F Capstick, B A Brooks, C M Burns, R R Zilkens, K S Steinbeck, D K Yue, The Diabetes Centre, Royal Prince Alfred Hospital, Sidney, Australia
Diabetes research and Clinical Practice (1997) 36, 105-111
14 type 2 noninsulin dependent diabetes mellitus “NIDDM” patients, including 7 treated with oral medication, 6 treated with combination of oral medication and insulin, and 1 with insulin alone.
Average BMI was 38.7 kg/m2 and average age 51.8 years.
The goal of treatment of obese NIDDM patients is to achieve weight loss and to improve glycemic control, but this may be difficult with conventional treatment. In fact, drug treatment may sometimes be counterproductive by contributing to weight gain and worsening glycemic control. A treatment that results in weight loss, reduced insulin resistance and improved glycemic control could therefore be a significant advance.
VLCD is already used to treat obesity and is considered to be safe. Earlier studies on diabetes show that VLCD treatment may have a positive effect on NIDDM patients, improving both weight loss and glycemic control.
Twelve weeks of pure VLCD treatment (425 kcal/day) – using the Modifast formulation at that time – followed by 4 weeks of stepwise return to ordinary healthy food.
At study start the patients' usual medication treatment was cut in half. Thereafter, blood glucose was closely monitored throughout the study, so the medication could be adjusted as needed.
Results and discussion:
Thirteen patients completed treatment. Average weight decreased from 108.9 to 94.5 kg (p = 0.002) and waist circumference from 116.0 to 103.0 cm (p = 0.001). In addition, significant reductions were achieved in systolic blood pressure (p = 0.05), HgbA1C (p = 0.02), fasting insulin (p = 0,002), total cholesterol (p = 0.02) and triglycerides (p = 0,002).
After treatment, all patients previously treated with insulin were able to manage on oral medication alone. Most of the patients previously treated with oral medications needed to continue, but were able to reduce their doses following the VLCD period.
Short-term use of VLCD is a highly effective way to improve glycemic control and significantly reduce weight in obese NIDDM diabetics.