Correa Livia Lugarinho, Medeiros de Sousa Priscila Alves, Dinis Leticia, Carloto Luana Barboza, Nuñez-Garcia Maitane, Sajoux Ignacio, Senhorini Sidney
Department of Obesity, Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil.
Pronokal® Group, Barcelona, Spain.
Endocrinol Diabetes Metab Case Rep. 2022 Sep 1;2022. doi: 10.1530/EDM-22-0295.
There is a close association between obesity and type 2 diabetes (T2D). The value of weight loss in the management of patients with T2D has long been known. Loss of 15% or more of body weight can have a disease-modifying effect in people with diabetes inducing remission in a large proportion of patients. Very low-carbohydrate ketogenic diets (VLCKDs) have been proposed as an appealing nutritional strategy for obesity management. The diet was shown to result in significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. The reported case is a 35-year-old man with obesity, dyslipidemia, and T2D for 5 years. Despite the use of five antidiabetic medications, including insulin, HbA1c was 10.1%. A VLCKD through a commercial multidisciplinary weight loss program (PnK method) was prescribed and all medications were discontinued. The method is based on high-biological-value protein preparations and has 5 steps, the first 3 steps (active stage) consist of a VLCKD (600-800 kcal/d) that is low in carbohydrates (<50 g daily from vegetables) and lipids. The amount of proteins ranged between 0.8 and 1.2 g/kg of ideal body weight. After only 3 months, the patient lost 20 kg with weight normalization and diabetes remission, and after 2 years of follow-up, the patient remained without the pathologies. Due to the rapid and significant weight loss, VLCKD emerges as a useful tool in T2D remission in patients with obesity.
Obesity and type 2 diabetes (T2D) are conditions that share key pathophysiological mechanisms. Loss of 15% or more of body weight can have a disease-modifying effect in people with T2D inducing remission in a large proportion of patients. Diabetes remission should be defined as a return of HbA1c to <6.5% and which persists for at least 3 months in the absence of usual glucose-lowering pharmacotherapy. The very low-carbohydrate ketogenic diet (VLCKD) is a nutritional approach that has significant beneficial effects on anthropometric and metabolic parameters. Due to the rapid and significant weight loss, VLCKD emerges as a useful tool in T2D remission in patients with obesity.
肥胖与2型糖尿病（T2D）之间存在密切关联。体重减轻在T2D患者管理中的价值早已为人所知。体重减轻15%或更多可对糖尿病患者产生疾病改善作用，使很大一部分患者病情缓解。极低碳水化合物生酮饮食（VLCKD）已被提议作为一种有吸引力的肥胖管理营养策略。该饮食在短期、中期和长期均显示可导致显著体重减轻，并改善身体成分参数以及血糖和血脂谱。报告的病例是一名35岁男性，患有肥胖症、血脂异常和T2D达5年。尽管使用了包括胰岛素在内的五种抗糖尿病药物，糖化血红蛋白（HbA1c）仍为10.1%。通过一个商业多学科体重减轻计划（PnK方法）开出了VLCKD处方，并停用了所有药物。该方法基于高生物价值蛋白质制剂，有5个步骤，前3个步骤（活跃阶段）包括一种VLCKD（每日600 - 800千卡），碳水化合物含量低（每日来自蔬菜的碳水化合物<50克）且脂肪含量低。蛋白质摄入量范围为理想体重的0.8至1.2克/千克。仅3个月后，患者体重减轻20千克，体重恢复正常且糖尿病缓解，经过2年随访，患者仍无这些病症。由于体重迅速且显著减轻，VLCKD成为肥胖患者T2D缓解的一种有用工具。
肥胖和2型糖尿病（T2D）是具有关键共同病理生理机制的病症。体重减轻15%或更多可对T2D患者产生疾病改善作用，使很大一部分患者病情缓解。糖尿病缓解应定义为在无常规降糖药物治疗的情况下，HbA1c恢复至<6.5%并持续至少3个月。极低碳水化合物生酮饮食（VLCKD）是一种对人体测量和代谢参数有显著有益影响的营养方法。由于体重迅速且显著减轻，VLCKD成为肥胖患者T2D缓解的一种有用工具。
