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Use of Low Calorie Diets in Type 2 Diabetes

Managing weight in patients with type 2 diabetes (most of who have significant overweight or obesity) is always challenging, not least because many medications used to treat diabetes can also promote weight gain.

Now, a paper by Judy Shiau and colleagues from the University of Ottawa, in a paper published in the Canadian Journal of Diabetes, present the results of a retrospective cohort study (1992 to 2009) of weight, glycemic control and diabetes medications changes in 317 patients with obesity and type 2 diabetes at 6 months on a low-calorie diet program.

The program (week 1 to week 26) included mandatory weekly group sessions led by a dietitian, behaviour therapist or exercise therapist. All patients received OPTIFAST ®900 as full meal replacements (MR) starting at week 2. Patients consume 4 MR shakes per day for a total of 900 kcal per day, a regimen that is high in proteins (90g/day) and moderate in carbohydrates (67 g/day). Patients with initial body mass indexes (BMIs) of 33 kg/m2 or higher commited to 12 weeks of full MRs, while patients with initial BMIs below 33 started with 6 weeks of full MRs and the option to increase to up to 12 weeks of full MRs. Once patients completed their full MR regimen, there was a 5-week transition period to regular food, typically followed by a maintenance diet, as determined in a one-on- one dietitian counselling session.

As glycemic control improved with weight loss, anti-diabetes medications were adjusted or discontinued, thereby stopping any weight-gain-promoting medications first.

As the authors note,

“At 6 months, both groups had lost 16% of their weight, and the decreases or discontinuations of medications were 92% sulfonureas, 87% insulins, 79% thiazolidinediones, 78% alpha-glucosidase inhibitors, 50% meglitinides, 33% dipeptidyl peptidase-4 (DPP-4) inhibitors and 33% metformin. At 6 months, compared with baseline, A1C levels improved significantly and 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).”

Thus, this paper shows that, a low-calorie meal replacement program can substantially improve glycemic control and reduce the need for anti-diabetes medications.

Unfortunately, as participants were transitioned to community care at 6 months, little is know about how long these effects last.

Nevertheless, with the increasing availability and use of weight-neutral or even weight-reducing anti-diabetes medications, one may expect that some of these effects can be sustained for relevant periods of time.

Edmonton, AB


  1. To recommend a low carb, moderate protein and fat, diet is a great alternative diet for a diabetic.
    But why not recommend a healthy ‘real’ food plan that does the same?
    This would be less costly and more sustainable long term. The same control of blood sugar and weight loss – long term. No one wants to drink these shakes the rest of their life.
    Diabetics will find when they cut the carbs (processed foods, sugars, wheat, even grains), they will get their sugars under good control, as well as cut their cravings for those foods. And it is real food!
    Dr Vera Tarman, author of “Food Junkies: the Truth about Food Addiction”.

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  2. I’m disappointed that you would encourage or endorse a liquid sugar starvation diet. Especially a liquid that contains so may chemicals (ingredients below). Have you given any thought to encouraging eating a real food “diet”? It works and people that follow it keep the weight off. 130 Pounds lost 7 years maintaining went from morbidly obese to normal. I look forward to your thoughts.

    Opitifast Ingredients (Vanilla): Milk protein isolate, fructose, maltodextrin (corn), canola oil, soybean oil, potassium citrate, sodium citrate, sodium caseinate, sodium chloride, dipotassium phosphate, artificial flavour, mono- and diglycerides, citric acid, magnesium oxide, choline bitartrate, aspartame*, ascorbic acid, ferrous sulphate, niacinamide, zinc sulphate, vitamin E acetate, copper gluconate, manganese sulphate, calcium-D-pantothenate, BHA/BHT, vitamin A palmitate, thiamine hydrochloride, pyridoxine hydrochloride, riboflavin, folic acid, chromium chloride, sodium molybdate, potassium iodide, sodium selenite, biotin, vitamin D3.

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  3. It is always very good to know about diabetes because this disease has killed many people I also have relatives who suffer from this disease and this information helped me thank you very much.

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  4. Liquid diets are well known for their dangers. They’re better now than they were in the 1970s, when people died from “over the counter” versions that didn’t have enough critical nutrition (many died from lack of potassium).

    And of course you can ‘cure’ Type 2 diabetes by not feeding people. You’re not really curing anything, though. You’re fixing a broken leg by making the person use a wheelchair. They can get around, but their leg is still broken.

    I can’t read the whole study (grumble, paywall) but I’m curious what kind of, and how much, “normal food” the participants were given when weaned off the liquid. A 900 cal/day diet is not one that is easily maintained and usually not done in a healthy manner. Low and Very Low calorie diets are notorious for requiring supplements for nutrition that could otherwise be found in normal, everyday, and healthful foods.

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  5. Thanks for sharing wonderful ideas!! Actually i was looking for this. only. I got what i want. I was having many of doubts. But your ideas clear my all doubts. Thanks for sharing wonderful ideas!!!

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