The role of formula low energy diets in Type 2 diabetes mellitus patients treated with insulin

Abstract

Type 2 diabetes mellitus (T2D) and obesity are two of the key health challenges of modern society. With an ageing population and increasing life expectancy, advanced T2D, including those treated with insulin, is now frequent within clinical practice. Effective treatment of glycaemic control in those treated with insulin relies at present on insulin intensification, that although effective at managing blood glucose, is associated with weight gain and an increased risk of cardiovascular disease (CVD) mortality.

Bariatric surgery has been shown to be one of the most effective treatments for obesity and T2D. One key mechanism by which bariatric surgery aids diabetes control is through energy restriction. The use of formula low energy diet (LED) to replicate this and attendant significant weight loss has been observed to bring about T2D remission in those with recently diagnosed T2D patients. However, evidence for the use of these formula diets is lacking in those T2D patients concurrently treated with insulin.

The work presented in this thesis aimed to investigate the role of formula low energy diets in obese type 2 diabetes patients concurrently treated with insulin.

Investigation 1 studied the effect of a formula LED, over a 24-week period, on weight loss insulin usage, and glycaemic control in obese T2D patients treated with insulin compared with gold standard clinical care (GSC). The presented data demonstrates that those on an LED had greater weight loss, improvement in HbA1c, and reduction in insulin usage compared to GSC.

Investigation 2 studied the effect of weight loss induced by an LED on surrogate markers of CVD. Compared with GSC, there were key reductions in triglycerides, diastolic blood pressure and high sensitivity C-reactive protein. Based on CVD risk algorithms, there may be a CVD benefit of weight loss through LED, at least in the short term.

The work presented in the thesis helps to support the use of formula LED as a therapeutic treatment for complex T2D patients. The exact mechanisms by which the LED brings about the observed improvements in glycaemic control and reduction in insulin usage remains be determined.