VLED and formula LED in the management of type 2 diabetes: defining the clinical need and research requirements

Lean, M. (2011) VLED and formula LED in the management of type 2 diabetes: defining the clinical need and research requirements. Clinical Obesity, 1(1), pp. 41-49. (doi:10.1111/j.1758-8111.2010.00007.x)

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Abstract

It has been known for many years that substantial weight loss, achieved by bariatric surgery or non-surgical means can mean normalise glucose tolerance. Recent RCT evidence indicates that >15 kg weight loss is necessary, to this and it may lead to near normalisation (doubling) of life expectancy. Less than 5% of patients achieve this through even the best, evidence-based medical weight management programme (Counterweight www.counterweight.org ). A weight loss of >15 kg is easily achievable by 8 weeks VLED/LELD in compliant patients, with little difference between 400-800 kcal/day, but weight maintenance after VLED has until recently been so poor that VLEDs are not, at present, recommended in clinical guidelines. However, mean weight loss close to >15 kg can be maintained 18-24 months using a variety of maintenance strategies. These include a structured reintroduction of foods linked to an education programme with behavioural strategies, intermittent VLED use and prescribable anti-obesity drugs (dexfenfluramine, orlistat, sibutramine). Most of these studies have been in non-diabetic subjects. A new “curative” paradigm in T2DM management, aiming to normalise glucose tolerance and health risks by achieving and maintaining >15 kg loss, as soon as possible after diagnosis, should be highly acceptable to patients, generating many additional QALYs. It is likely to be highly cost-effective by avoiding the current recommended, mainly palliative, model, using polypharmacy which provides an overall risk reduction of only 5-10%.. Clinical trials are on-going to establish the feasibility of delivering formula (LELD) and a maintenance programme to large numbers of patients within routine primary care. There is urgent need, to run similar studies in diabetic patients. New approaches to long-term (lifelong) maintenance of weight loss and a non-diabetic state may include anti-obesity drugs.

Item Type:Articles
Keywords:Guideline; obesity; weight loss
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lean, Professor Michael
Authors: Lean, M.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Clinical Obesity
Journal Abbr.:Clin. Obes.
ISSN:1758-8111
ISSN (Online):1758-8111
Copyright Holders:Copyright © 2011 The Author
First Published:First published in Clinical Obesity 1(1):41-49
Publisher Policy:Reproduced in accordance with the copyright policy of the author

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