than IFG on the lower-carbohydrate/higher-fat diet; this pattern was not observed among NGT. Within IFG, fasting glucose at baseline and the change in fasting glucose over the intervention were inversely associated with baseline PhiD (−0.40, P<0.05) and the change in PhiD (−0.42, P<0.05), respectively. Conclusions-Eight weeks of a higher-carbohydrate/lower-fat diet resulted in higher insulin sensitivity in healthy NGT overweight/obese individuals, and lower fasting glucose and greater
Scandinavian Journal of Clinical & Laboratory Investigation, 2012
Objective. Evaluation of the effect of an 8-week very low calorie diet (VLCD, 500 -600 kcal daily) on weight, body fat distribution, glucose, insulin and lipid metabolism, androgen levels and incretin secretion in obese women. Methods. Seventeen overweight women (BMI Ͼ 28) were recruited to the study. Glucose, insulin and lipid metabolism were evaluated by euglycemic clamp technique, indirect calorimetry and an oral glucose tolerance test (OGTT) . Insulin sensitivity was calculated as glucose disposal rate (GDR) and insulin sensitivity index (ISI), and also by HOMA-IR. Insulin secretion rate (ISR) was calculated from plasma C-peptide measurements. Secretion of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) was measured during an oral glucose tolerance test. Abdominal fat distribution was assessed by dual x-ray absorptiometry scan and computed tomography. Results. Ten women completed the intervention. The subjects lost an average 11% of their baseline weight. There was a signifi cant loss of subcutaneous abdominal fatty tissue ( p Ͻ 0.01) and intra-abdominal fatty tissue ( p ϭ 0.05). Whole body (HOMA-IR) ( p Ͻ 0.05) insulin sensitivity increased signifi cantly, but peripheral (ISI) insulin sensitivity was unaltered after weight loss. GIP increased ( p Ͻ 0.05) and GLP-1 was unaltered after the dietary intervention. Insulin responses did not differ before and after dietary intervention, however, a signifi cant increase in insulin clearance ( p Ͻ 0.05) was observed. The weight loss resulted in a signifi cant decrease in free testosterone. Conclusion. A VLCD is an effective weight loss treatment, which results in an immediate improvement in several metabolic parameters.