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

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, HbA1c, 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/m2 (P 0.0001) and HbA1c 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 VLCD fo