Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, 00166 Rome, Italy.
PhD Programme in Endocrinological Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Nutrients. 2021 Feb 26;13(3):758. doi: 10.3390/nu13030758.
Obesity-related type 2 diabetes represents one of the most difficult challenges for the healthcare system. This retrospective study aims to determine the efficacy, safety and durability of a very-low-calorie ketogenic diet (VLCKD), compared to a standard low-calorie diet (LCD) on weight-loss, glycemic management, eating behavior and quality of life in patients with type 2 diabetes (T2DM) and obesity. Thirty patients with obesity and T2DM, aged between 35 and 75 years, who met the inclusion criteria and accepted to adhere to a VLCKD or a LCD nutritional program, were consecutively selected from our electronic database. Fifteen patients followed a structured VLCKD protocol, fifteen followed a classical LCD. At the beginning of the nutritional protocol, all patients were asked to stop any antidiabetic medications, with the exception of metformin. Data were collected at baseline and after 3 (T1) and 12 (T2) months. At T1 and T2, BMI was significantly reduced in the VLCKD group ( < 0.001), whereas it remained substantially unchanged in the LCD group. HbA1c was significantly reduced in the VLCKD group ( = 0.002), whereas a slight, although not significant, decrease was observed in the LCD group. Quality of life and eating behavior scores were improved in the VLCKD group, whereas no significant changes were reported in the LCD group, both at T1 and T2. At the end of the study, in the VLCKD group 26.6% of patients had stopped all antidiabetic medications, and 73.3% were taking only metformin, whereas 46.6% of LCD patients had to increase antidiabetic medications. The study confirms a valuable therapeutic effect of VLCKD in the long-term management of obesity and T2DM and its potential contribution to remission of the disease.
肥胖相关的 2 型糖尿病是医疗保健系统面临的最艰巨挑战之一。本回顾性研究旨在比较极低卡路里生酮饮食（VLCKD）与标准低卡路里饮食（LCD）在减肥、血糖管理、饮食行为和 2 型糖尿病（T2DM）和肥胖患者的生活质量方面的疗效、安全性和持久性。从我们的电子数据库中连续选择了 30 名符合纳入标准并同意接受 VLCKD 或经典 LCD 营养方案的肥胖和 T2DM 患者。15 名患者遵循结构化的 VLCKD 方案，15 名患者遵循经典的 LCD。在营养方案开始时，所有患者均被要求停止使用任何降糖药物，除二甲双胍外。数据在基线和 3 个月（T1）和 12 个月（T2）时收集。在 T1 和 T2，VLCKD 组的 BMI 显著降低（<0.001），而 LCD 组则基本不变。VLCKD 组的 HbA1c 显著降低（=0.002），而 LCD 组略有降低，但无统计学意义。VLCKD 组的生活质量和饮食行为评分均有所改善，而 LCD 组则无明显变化，在 T1 和 T2 时均如此。研究结束时，VLCKD 组 26.6%的患者停止了所有降糖药物，73.3%仅服用二甲双胍，而 LCD 组 46.6%的患者不得不增加降糖药物。该研究证实了 VLCKD 在肥胖和 T2DM 的长期管理中的有价值的治疗效果及其对疾病缓解的潜在贡献。
