Very-low-energy diet for type 2 diabetes: An underutilized therapy?


Amy E. Rothberg et al. USA


J Diabetes Complications. 2014;28(4): 506-510


The purpose of the study was to determine whether 12 weeks on a VLED (very low energy diet), in combination with low to medium-intensity physical activity, was effective in treating type II diabetes.

Patient Group:

66 patients with BMI >32 kg/m2 then type II diabetes.


The patients began a two-year treatment programme for obesity. They met an endocrinologist in order to make an initial assessment during the first month, and thereafter once every three months. Upon the first visit, medication was reviewed and adjusted. If the patient took fewer than 15 units of insulin per day, the medication was terminated. For patients that took 15 units or more, the short-term effective insulin doses were terminated, while long-term effective insulin doses were cut in half. Metformin was administered only if HbA1c was at 6.5 % or less, and if the patient requested to cease taking the medication.

The patients met a dietician on a weekly basis during the first month, every other week in the following two months and once per month thereafter.

The focus of the treatment was initially a weight reduction of 15% during the first 12 weeks of intensive energy restriction (800 kcal per day) with the help of meal replacements. Dietary supplements are prescribed to patients weighing more than 160 kg (160 to 170 kcal/day for every 23 kg over 160 kg).

Patients were encouraged gradually to increase physical activity to 40 minutes per day, either divided up or in a single session, during the first 12 weeks. After 12 weeks, they received continued intensive behaviour-focused guidance; they began a reintroduction of food and were asked to increase physical activity to include 40 to 90 minutes of moderate to intensive physical activity in order to maintain their weight.

Results and Discussion:

Of the 66 patients that were included, 58 patients had established diabetes and thereby had Hba1c-values at both baseline and follow-up. The other eight were newly diagnosed with diabetes according to a glucose tolerance test. After 12 weeks, BMI fell from 40.1 to 35.1 kg/m2, and weight was reduced by 15 kg HbA1c was reduced from 7.4% to 6.5% in patients with established diabetes, and the average HbA1c value for the entire group was 6.4% upon follow-up. Patients with newly diagnosed diabetes had significantly lower HbA1c compared with patients with established diabetes. 76% of patients with established diabetes, and 100% of patients with newly diagnosed diabetes, achieved HbA1c values of less than 7%. The improvement in HbA1c during these 12 weeks was associated with a higher value at baseline and at a larger reduction of BMI. Insulin medication during the entire 12-week period was associated with a 0.9% higher HbA1c value at follow-up, in comparison with not taking insulin.


The authors conclude that 12 weeks on a VLED diet (800 kcal) along with guidance for physical activity, as part of an intensive poly-clinical weight-management programme, was associated with a substantial reduction in weight, a reduced need for medication and a dramatic improvement of HbA1c. This kind of arrangement should be implemented upon treating patients with both newly diagnosed and established diabetes.