medwirenews: Following a very low-calorie total diet replacement plan may lead to remission of type 2 diabetes in South Asian individuals, the STANDby study shows.
Naveed Sattar (University of Glasgow, UK) and co-researchers say that people of South Asian descent develop type 2 diabetes at a lower BMI and on average younger age than white European people.
“The mechanism for their additional risk likely involves greater total fat mass and lower lean body mass, which in turn leads to more rapid ectopic fat gain as weight increases, and possibly lower beta cell reserve,” they write. The Lancet Regional Health: Southeast Asia.
Indeed, mean liver fat in STANDby was 15.6%, similar to the 16.0% in DiRECT, despite the overall lower weight in the South Asian STANDby population.
Assuming a large effect size, based on the results of DiRECT and DIADEM-I, the STANDby team recruited only 25 people of South Asian ethnicity, 45.8 years old on average, with type 2 diabetes for no more than 4 years and a BMI of 25–45 kg/m²2 (average 32.1 kg/m2).
Thirteen of these study participants were randomly assigned to begin the dietary intervention immediately (total meal replacement provides 825-853 kcal/day), followed by a stepwise food reintroduction over 6-8 weeks. During 3-5 months of the intervention, these people lost an average of 7.2 kg, representing an average reduction of 7.7% in their baseline body weight.
The researchers note that this was less than in the predominantly white participants of DiRECT “partly because the calorie deficit was less in the lighter South Asians,” consistent with other published data.
Thirty-eight percent of STANDby participants lost less than 5% of their body weight, which Sattar and team say implies a segment of the population for whom the intervention was “minimally acceptable, resulting in” only brief engagement.
They believe that “[t]there is clearly an opportunity here to tailor and refine the intervention, and better present the opportunity to achieve something [type 2 diabetes] remission” for South Asian people.
Nevertheless, 15% of the participants lost 5.0-9.9% of their initial body weight, 46% lost more than 10%, and 38% achieved remission of type 2 diabetes (without glucose-lowering medication for at least 3 months).
In the control group, consisting of 12 people assigned to the delayed intervention, the average weight loss over this period was 0.9 kg, resulting in a difference between the groups of 6.3 kg or 6.5% of the starting weight. None of these people lost more than 5% of their body weight.
When participants assigned to the delayed intervention were included, 43% achieved remission after completing the program, losing an average of 9.5 kg, representing 10.8% of their body weight, compared to 4.7 kg and 5.2% in those who did not achieve remission.
“These results provide important proof of concept for a disabling disease that is rapidly increasing in an ethnic group that makes up a quarter of the world’s population,” the researchers concluded.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
Lancet Reg Health Southeast Asia 2022; doi:10.1016/j.lansea.2022.100111