title: A Systematic Review of Evidence on the Use of Very Low Calorie Diets in People with Diabetes.
abstract: BACKGROUND
  Recent interest has emerged regarding the effects of Very Low Calorie Diet (VLCD) in people with type 2 diabetes (T2D). We therefore performed a systematic review to investigate the effects of VLCD on HbA1c, weight and cardiovascular risk profile outcomes as well as its safety and tolerability among people with T2D.
  
  
  METHODS
  We conducted searches of Cochrane Database of Systematic Reviews, Centre for reviews and Dissemination databases, Medline, Embase, Pubmed, Web of Science, Web of Knowledge and Turning Research into Practice (TRIP) as well as ongoing trial resources. We included all studies involving VLCD and diabetes published until December 2013. Outcome measures include weight, HbA1c, fasting glucose, fasting insulin, lipid profile, blood pressure, safety and drop out rates.
  
  
  RESULTS
  17 studies were included in the systematic review. Duration of VLCD duration ranged from 5 days to 6 months and duration of follow up ranged from 8 days to 5 years. The age range was 14 years to 59 years of age. Mean weight loss was 13.2kg, ranging from 4.1 to 24kg. Mean Hba1c reduction was 1.4% (ranging between 0.1 to 3.1% reduction across different studies). Three studies reported a significant reduction in the daily doses of insulin. All studies which reported cardiovascular risk profile showed a significant decrease in total cholesterol, systolic and diastolic blood pressure post VLCD. Apart from two studies, all of the other studies showed that the decrease in blood pressure and total cholesterol was not only present immediately post VLCD, but it was also maintained at follow up. However it is important to note that the follow up periods did differ between studies. Overall, drop out rates ranged from 4.7% to 33% and appeared to be lower during the active intervention phase compared with during the follow-up period. No major adverse event was reported apart from one study which recorded a non-fatal myocardial infarction.
  
  
  CONCLUSIONS
  This review demonstrated that VLCD in people with T2D was associated with significant weight loss, reduction in blood glucose profile and improvement in cardiovascular risk profile, high tolerability and good safety outcomes. Studies were heterogeneous and longer term outcomes data post VLCD is still required.
authors.forename: Luckni
authors.initials: L
authors.lastname: Sellahewa
authors.forename: Corniche
authors.initials: C
authors.lastname: Khan
authors.forename: Sindujah
authors.initials: S
authors.lastname: Lakkunarajah
authors.affiliation: Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, DE22 3DT, Staffordshire, UK.
authors.forename: Iskandar
authors.initials: I
authors.lastname: Idris
mesh_terms: D001786:Blood Glucose; D001794:Blood Pressure; D001835:Body Weight; D031204:Caloric Restriction / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
keywords: HbA1c; Very low calorie diet; adverse effect; diabetes; drop out; weight