Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders
Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders
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DOI：
10.2337/dc15-1942
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发表时间：
2016-05-01
期刊：
影响因子：
16.2
通讯作者：
Taylor, Roy
中科院分区：
文献类型：
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作者：
Steven, Sarah;Hollingsworth, Kieren G.;Taylor, Roy
糖尿病2型糖尿病（T2 DM）是一种不可逆的慢性疾病。由于极低热量饮食（VLCD）可以使一些T2 DM患者迅速恢复正常血糖控制，因此本研究测试了这种正常化的潜在持久性。研究设计和方法T2 DM持续时间为0.5-23年（n = 30）的人遵循VLCD 8周。在基线时停用所有口服药物或胰岛素。在逐步恢复等热量饮食后，提供了结构化的个体化体重维持计划。在基线时、恢复等热量饮食后以及6个月后对葡萄糖控制、胰岛素敏感性、胰岛素分泌以及肝脏和胰腺脂肪含量进行量化，以初步比较反应者体重减轻后和6个月之间的变化。应答者被定义为恢复等热量饮食后空腹血糖< 7 mmol/L。TSWeight下降（98.0 +/- 2.6至83.8 +/- 2.4 kg），并在6个月内保持稳定（84.7 +/- 2.5 kg）。30名参与者中有12名在恢复等热量饮食后达到空腹血糖< 7 mmol/L（反应者），6个月后30名参与者中有13名达到空腹血糖< 7 mmol/L。应答者的糖尿病病程较短，初始空腹血浆胰岛素水平较高。HbA 1c从7.1 +/- 0.3降至5.8 +/- 0.2%（55 +/- 4至40 +/- 2 mmol/mol）（P < 0.001）和8.4 +/- 0.3至8.0 +/- 0.5%（68 +/- 3至64 +/- 5 mmol/mol），在6个月时保持恒定（分别为5.9 +/- 0.2和7.8 +/- 0.3% [41 +/- 2和62 +/- 3 mmol/mol]）。应答者的特点是恢复第一时相胰岛素respons.CONCLUSIONSA强大和可持续的减肥计划实现了持续缓解糖尿病至少6个月的40%谁回应了VLCD通过实现空腹血糖< 7 mmol/L。T2 DM是一种潜在的可逆疾病。
OBJECTIVEType 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.RESEARCH DESIGN AND METHODSPeople 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.RESULTSWeight 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.CONCLUSIONSA 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.