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Obese Patients with Type 2 Diabetes on Conventional Versus Intensive Insulin Therapy: Efficacy of Low-Calorie Dietary Intervention

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Abstract

Introduction

The aim of this prospective study was to assess the results of a standard low-calorie dietary intervention (7.5 MJ/day) on body weight (BW) and the metabolic profile of obese patients with type 2 diabetes mellitus (T2DM) on intensive insulin therapy (IIT: 4 insulin injections/day) versus conventional insulin therapy (CIT: 2/3 insulin injections/day).

Methods

A total of 60 patients (n = 60, 23 males and 37 postmenopausal females) were recruited and categorized into two groups according to the scheme of insulin treatment. Thirty were on IIT (13 males and 17 females) and an equal number on CIT (10 males and 20 females). BW, body mass index (BMI), HbA1c, and metabolic parameters were compared at 6 and 12 months after baseline.

Results

Significant reductions were observed in the BW, BMI, HbA1c (p ≤ 0.001 for all) and cholesterol (p ≤ 0.05) at 6 months post-intervention. At 1 year, median BW reduction was 4.5 kg (3.3, 5.8) for patients on IIT and 4.8 kg (3.6, 7.0) for those on CIT. The 12-month dietary intervention increased prevalence of normoglycemia in the IIT group and reduced the prevalence of obesity prevalence among the CIT participants (all p < 0.001). CIT patients with BW reduction ≥5.0% demonstrated 11-fold greater chances of being normoglycemic (odds ratio 11.3, 95% CI 1.1–110.5). BW reduction ≥7.0% was associated with CIT, being overweight, and having normal HDLc, LDLc, and cholesterol levels. A reduction in BW between 5.0% and 6.9% was associated with IIT, normoglycemia, and obesity.

Conclusion

A 12-month 1800-kcal dietary intervention achieved significant BW and HbA1c reductions irrespectively of insulin regimen. CIT was associated with BW reduction greater than 8.0%, whereas IIT was associated with higher rates of normoglycemia.

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Acknowledgments

No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Dimitrios Baltzis, Maria G. Grammatikopoulou, Nikolaos Papanas, Christina-Maria Trakatelli, Evangelia Kintiraki, Maria N. Hassapidou, and Christos Manes declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Compliance with Ethics Guidelines

The institutional ethics committee of the Papageorgiou General Hospital approved the study and patients gave their informed consent prior to participation.

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Authors and Affiliations

  1. 3rd Department of Internal Medicine, Papageorgiou General Hospital, Thessaloniki, Greece

    Dimitrios Baltzis, Christina-Maria Trakatelli & Evangelia Kintiraki

  2. Microcirculation Lab and Joslin-Beth Israel Deaconess Foot Center, Harvard Medical School, Boston, MA, USA

    Dimitrios Baltzis

  3. Department of Human Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece

    Maria G. Grammatikopoulou & Maria N. Hassapidou

  4. Diabetes Center, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Nikolaos Papanas

  5. Diabetes Center, Papageorgiou General Hospital, Thessaloniki, Greece

    Christos Manes

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  1. Dimitrios Baltzis
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Baltzis, D., Grammatikopoulou, M.G., Papanas, N. et al. Obese Patients with Type 2 Diabetes on Conventional Versus Intensive Insulin Therapy: Efficacy of Low-Calorie Dietary Intervention. Adv Ther 33, 447–459 (2016). https://doi.org/10.1007/s12325-016-0300-2

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