title: Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders.
abstract: Type 2 diabetes mellitus (T2DM) is generally regarded as an irreversible chronic condition. Because a very low-calorie diet (VLCD) can bring about acute return to normal glucose control in some people with T2DM, this study tested the potential durability of this normalization. The underlying mechanisms were defined.
  
  
  
  People with a T2DM duration of 0.5-23 years (n = 30) followed a VLCD for 8 weeks. All oral agents or insulins were stopped at baseline. Following a stepped return to isocaloric diet, a structured, individualized program of weight maintenance was provided. Glucose control, insulin sensitivity, insulin secretion, and hepatic and pancreas fat content were quantified at baseline, after return to isocaloric diet, and after 6 months to permit the primary comparison of change between post-weight loss and 6 months in responders. Responders were defined as achieving fasting blood glucose <7 mmol/L after return to isocaloric diet.
  
  
  
  Weight fell (98.0 ± 2.6 to 83.8 ± 2.4 kg) and remained stable over 6 months (84.7 ± 2.5 kg). Twelve of 30 participants achieved fasting plasma glucose <7 mmol/L after return to isocaloric diet (responders), and 13 of 30 after 6 months. Responders had a shorter duration of diabetes and a higher initial fasting plasma insulin level. HbA1c fell from 7.1 ± 0.3 to 5.8 ± 0.2% (55 ± 4 to 40 ± 2 mmol/mol) in responders (P < 0.001) and from 8.4 ± 0.3 to 8.0 ± 0.5% (68 ± 3 to 64 ± 5 mmol/mol) in nonresponders, remaining constant at 6 months (5.9 ± 0.2 and 7.8 ± 0.3% [41 ± 2 and 62 ± 3 mmol/mol], respectively). The responders were characterized by return of first-phase insulin response.
  
  
  
  A robust and sustainable weight loss program achieved continuing remission of diabetes for at least 6 months in the 40% who responded to a VLCD by achieving fasting plasma glucose of <7 mmol/L. T2DM is a potentially reversible condition.
authors.affiliation: Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steven
authors.affiliation: Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: Kieren G
authors.initials: KG
authors.lastname: Hollingsworth
authors.affiliation: Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al-Mrabeh
authors.affiliation: MoveLab, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: Leah
authors.initials: L
authors.lastname: Avery
authors.affiliation: Computer Science Department, Faculty of Science, Lagos State University, Lagos, Nigeria.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Aribisala
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
authors.forename: Muriel
authors.initials: M
authors.lastname: Caslake
authors.affiliation: Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K. roy.taylor@ncl.ac.uk.
authors.forename: Roy
authors.identifier: 0000-0001-6273-0170
authors.initials: R
authors.lastname: Taylor
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000502:physiology; D000068959:Body Weight Maintenance; D031204:Caloric Restriction / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy*; D004038:Diet, Reducing / Q000379:methods*; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin