Treatment of type 2 diabetes in childhood using a very-low-calorie diet

Objective-Pharmacologic agents currently approved for use in children with type 2 diabetes (metformin and insulin) are less than optimal for some patients. We evaluated the use of a ketogenic, very-low-calorie diet (VLCD) in the treatment of type 2 diabetes. Research Design and Methods-We conducted a chart review of 20 children (mean age 14.5+/-0.4 years) who consumed a ketogenic VLCD in the treatment of type 2 diabetes. Several response variables (BMI, blood pressure, HbA(1c), blood glucose, and treatment regimens) were examined before, during, and up to 2 years after the diet and compared with a matched diabetic control group. Results-Before starting the diet, 11 of 20 patients were treated with insulin and 6 with metformin. Mean daily blood glucose values fell from 8.9+/-1.1 to 5.5+/-0.38 mmol/l (P<0.0001) in the first 3 days of the VLCD, allowing insulin and oral agents to be discontinued in all but one subject. BMI fell from 43.5±1.8 to 39.3±1.8 kg/m(2) (P<0.0001) and HbA(1c) dropped from 8.8+/-0.6 to 7.4+/-0.6% (P<0.005) as the diet was continued for a mean of 60±8 days (range 4-130 days), and none required resumption of antidiabetic medications. Sustained decreases in BMI and insulin requirements were observed in patients remaining on the VLCE for at least 6 weeks when compared with those of the control group. Conclusions-The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes. Blood glucose control and BMI improve, allowing the discontinuation of exogenous insulin and other antidiabetic agents. This diet, although strict, has potential as an alternative to pharmacologic therapies for this emerging subset of diabetic individuals.