Very-low-energy diet for type 2 diabetes: an underutilized therapy?
BACKGROUND
Current approaches to the management of type 2 diabetes focus on the early initiation of novel pharmacologic therapies and bariatric surgery.


OBJECTIVE
The purpose of this study was to revisit the use of intensive, outpatient, behavioral weight management programs for the management of type 2 diabetes.


METHODS
Prospective observational study of 66 patients with type 2 diabetes and BMI ≥ 32 kg/m² who enrolled in a program designed to produce 15% weight reduction over 12 weeks using total meal replacement and low- to moderate-intensity physical activity.


RESULTS
Patients were 53 ± 7 years of age (mean ± SD) and 53% were men. After 12 weeks, BMI fell from 40.1 ± 6.6 to 35.1 ± 6.5 kg/m². HbA1c fell from 7.4% ± 1.3% to 6.5% ± 1.2% (57.4 ± 12.3 to 47.7 ± 12.9 mmol/mol) in patients with established diabetes: 76% of patients with established diabetes and 100% of patients with newly diagnosed diabetes achieved HbA1c <7.0% (53.0 mmol/mol). Improvement in HbA1c over 12 weeks was associated with higher baseline HbA1c and greater reduction in BMI.


CONCLUSIONS
An intensive, outpatient, behavioral weight management program significantly improved HbA1c in patients with type 2 diabetes over 12 weeks. The use of such programs should be encouraged among obese patients with type 2 diabetes.
University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH). Electronic address: arothber@umich.edu.
Amy E
AE
Rothberg
University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH).
Laura N
LN
McEwen
University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH).
Andrew T
AT
Kraftson
University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH).
Christine E
CE
Fowler
University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH).
William H
WH
Herman
D001521:Behavior Therapy; D015992:Body Mass Index; D031204:Caloric Restriction; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D002149:Energy Intake; D005260:Female; D019648:Foods, Specialized; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D008297:Male; D008329:Managed Care Programs; D062407:Meals; D008824:Michigan; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D015431:Weight Loss
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Obesity; Type 2 diabetes mellitus; Very-low energy diet; Weight management