LOW-CARB AND CALORIE DIETS AND THEIR ROLE IN TYPE 2 DIABETES Substantial weight loss can induce remission of Type 2 diabetes by improving glycaemic control, enabling patients to reduce or potentially omit their insulin or diabetic oral medication.1 This article examines the role of very low-calorie/carbohydrate diets in maintaining weight loss to benefit glycaemic control. Very low-calorie diets (VLCDs), which tend to last for 12 weeks, have been proposed to be a promising intervention to achieve significant weight loss in a short amount of time. VLCDs are defined as clinically supervised diet plans that consist of <800 calories per day and aim to induce weight loss and/or remission of Type 2 diabetes.2 They have consistently been shown to lead to statistically significantly greater weight loss than behavioural weight management programmes based on usual foods.3 Weight loss programmes provided in community groups by commercial organisations have been shown to be more effective than routine management delivered by primary care clinicians, and their efficacy continues to be a prime topic of research in diabetes and weight management.4,5 RESEARCH INTO VLCDS
DiRECT The Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT) aims to gain understanding of why weight loss can induce remission.6 The study is ongoing and only recruits participants via NHS General Practices. They are currently collecting data on participants in their fourth and fifth years of support and follow-up. So far, the authors have found that a VLCD successfully induced Type 2 diabetes remission in 46% of participants.6 An average weight loss of 10kg was achieved at 12 months, and the more weight participants lost, the more likely they were to induce
remission. Those in the intervention arm who lost >15kg, had remissions for 86% at one year and 82% at two years.6 These participants mostly had an HbA1c in the range of â&#x20AC;&#x2DC;prediabetesâ&#x20AC;&#x2122; (42-48mmol/l). So far, the study has proven to be more cost effective and cost saving when compared with standard care.7 DROPLET Results from the DiRECT study are supported by the Doctor Referral of Overweight People to Low Energy Total Diet Replacement (TDR) Treatment (DROPLET) randomised controlled trial (RCT).8 One hundred and thirtyeight participants were assigned to the TDR programme, which was a 12-week 810kcal/day diet with behavioural support. One hundred and forty participants were assigned to usual care, consisting of behavioural support for weight loss from a practice nurse and a modest calorie deficit, which was not specified. Those in the TDR group lost approximately 7.2kg more than the usual care group, with 45% of them achieving >10% weight loss, compared with only 15% of participants achieving this in the usual care group (see Figure 1). There were also greater improvements in the risk of cardiometabolic disease in the VLCD group.8
DIET & LIFESTYLE
Harriet Drennan RD Harriet is a Specialist Diabetes and Acute Medicine Dietitian at the University Hospital of North Midlands. hdrennanrd
REFERENCES Please visit: nhdmag.com/ references.html
MIDAS With recent national and regional lockdown restrictions, more remote ways of supporting patients are being researched. The Manchester Diabetes www.NHDmag.com February 2021 - Issue 160
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