Controlling type 2 diabetes with a VLCD approach

In honour of world diabetes day on 14 November, RMA invited registered dietician, Nicola Wilken, to share her insights into Controlling type 2 diabetes with a VLCD approach. Nicola is employed at the CDE

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in South Africa, providing her expert knowledge and guidance to diabetic patients across Southern Africa.

 For many years, type 2 diabetes (T2DM) was regarded as an irreversible chronic condition. However, relatively recent evidence has shown that normal blood glucose (sugar) control can be restored after weight-loss in some individuals with T2DM.

DiRECT Trial

A landmark trial, known as the DiRECT Tiral (The Diabetes Remission Clinical Trial), was the first study which aimed to achieve diabetes remission at a primary care level. The initial phase of the trial involved a Very Low Calorie Diet (VLCD) and then moved on to the introduction of food in a stepwise manner, and finally structured support for weight-loss maintenance and relapse management. The results from the study clearly show that achieving and maintaining weight-loss is the principal factor behind remission of T2DM.

Very low calorie diets (VLCDs)

A VLCD is a weight-loss strategy which uses severe and controlled energy restriction to induce rapid weight-loss. The aim is to achieve a large amount of weight-loss (mostly in the form of excess fat in the organs), whilst preserving lean body mass. A VLCD is a nutritionally complete programme that provides less than 800 kcal per day and can be followed for up to 12 weeks. VLCDs are usually administered in the form of specific meal replacements that serve as the sole source of nutrition. They include shakes, bars, soups and desserts that contain the recommended daily requirements for protein, fatty acids, vitamins, minerals and trace elements. After this VLCD intensive phase, food is gradually reintroduced into the diet until a food-based weight-maintenance diet is established. It is crucial to get professional support alongside the meal replacements and food-reintroduction phases. Physical activity should also be increased during the Programme, to assist with weight maintenance and improving heart health.

‘Responders’ and ‘non-responders’

The benefits seen with a VLCD for achieving diabetes remission do not necessarily apply to everyone. People who are more likely to achieve remission include those who have had diabetes for a shorter duration and who have had the greatest amount of weight-loss. Even if people are not able to achieve remission indefinitely, the effect of a period of normal blood glucose levels provides substantial benefit for reducing the risk of complications. Reductions in blood pressure and blood lipids also offer a major benefit in vascular risk. Furthermore, even if remission is not achieved, the opportunity to decrease the type and dose of treatment in T2DM through a VLCD is also appealing.

VLCD Training

The CDE (Centre for Diabetes & Endocrinology in Houghton, Johannesburg, South Africa) provides training on VLCDs for healthcare professionals. This programme needs to be medically monitored, and anyone wanting to use a VLCD should consult an accredited-practitioner.

VLCD Recipe e-Book

\"RealUsually specific meal replacement products are used for Controlling type 2 diabetes with a VLCD, but for those who prefer eating real food to break the monotony of the diet, the CDE has developed a fabulous recipe book designed with this approach in mind. There are 2 components to the book. The first section aims to provide you with basic nutrition knowledge to help you plan safe and delicious meals as part of a VLCD. The second section of the book contains recipes suitable for a VLCD. Each recipe has been designed to provide 200 kcal of energy per meal. It is important to consult your healthcare practitioner to ensure that you are getting adequate nutrition according to your specific needs.

The recent launch of this recipe book, titled Real Food-based 200 kcal Meals, has been tremendously successful and well received by everyone looking for an approach of this nature. It is now available on the CDE Online Store for R299.95 –




REFERENCES: Controlling type 2 diabetes with a VLCD approach

Asher, R.C.Z, Burrows, T.L. and Collins C.E. (2013) ‘Very low-energy diets for weight loss in adults: a review’, Nutrition & Dietetics, 70(2), pp. 101-112.

Delbridge, E. and Proietto, J (2006) ‘State of the science: VLED (very low energy diet) for obesity’, Asia Pacific Journal of Clinical Nutrition, 15(Suppl), pp. 49-54.

Lean, M.E.J., Leslie, W.S., Barnes, A.C., et al. (2019) ‘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, 7(5), pp. 344-355.

Leeds, R. (2014) ‘Formula food-reducing diets: a new evidence-based addition to the weight management tool box’, Nutrition Bulletin, 39, pp. 238-246.

Leslie, W.S., Taylor, R., Harris, L., et al. (2017) ‘Weight losses with low-energy formula diets in obese patients with and without type 2 diabetes: systematic review and meta-analysis’, International Journal of Obesity, 41, pp. 96-101.

Lim, E.L., Hollingsworth, K.G., Aribisala, B.S., et al. (2011) ‘Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol’, Diabetologia, 54, pp. 2506-2514.

National Health and Medical Research Council (2013) ‘Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia’, National Health and Medical Research Council.

Steven, S., Hollingsworth, K.G., Al-Mrabeh, A., et al. (2016) ‘Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and non-responders’, Diabetes Care, 39, pp. 808-815.

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