Managing Diabetes: Low-Calorie Diet

Managing Diabetes: Low-Calorie Diet

What Is a Low-Calorie Diet?

A low-calorie or a hypocaloric diet is a diet designed to lower daily caloric intake.1 A conventional low-calorie diet usually aims for daily caloric intake of 1,500-1,800 kcal/day for males and 1,200-1,500 kcal/day for females, lower than the average daily caloric requirements of 2,600-2,800 kcal/day for males and 2,000-2,200 kcal/day for females.1,2 A very low-calorie diet aims for daily caloric intake of less than 800 kcal/day, typically ranging between 400 kcal and 800 kcal daily. The very low-calorie diet is recommended only for a short period of time (<12 weeks) for rapid weight loss.

 

Can Low-Calorie Diets Improve Diabetes?

Obesity is one of the leading causes of global morbidity and mortality,3 known to be associated with a host of chronic and metabolic diseases.4 It is the greatest risk factor for developing prediabetes and type 2 diabetes mellitus (T2DM), with estimates that nearly 90% of T2DM can be attributed to obesity.5

 

The current guidelines by the American Diabetes Association (ADA) recommend that adults with prediabetes or T2DM who are overweight (body mass index (BMI) >25 kg/m2) or obese (BMI >30 kg0/0/00 0:00:00 AM/m2) to achieve and maintain a >5% weight loss.6,7 The ADA emphasizes the importance of making significant lifestyle changes to achieve appropriate weight loss and glycemic control.8 Making dietary changes and engaging in physical activity to create a 500-700 kcal/day energy (ie, calorie) deficit are recommended. Modest and sustained weight loss in overweight or obese individuals with T2DM has shown to improve glycemic control, blood pressure, and lipid profile.

 

Although various lifestyle and dietary approaches exist to improve diabetes, studies indicate that low-calorie diets can be an effective method for improved weight and glycemic control in individuals with T2DM.2,9,10 For instance, a systematic review and meta-analysis of 16 randomized controlled trials found that very low-calorie diets resulted in significant improvements in hemoglobin (Hb) A1C and fasting glucose levels in individuals with T2DM when compared to non-dietary therapies.9 Other reviews have similarly observed that very low-calorie diets can effectively promote weight loss, improve insulin response, normalize HbA1C levels, and potentially reverse T2DM.2 One landmark randomized controlled trial called the Diabetes Remission Clinical Trial found that a dietary intervention in T2DM with very low-calorie diet and nutritional support resulted in significant weight loss and remission of diabetes when compared to the control group who received routine care.10 At 1-year and 2-year follow-up, 24% and 11% of those in intervention achieved 15 kg weight loss and 46% and 36% were in remission, respectively, showing that a low-calorie diet can result in significant and long-term improvement in diabetes when weight loss is sustained.

 


References:
1. Koliaki C, Spinos T, Spinou Μ, Brinia ΜE, Mitsopoulou D, Katsilambros N. Defining the Optimal Dietary Approach for Safe, Effective and Sustainable Weight Loss in Overweight and Obese Adults. Healthcare (Basel). 2018;6(3):73. doi:10.3390/healthcare6030073
2. Juray S, Axen KV, Trasino SE. Remission of Type 2 Diabetes with Very Low-Calorie Diets—A Narrative Review. Nutrients. 2021;13(6):2086. doi:10.3390/nu13062086
3. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13-27. doi:10.1056/NEJMoa1614362
4. Mitchell N, Catenacci V, Wyatt HR, Hill JO. Obesity: Overview of an Epidemic. Psychiatr Clin North Am. 2011;34(4):717-732. doi:10.1016/j.psc.2011.08.005
5. Verma S, Hussain ME. Obesity and Diabetes: An Update. Diabetes Metab Syndr. 2017;11(1):73-79. doi:10.1016/j.dsx.2016.06.017
6. Standards of Medical Care in Diabetes—2016 Abridged for Primary Care Providers. Clin Diabetes. 2016;34(1):3-21. doi:10.2337/diaclin.34.1.3
7. American Diabetes Association. 5. Lifestyle Management: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2018;42(Supplement_1):S46-S60. doi:10.2337/dc19-S005
8. American Diabetes Association Professional Practice Committee. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2021;45(Supplement_1):S113-S124. doi:10.2337/dc22-S008
9. Kashyap A, Mackay A, Carter B, Fyfe CL, Johnstone AM, Myint PK. Investigating the Effectiveness of Very Low-Calorie Diets and Low-Fat Vegan Diets on Weight and Glycemic Markers in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutrients. 2022;14(22):4870. doi:10.3390/nu14224870
10. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a Primary Care-Led Weight-Management Intervention for Remission of Type 2 Diabetes: 2-Year Results of the Direct Open-Label, Cluster-Randomised Trial. The Lancet Diabetes & Endocrinology. 2019;7(5):344-355. doi:10.1016/S2213-8587(19)30068-3

  

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