medwireNews: Following a very-low-calorie total diet replacement plan can lead to type 2 diabetes remission in South Asian individuals, shows the STANDby trial.
Naveed Sattar (University of Glasgow, UK) and co-researchers say that people with South Asian ancestry develop type 2 diabetes at a lower BMI and younger age, on average, than White European people.
“The mechanism for their excess risk likely includes greater total fat mass and lower lean mass, leading, in turn, to more rapid ectopic fat gain when weight increases, and potentially lower beta cell reserve,” they write in The Lancet Regional Health: Southeast Asia.
Indeed, the average liver fat in STANDby was 15.6%, similar to the 16.0% seen 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 just 25 people of South Asian ethnicity, aged an average of 45.8 years, with type 2 diabetes for no more than 4 years and a BMI of 25–45 kg/m2 (average 32.1 kg/m2).
Thirteen of these study participants were randomly assigned to immediately begin the dietary intervention (total meal replacement providing 825–853 kcal/day) followed by a 6–8 week stepped food re-introduction. During 3–5 months of the intervention, these people lost an average of 7.2 kg, equating to an average 7.7% reduction in their baseline bodyweight.
The researchers note this was less than in the predominantly White participants in DiRECT “in part as the calorie deficit was less in the lighter South Asians,” in line with other published data.
Thirty-eight percent of the STANDby participants lost less than 5% of their bodyweight, which Sattar and team say implies a proportion of the population for whom the intervention was “minimally acceptable, resulting in “only brief engagement.”
They believe that “[t]here is clearly an opportunity to tailor and refine the intervention, and better present the opportunity to achieve [type 2 diabetes] remission” for South Asian people.
Nevertheless, 15% of the participants lost 5.0–9.9% of their starting bodyweight, 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 who were assigned to the delayed intervention, the average weight loss over this period was 0.9 kg, giving a between-group difference of 6.3 kg or 6.5% of starting bodyweight. None of these people lost more than 5% of their bodyweight.
When including participants assigned to the delayed intervention, after program completion, 43% achieved remission, losing an average of 9.5 kg, representing 10.8% of their bodyweight, compared with 4.7 kg and 5.2% among those who did not achieve remission.
“These results provide important proof of concept for a disabling disease that is rising rapidly in an ethnic group that makes up a quarter of the world’s population,” conclude the researchers.
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Lancet Reg health Southeast Asia 2022; doi:10.1016/j.lansea.2022.100111