LEAF Weight Management Clinic, Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Ontario, Canada.
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Can J Diabetes. 2018 Feb;42(1):56-60. doi: 10.1016/j.jcjd.2017.03.006. Epub 2017 Jun 7.
A 6-month weight-management program with full meal replacement, low-calorie diet (full MR-LCD) (900 kcal/day for 6 to 12 weeks) follows a protocol for patients with diabetes for decreasing or discontinuing weight-gaining diabetes medications first (Group WG) and then titrating weight-neutral medications (Group WN).
This is a retrospective cohort study (1992 to 2009) of weight, glycemic control and diabetes medications changes in 317 patients with obesity and type 2 diabetes who were taking medications.
Group WG and Group WN were similar at baseline, except that glycated hemoglobin (A1C) levels were significantly lower in Group WN (7.5% vs. 6.6%; p<0.001). At 6 months, both groups had lost 16% of their weight, and the decreases or discontinuations of medications were 92.1% sulfonureas, 86.5% insulins, 78.8% thiazolidinediones, 77.8% alpha-glucosidase inhibitors, 50% meglitinides, 33.3% dipeptidyl peptidase-4 (DPP-4) inhibitors and 32.8% metformin. At 6 months, compared with baseline, A1C levels improved in Group WG and Group WN (6-month A1C levels 6.7% and 5.8%, respectively; p<0.0001), and Group WN had significantly better A1C levels than Group WG. At 6 months, 30% of patients were no longer taking diabetes medications and had significantly better percentages of weight loss compared with those taking medications (18.6% vs. 16%; p=0.002); both groups had improved glycemic control at 6 months (A1C 6.0% vs. A1C 6.6%; NS).
In patients with obesity and type 2 diabetes taking medications, a full MR-LCD program appears to be safe and includes improvement in A1C levels. At 6 months, the percentage of weight loss can be significantly better in patients who no longer require diabetes medications, and A1C levels are best controlled in patients who are on WN medications.
一项为期 6 个月的体重管理计划，采用全代餐、低热量饮食（6 至 12 周内每天摄入 900 千卡），遵循针对糖尿病患者的方案，首先减少或停止体重增加的糖尿病药物（WG 组），然后调整体重中性药物（WN 组）。
这是一项回顾性队列研究（1992 年至 2009 年），纳入 317 名正在服用药物的肥胖和 2 型糖尿病患者，评估体重、血糖控制和糖尿病药物变化。
WG 组和 WN 组在基线时相似，除了 WN 组的糖化血红蛋白（A1C）水平明显较低（7.5%比 6.6%；p<0.001）。6 个月时，两组体重均减轻 16%，药物减少或停用率分别为 92.1%的磺脲类药物、86.5%的胰岛素、78.8%的噻唑烷二酮类药物、77.8%的α-葡萄糖苷酶抑制剂、50%的米格列奈类药物、33.3%的二肽基肽酶-4（DPP-4）抑制剂和 32.8%的二甲双胍。6 个月时，与基线相比，WG 组和 WN 组的 A1C 水平均改善（6 个月时 A1C 水平分别为 6.7%和 5.8%；p<0.0001），WN 组的 A1C 水平显著优于 WG 组。6 个月时，30%的患者不再服用糖尿病药物，与服用药物的患者相比，体重减轻的百分比显著更高（18.6%比 16%；p=0.002）；两组患者的血糖控制均在 6 个月时改善（A1C 6.0%比 A1C 6.6%；NS）。
在服用药物的肥胖和 2 型糖尿病患者中，全代餐低热量饮食方案似乎是安全的，并可改善 A1C 水平。6 个月时，不再需要糖尿病药物的患者体重减轻百分比显著更高，服用 WN 药物的患者 A1C 水平控制最佳。
