Abstract
Aim/ Hypothesis: Caloric restriction in patients with type 2 diabetes mellitus and obesity can induce diabetes remission but the beneficial effects often disappear after discontinuation of caloric restriction. Intermittent caloric restriction may be beneficial in the long term. This study aims to examine the effects of intermittent caloric restriction by means of very-low calorie diet (2 and 4 days/week) on diabetes remission, glucose homeostasis, metabolic and anthropometric changes, quality of life, as well as beta cell function and insulin resistance. Method: Forty-two patients with type 2 diabetes and obesity (mean age 40.6 years, BMI 36.9 kg/m2) were enrolled. Participants were randomly assigned into 3 groups (control [n=12], intermittent VLCD 2 days/week [n=14] and intermittent VLCD 4 days/week [n=14]) for 20 weeks. They received blood tests, anthropometric measurement and answered the quality of life questionnaire at weeks 0, 2, 10 and 20. Results: At 20 weeks, diabetes remission was found only in the intermittent VLCD 2 days/week and the 4 days/week groups (4 each). Anti-diabetic medications were successfully withdrawn in 7, 9 and 12 subjects, representing 58%, 63% and 86%, in the control, the intermittent VLCD 2 days/week and the intermittent VLCD 4 days/week groups, respectively. In both the intermittent VLCD 2 days/week and the intermittent VLCD 4 days/week groups, there were significant decreases in FPG, 2 hr glucose after a 75 gm OGTT, and HbA1C. In addition, triglyceride level, body weight, BMI, body fat percentage, fat mass, fat free mass and muscle mass were significantly decreased. Improvement in glycemic control was associated with a reduction in a decrease in insulin resistance. Quality of life was also significantly increased in borth VLCD groups. No serious adverse events were observed. Moreover, in the intermittent VLCD 4 days/week group, there were significant decreases in SBP, DLP, AST and ALT. Conclusion: Intermittent dietary caloric restriction (2 days/week and 4 days/week) for 20 weeks was highly effective in rapidly achieving glycemic control without serious adverse ecvents. Improvements in the intermittent VLCD 4 days/week were more pronounced than those in the intermittent VLCD 2 days/week.
