Two-Year Outcome of a Combination of Weight Loss Therapies for Type 2 Diabetes

Abstract

OBJECTIVE -To evaluate the effects over 2 years of a weight loss program combining several weight loss strategies on weight loss and diabetes control in overweight subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 59 overweight or obese individuals with type 2 diabetes were randomly assigned to either a combination therapy weight loss program for 2 years (C therapy) or a standard therapy weight loss program for 1 year followed by a combination therapy weight loss program in the 2nd year (S/C therapy). C therapy combined the use of meal replacement products, repetitive intermittent low-calorie-diet weeks, and pharmacologic therapy with sibutramine. Outcome measures included changes in weight, glycemic control, plasma lipids, blood pressure, and body composition over 2 years.RESULTS -A total of 48 participants (23 in the C therapy group and 25 in the S/C therapy group) completed 2 years of study. After 2 years, the C therapy group had weight loss of 4.6 Ϯ 1.2 kg (P Ͻ 0.001) and a decrease in HbA 1c of 0.5 Ϯ 0.3% (P ϭ 0.08) from baseline. At 2 years, the C therapy group had significant reductions in BMI, fat mass, lean body mass, and systolic blood pressure. The S/C therapy group showed changes in weight and HbA 1c in year 2 of the study that were similar to those demonstrated by the C therapy group in year 1.CONCLUSIONS -This combination weight loss program resulted in significant weight loss and improved diabetes control over a 2-year period in overweight subjects with type 2 diabetes. Diabetes Care 28:1311-1315, 2005W eight loss is an important therapeutic objective for individuals with type 2 diabetes (1). Shortterm studies have demonstrated that weight loss in overweight or obese type 2 diabetic subjects is associated with decreased insulin resistance, improved measures of glycemic control, reduced lipemia, and reduced blood pressure (2-4). However, the most recent American Diabetes Association nutrition recommendations concluded that "optimal strategies for preventing and treating obesity long term have yet to be defined" (5).Long-term options to promote weight loss in people with type 2 diabetes include standard weight-reduction diets and very-low-calorie diets. However, standard weight-reduction diets are usually not effective (5). Very-low-calorie diets produce substantial initial weight loss but do not maintain weight loss long term (6).Other approaches to weight loss that might be effective in type 2 diabetic subjects include use of meal replacements, repetitive use of low-calorie diets, and weight loss medications. Hensrud (7) reported significant weight loss at 3 months using meal replacements in type 2 diabetic subjects, but weight and measures of glycemic control trended toward baseline values at 1 year. Williams et al. (8) compared a standard diet to very-low-calorie diets used either 1 day per week or 5 consecutive days every 5 weeks in type 2 diabetic subjects. After 15 weeks, the verylow-calorie diet groups lost 9.6 and 10.4 kg, respectively, compared with weight loss of 5.4 k...

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