Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

Abstract

Aims/hypothesis The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies. Methods Eight participants with type 2 diabetes and obesity, aged 7-16 years, non-medicated (n = 1) or treated with metformin (n = 7) and in some cases insulin (n = 3), followed a VLED (<3360 kJ/day) for 8 weeks, then transitioned to a hypocaloric diet (∼6300 kJ/day) that they followed to 34 weeks. HbA 1c , fasting glucose and 2 h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as ≥5% weight loss during the 8 week VLED. Results Adherers (n = 5) and non-adherers (n = 3) had median weight loss of 7.5% and 0.5%, respectively, at 8 weeks. Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (≥5.5%) at 8 weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8 week VLED. At 34 weeks, adherers (n = 5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes.

Efficacy of very low‐energy diet programs for weight loss: A systematic review with meta‐analysis of intervention studies in children and adolescents with obesity

“…Most studies were published in the 1990s (n = 13), seven in the 1980s and four since 2000. Most were conducted in the United States (n = 13), with the remaining conducted in either Austria (n = 6), Italy (n = 4), or Australia (n = 1) . Most were pre‐post studies (n = 16), with other study types including four nonrandomized comparison studies, two randomized controlled trials, and two chart reviews …”

“…No studies were conducted in child‐only cohorts. Six studies had less than 10 participants . Seven of the interventions incorporated an inpatient phase of at least 1 week, 15 were outpatient based, and two did not describe the intervention setting …”

“…Two studies included participants with a weight‐for‐height greater than 30% above the mean, whilst one study included participants based on a weight‐for‐height greater than 40% above the mean . BMI was used as an inclusion criterion in four studies, using the International Obesity Task Force cut‐offs or arbitrary cut‐offs described by studies ranging from a BMI (kg/m 2 ) of 27 to greater than or equal to 35. The remaining 10 studies did not clearly define a weight‐related inclusion criterion .…”

“…Four studies stated that they included participants who had previously failed conventional weight loss approaches . Two studies included only patients with a previous diagnosis of type 2 diabetes …”

“…Seventeen studies evaluated a food‐based VLED, generally termed a protein‐sparing modified fast (PSMF), whilst six studies used a formulated meal replacement VLED product, typically Modifast or Optifast . All formulated meal replacement–based VLED programs described the use of formula only, except for the study by Gow et al, which included one low carbohydrate meal per day consisting of 100 g of lean meat and limitless low‐carbohydrate vegetables. Of the food‐based interventions, 14 studies reported providing additional vitamin and mineral supplementation to participants for the duration of the intervention.…”