A recent study conducted by scientists at the University of Nottingham, UK, has highlighted the efficacy of combining a very-low calorie diet (VLCD) with the glucagon-like peptide-1 receptor agonist (GLP1RA) semaglutide in managing type 2 diabetes. Published in the journal Clinical Nutrition, the study aimed to investigate the effects of these interventions, both individually and in combination, on weight loss and glycemic control in patients with type 2 diabetes.
Background
Type 2 diabetes is characterized by elevated blood glucose levels and insulin resistance, primarily attributed to impaired insulin secretion from pancreatic beta-cells. Obesity and overweight are significant risk factors contributing to the development of type 2 diabetes, affecting a vast majority of patients.
Semaglutide, known for its effectiveness in reducing body weight, acts as an antidiabetic medication by mimicking the action of GLP-1. VLCD, on the other hand, is a proven method for substantial weight loss and has shown potential in improving beta-cell function and glycemic control in type 2 diabetes.
Study Design
The study involved 30 adult participants with type 2 diabetes and a body mass index (BMI) ranging from 27 to 50 kg/m². Participants were randomly assigned to one of three groups: VLCD alone, Semaglutide alone, and a combination of VLCD and Semaglutide. Each intervention lasted 12 weeks.
The VLCD group adhered to a strict 800-kilocalorie per day diet, while the Semaglutide group received weekly subcutaneous injections of Semaglutide, gradually increasing from 0.25 to 1 milligram over two-week intervals. The combined group received both interventions concurrently.
Key Findings
All intervention groups experienced significant reductions in body weight; however, the VLCD and combined intervention groups achieved notably higher percentages of weight loss compared to the Semaglutide-alone group. Specifically, weight loss in the VLCD and combined groups exceeded that of the Semaglutide group by 5.4% and 7% respectively.
Moreover, reductions in fat mass were more than double in the VLCD and combined groups compared to the Semaglutide group, although there were no significant differences in lean body mass reduction among the groups.
Dietary and Metabolic Assessments
Participants in the VLCD and combined groups demonstrated greater reductions in daily energy intake compared to the Semaglutide group. Analysis of macronutrient intake revealed higher proportions of daily energy from protein and lower from fat in the VLCD and combined groups compared to the Semaglutide group.
Glycated hemoglobin levels, a marker of glycemic control, decreased significantly in all groups, with the combined intervention group showing the greatest reduction. Fasting insulin levels decreased significantly in the VLCD and combined groups but increased slightly in the Semaglutide group. However, fasting glucose reduction was comparable across all groups.
Insulin sensitivity and acute insulin response to glucose improved significantly in the Semaglutide and combined groups, with the combined group demonstrating a 9-fold higher increase in insulin response compared to the VLCD group.
Adverse Events
Common adverse effects reported in the Semaglutide group included mild nausea, constipation, mild abdominal discomfort, abdominal bloating, and lethargy. In the VLCD and combined groups, constipation was the most frequent adverse event, with some participants also experiencing mild abdominal discomfort, nausea, or headache.
Study Significance
The study underscores the enhanced efficacy of combining Semaglutide with a VLCD in improving pancreatic beta-cell function and reducing insulin resistance compared to Semaglutide alone. Furthermore, VLCD proved more effective than Semaglutide in achieving rapid weight loss and reducing fat mass.
Further research with longer intervention periods and follow-up is warranted to fully elucidate the long-term impacts of the Semaglutide-VLCD combination on managing type 2 diabetes and obesity.
In summary, the study represents a significant step toward developing more effective treatment strategies for type 2 diabetes, emphasizing the potential benefits of combining pharmacological and dietary interventions to achieve comprehensive metabolic improvements.