Effect of Calorie Restriction and Exercise on Type 2 Diabetes (original) (raw)
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American Journal of Clinical Nutrition, 2012
Background: Caloric restriction in obese diabetic patients quickly improves glucose control, independently from weight loss. However, the early effects of a very-low-calorie diet (VLCD) on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes are still unclear. Objective: The objective was to study the relative contributions of insulin sensitivity, insulin secretion, or both to improvement in glucose metabolism, after 1 wk of caloric restriction, in severely obese diabetic patients. Design: Hyperglycemic clamps were performed in 14 severely obese (BMI, in kg/m 2 : .40) patients with type 2 diabetes in good glucose control (glycated hemoglobin , 7.5%) before and after 7 d of a VLCD (400 kcal/d). Results: The VLCD caused a 3.22 6 0.56% weight loss (P , 0.001), 42.0% of which was fat loss, accompanied by decreases in fasting plasma glucose (P , 0.05) and triglycerides (P , 0.01). In parallel, the Disposition Index, which measures the body's capability to dispose of a glucose load, increased from 59.0 6 6.3 to 75.5 6 6.3 mLÁ min 21 Á m 22 body surface area (P , 0.01), because of improvements in indexes of both first-and second-phase insulin secretion (P , 0.02), but with no changes in insulin sensitivity (P = 0.33). Conclusion: The marked improvement in metabolic profile, observed in severely obese patients with type 2 diabetes after a 7-d VLCD, was primarily due to the amelioration of b cell function, whereas no contribution of insulin sensitivity was shown. This trial was registered at www.clinicaltrials.gov as NCT01447524.
British Journal of Diabetes
Introduction: There is a paucity of evidence regarding the efficacy of a very low-calorie diet (VLCD) in the real-world setting. We evaluated outcomes in patients with type 2 diabetes mellitus (T2DM) who underwent VLCD. Methods: This retrospective observational study included all patients who had undergone VLCD from 2014 to 2017 (n=61). The VLCD consisted of an eight-week 800 kcal/day dietary restriction. Metabolic parameters and medications were recorded at baseline, immediately post-VLCD and at 6 and 12 months. Results: There was a significant reduction in weight of 9.96 kg (p<0.001) immediately post-VLCD, with net weight loss sustained to 12 months (p<0.05). There was a significant reduction in body mass index (BMI) sustained to 12 months (p<0.05). Paired HbA1c data were available for 38 patients. There was a significant reduction in HbA1c of 13.29 mmol/mol immediately post-VLCD (p<0.001), however no significant reduction was observed at 12 months (p>0.05). 78.7% p...
Quality of life in type 2 diabetes mellitus after a very low calorie diet and exercise
European Journal of Internal Medicine, 2012
Objective: To evaluate whether the addition of exercise to a very low calorie diet (VLCD) has beneficial shortand long-term effects on health-related quality of life (QoL) in obese patients with type 2 diabetes mellitus (T2DM). Methods: We included 27 obese, insulin-dependent T2DM patients in a 16-week VLCD study, of whom 13 participated simultaneously in an exercise program (VLCD + E). Before, immediately after and 18 months after the intervention anthropometric measurements, glucoregulation and QoL (SF-36, HADS, NHP and MFI-20) were assessed. Patients were compared to healthy lean and obese (matched for body mass index) controls matched for gender and age. Results: At baseline, T2DM patients had significantly worse QoL scores in 18 and 14 of the 22 subscales of the QoL questionnaires, compared to lean and obese controls, resp. The 16-week VLCD (n= 27) decreased bodyweight (−25.4 ± 1.3 kg, p b 0.0001, p = 0.179 between groups), and improved glucoregulation (HbA1c −1.3 ± 0.3%, p b 0.0001, p = 0.488 between groups) and 9 (VLCD-only) and 11 (VLCD + E) of the 22 subscales of QoL. After 18 months, in the VLCD + E group the QoL subscales did not differ from those in obese controls and only 4 of the 22 subscales were significantly worse compared to lean controls. However, in the VLCD-only group 17 and 13 of the 22 QoL subscales were significantly worse compared to the lean and obese controls, resp. Conclusion: A 16-week VLCD induces considerable weight loss, metabolic amelioration, and major improvements in QoL in obese T2DM patients. The addition of exercise is of paramount importance for the maintenance of better QoL.
Diabetes and Its Complications
Type 2 diabetes mellitus (DM) is a chronic and multifactorial disease strongly linked to a low-grade inflammatory process. Thus far, type 2 DM is generally regarded as an incurable disease by common therapies. However, very low-calorie diet (VLCD) regimens have demonstrated beneficial and rapid effects on glucose metabolism in subjects with type 2 DM. These beneficial effects include improvement of diabetes complications, insulin sensitivity and reduction in glycaemia, glycated hemoglobin (HbA1C), and triglyceride levels. VLCD regimens commonly comprise no more than 800 kcal/day and are therefore associated with rapid weight loss in overweight and obese individuals. This group of diets positively affects local/systemic inflammation and oxidative stress (OS) by modulating inflammatory cytokines, adipokines and endogenous antioxidant levels. The investigation of VLCDs in the field of type 2 DM treatment is progressively augmenting due to the multiple benefits in cardiometabolic health of overweight/obese subjects with type 2 DM. Here, we gather and review the evidence regarding the role of inflammation and OS in individuals with type 2 DM under VLCD regimens.
The American Journal of Clinical Nutrition, 2012
Background: Caloric restriction in obese diabetic patients quickly improves glucose control, independently from weight loss. However, the early effects of a very-low-calorie diet (VLCD) on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes are still unclear. Objective: The objective was to study the relative contributions of insulin sensitivity, insulin secretion, or both to improvement in glucose metabolism, after 1 wk of caloric restriction, in severely obese diabetic patients. Design: Hyperglycemic clamps were performed in 14 severely obese (BMI, in kg/m 2 : .40) patients with type 2 diabetes in good glucose control (glycated hemoglobin , 7.5%) before and after 7 d of a VLCD (400 kcal/d). Results: The VLCD caused a 3.22 6 0.56% weight loss (P , 0.001), 42.0% of which was fat loss, accompanied by decreases in fasting plasma glucose (P , 0.05) and triglycerides (P , 0.01). In parallel, the Disposition Index, which measures the body's capability to dispose of a glucose load, increased from 59.0 6 6.3 to 75.5 6 6.3 mLÁ min 21 Á m 22 body surface area (P , 0.01), because of improvements in indexes of both first-and second-phase insulin secretion (P , 0.02), but with no changes in insulin sensitivity (P = 0.33). Conclusion: The marked improvement in metabolic profile, observed in severely obese patients with type 2 diabetes after a 7-d VLCD, was primarily due to the amelioration of b cell function, whereas no contribution of insulin sensitivity was shown. This trial was registered at www.clinicaltrials.gov as NCT01447524.
Very-low-energy diet for type 2 diabetes: An underutilized therapy?
Journal of Diabetes and its Complications, 2014
Background-Current approaches to the management of type 2 diabetes focus on the early initiation of novel pharmacologic therapies and bariatric surgery. Objective-The purpose of this study was to revisit the use of intensive, outpatient, behavioral weight management programs for the management of type 2 diabetes. Design-Prospective observational study of 66 patients with type 2 diabetes and BMI ≥ 32 kg/m 2 who enrolled in a program designed to produce 15% weight reduction over 12 weeks using total meal replacement and low-to moderate-intensity physical activity. Results-Patients were 53 ± 7 years of age (mean ± SD) and 53% were men. After 12 weeks, BMI fell from 40.1 ± 6.6 to 35.1 ± 6.5 kg/m 2. HbA1c fell from 7.4 ± 1.3% to 6.5 ± 1.2% (57.4 ± 12.3 to 47.7 ± 12.9 mmol/mol) in patients with established diabetes: 76% of patients with established diabetes and 100% of patients with newly diagnosed diabetes achieved HbA1c <7.0% (53.0 mmol/mol). Improvement in HbA1c over 12 weeks was associated with higher baseline HbA1c and greater reduction in BMI. Conclusions-An intensive, outpatient, behavioral weight management program significantly improved HbA1c in patients with type 2 diabetes over 12 weeks. The use of such programs should be encouraged among obese patients with type 2 diabetes.