title: Quality of life in type 2 diabetes mellitus after a very low calorie diet and exercise.
abstract: OBJECTIVE
  To evaluate whether the addition of exercise to a very low calorie diet (VLCD) has beneficial short- and 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<0.0001, p=0.179 between groups), and improved glucoregulation (HbA1c -1.3±0.3%, p<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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Endocrinology and Metabolism/General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. M.Snel@lumc.nl
authors.forename: Marieke
authors.initials: M
authors.lastname: Snel
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sleddering
authors.forename: Inge D
authors.initials: ID
authors.lastname: Vd Peijl
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.forename: Hanno
authors.initials: H
authors.lastname: Pijl
authors.forename: A Edo
authors.initials: AE
authors.lastname: Meinders
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Jazet
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D031204:Caloric Restriction / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology* / Q000628:therapy; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
chemical_list: D001786:Blood Glucose