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)

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