Abstract
Very low-calorie diets (VLCD) are hypocaloric dietary regimens of approximately 400–800 kcal/day that result in 20–30% reductions in body weight, sometimes in just 12–16 weeks. A body of evidence demonstrates that adherence to VLCD in adults with type 2 diabetes (T2D) can result in marked improvements to glycemic control and even full T2D remission, challenging the convention that T2D is a lifelong disease. Although these data are promising, the majority of VLCD studies have focused on weight loss and not T2D remission as a primary endpoint. Moreover, there is a wide range of VLCD protocols and definitions of T2D remission used across these hypocaloric studies. Together the large degree of heterogeneity in VLCD studies, and how T2D remission is defined, leave many gaps in knowledge to efficacy and durability of VLCD approaches for T2D remission. This narrative review examines findings from a body of data from VLCD studies that specifically sought to investigate T2D remission, and discusses the efficacy of VLCD compared to other hypocaloric approaches, and who is likely to benefit from VLCD approaches for T2D remission.
Highlights
Sergio Martínez-Hervás andType 2 diabetes (T2D) and its comorbidities have reached epidemic proportions globally [1], largely driven by high rates of obesity in adults and children
A Very low-calorie diets (VLCD) protocol typically involves the replacement of all food with a medical grade liquid diet formulation that provides approximately 400–800 kcal/day for 12 to 16 weeks, followed by a structured solid food reintroduction phase with kcal/day tailored for weight loss maintenance [30]
Most VLCD liquid formulas consisted of approximately 50–60% of kcal from carbohydrate to prevent ketosis, sufficient levels of essential fatty acids to meet the recommended dietary allowances, and high-biological-value protein at 1.2–1.5 g/kg body weight to prevent loss of lean muscle mass during rapid weight loss [30]
Summary
Sergio Martínez-Hervás andType 2 diabetes (T2D) and its comorbidities have reached epidemic proportions globally [1], largely driven by high rates of obesity in adults and children. VLCD approaches have shown to be the most effective in producing rapid weight loss, improvement to pancreatic insulin secretory capacity, and reduction of hemoglobin A1c (HbA1c) to pre-diabetic and non-diabetic levels, sometimes within days [13,14,15,16,17,18,19,20,21,22,23,24,25] Despite this body of evidence [13,14,15,16,17,18,19,20,21,22,23,24,25], the long-term efficacy of VLCD for reversing T2D remains unclear, as many of these studies have been of short duration (< 12 weeks), did not have T2D remission as a primary endpoint, and varied greatly in their VLCD protocols, follow up duration, and definitions of T2D remission
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