title: Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study.
abstract: The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies.
  
  
  
  Eight participants with type 2 diabetes and obesity, aged 7-16 years, non-medicated (n = 1) or treated with metformin (n = 7) and in some cases insulin (n = 3), followed a VLED (<3360 kJ/day) for 8 weeks, then transitioned to a hypocaloric diet (∼6300 kJ/day) that they followed to 34 weeks. HbA1c, fasting glucose and 2 h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as ≥5% weight loss during the 8 week VLED.
  
  
  
  Adherers (n = 5) and non-adherers (n = 3) had median weight loss of 7.5% and 0.5%, respectively, at 8 weeks. Overall, HbA1c(mean [SE] 8.1% [0.7%] to 6.6% [0.5%]; p = 0.004) and 2hG (15.6 [1.6] mmol/l to 11.3 [1.0] mmol/l; p = 0.009) were significantly reduced at 8 weeks compared with baseline. Liver fat was also significantly reduced from baseline (14.7% [2.2%]) to 8 weeks (5.8% [1.7%]; p = 0.001). Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (≥5.5%) at 8 weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8 week VLED. At 34 weeks, adherers (n = 5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes.
  
  
  
  A VLED appears to be a feasible treatment option for some youth with type 2 diabetes on metformin therapy. Youth who agree to participate and adhere to a VLED achieve rapid weight loss, dramatic reductions in liver fat and reversal of type 2 diabetes. This highlights the capacity of a VLED to be used as a first-line treatment option in newly diagnosed youth. A larger trial with a control group and longer follow-up will be required to encourage a change in standard treatment.
  
  
  
  Australian New Zealand Clinical Trial Registration Number (ACTRN) ACTRN12616000375459 ( www.ANZCTR.org.au/ACTRN12616000375459.aspx ).
authors.affiliation: Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia. megan.gow@health.nsw.gov.au.|Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Corner of Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia. megan.gow@health.nsw.gov.au.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Gow
authors.affiliation: Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.|The Children's Hospital at Westmead Clinical School, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Baur
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Johnson
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Corner of Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia.|Kids' Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Cowell
authors.affiliation: Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.|Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Corner of Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW, 2145, Australia.|Kids' Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects; D031204:Caloric Restriction; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D004038:Diet, Reducing / Q000379:methods*; D005215:Fasting / Q000097:blood; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008687:Metformin / Q000627:therapeutic use; D009765:Obesity / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D010179:Pancreas / Q000187:drug effects / Q000378:metabolism; D010865:Pilot Projects; D011788:Quality of Life
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D008687:Metformin
keywords: Adolescents; Children; Liver fat; Type 2 diabetes; Very-low-energy diet; Youth