Introduction
Type 2 diabetes (T2D) in youth has an aggressive clinical course, associated with the early development of chronic complications and a reduced life expectancy. Hence effective treatment strategies are urgently required. In adults a very low energy diet (VLED) can reverse the underlying pathology of T2D. We aimed to determine whether an 8-week VLED followed by a 6-month hypocaloric diet would lead to weight loss, improved glycaemic status and remission of T2D in youth.
Methods
Eight participants aged 7-16 years with T2D were recruited. Participants followed an 8-week VLED comprising three Optifast meal replacements and one low-carbohydrate meal totalling ~800kcal/day. Over a 2-4 week period, participants transitioned to an individualised hypocaloric diet (~1500kcal) which they followed to 34-weeks. HbA1c and 2-hour plasma glucose (2hPG) were determined from fasting blood and oral glucose tolerance tests. Adherence was defined as ≥5% weight loss during the 8-week VLED.
Results
Adherers (n=5) had a mean 7.8% (range: 6.8-8.8%) weight loss during the 8-week VLED while non-adherers (n=3) had a mean 0.2% (range: 2.9% reduction–2.8% gain) weight loss. Overall, HbA1c and 2hPG were significantly reduced at 8-weeks (mean±SD: 6.6±1.3% and 11.3±2.8mmol/L, respectively) compared with baseline (8.1±2.1%, P=0.004 and 15.6±4.6mmol/L, P=0.009, respectively). Non-adherers dropped out during the follow-up period. The four participants who completed the study had a mean 10.7% (range: 3.7-14.3%) weight loss and no longer met the American Diabetes Association criteria for T2D at 34-weeks.
Conclusions
Adherence to a VLED can lead to the reversal of T2D in youth, at least short-term. We speculate that the rapid weight loss achieved at 8-weeks and maintained at 34-weeks by adherers may lead to fat loss from the liver. Future analysis of hepatic fat content, measured using magnetic resonance spectroscopy as part of this study, may confirm this as the mechanism of our findings.