(01-03-12) Very-low-calorie diet: a quick therapeutic tool to improve ? cell function in morbidly obese patients with type 2 diabetes1,2,3

1. Ilaria Malandrucco,
2. Patrizio Pasqualetti,
3. Ilaria Giordani,
4. Dario Manfellotto,
5. Federica De Marco,
6. Filippo Alegiani,
7. Anna Maria Sidoti,
8. Fabiana Picconi,
9. Alessandra Di Flaviani,
10. Gaetano Frajese,
11. Riccardo C Bonadonna, and
12. Simona Frontoni
+Author Affiliations
1. 1From the Department of Medicine, University of Rome Tor Vergata, Rome, Italy (IM, IG, FDM, FP, ADF, GF, and SF); the Unit of Endocrinology, Diabetes, and Metabolism, S Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy (IM, IG, FDM, FP, ADF, GF, and SF); the Service of Medical Statistics & Information Technology, Fatebenefratelli Association for Research S Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy (PP); the AFaR, Unit of Internal Medicine, S Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy (DM, FA, AMS, and PP); the Department of Medicine, University of Verona, Verona, Italy (RCB); the Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy (RCB).
+Author Notes
? ↵2 Supported in part by AFaR, S Giovanni Calibita Fatebenefratelli Hospital, and by University of Rome Tor Vergata Research Grants (to SF) and by University of Verona Research Grants (to RCB).
? ↵3 Address correspondence to S Frontoni, Fatebenefratelli Hospital, Endocrinology and Metabolism, Via di Ponte Quattro Capi, 39, 00186 Rome, Italy. E-mail: [email protected].
Abstract
Background: Caloric restriction in obese diabetic patients quickly improves glucose control, independently from weight loss. However, the early effects of a very-low-calorie diet (VLCD) on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes are still unclear.
Objective: The objective was to study the relative contributions of insulin sensitivity, insulin secretion, or both to improvement in glucose metabolism, after 1 wk of caloric restriction, in severely obese diabetic patients.
Design: Hyperglycemic clamps were performed in 14 severely obese (BMI, in kg/m2: >40) patients with type 2 diabetes in good glucose control (glycated hemoglobin < 7.5%) before and after 7 d of a VLCD (400 kcal/d).
Results: The VLCD caused a 3.22 ? 0.56% weight loss (P < 0.001), 42.0% of which was fat loss, accompanied by decreases in fasting plasma glucose (P < 0.05) and triglycerides (P < 0.01). In parallel, the Disposition Index, which measures the body's capability to dispose of a glucose load, increased from 59.0 ? 6.3 to 75.5 ? 6.3 mL? min−1 ? m−2 body surface area (P < 0.01), because of improvements in indexes of both first- and second-phase insulin secretion (P < 0.02), but with no changes in insulin sensitivity (P = 0.33).
Conclusion: The marked improvement in metabolic profile, observed in severely obese patients with type 2 diabetes after a 7-d VLCD, was primarily due to the amelioration of ? cell function, whereas no contribution of insulin sensitivity was shown.

Source: Am J Clin Nutr March 2012 vol. 95 no. 3 609-613

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