Mild caloric restriction decreases insulin requirements in patients with type 2 diabetes and severe insulin resistance

Authors

• CA Meehan
• E Cochran
• M Mattingly
• P Gorden
• RJ Brown

Abstract

Background: Type 2 diabetes (T2D) affects ~10% of the US population, a subset of whom have severe insulin resistance (>200 units/day). Treatment of these patients with high-dose insulin presents logistical and compliance challenges. We hypothesized that mild caloric restriction would reduce insulin requirements in patients with T2D and severe insulin resistance (SIR). Methods: This was a retrospective study at the National Institutes of Health Clinical Center. Inclusion criteria were: T2D, and insulin dose >200 units/day or >2 units/kg/day. The intervention consisted of mild caloric restriction during a 3-6 day hospitalization. The major outcomes were change in insulin dose and blood glucose from admission to discharge. Results: Ten patients met inclusion criteria. Baseline HbA1C was 10.0 ± 1.6% and BMI 38.8 ± 9.0 kg/m2. Food intake was restricted from 2210 ± 371 kcal/day preadmission to 1810 ± 202 during the hospital stay (16.5% reduction). Insulin dose decreased from 486 ± 291 units/day preadmission to 223 ± 127 at discharge (44% reduction, P=0.0025). Blood sugars decreased non-significantly in the fasting state (from 184 ± 85 to 141 ± 42, P=0.20), before lunch (239 ± 68 to 180 ± 76, P=0.057), and at bedtime (212 ± 95 to 176 ± 48, P=0.19), and significantly decreased before dinner (222 ± 92 to 162 ± 70, P=0.016). Conclusions: Mild caloric restriction, an accessible and affordable intervention, substantially reduced insulin doses in patients with T2D and SIR. Further studies are needed to determine if the intervention and results are sustainable outside of a hospital setting.

Scientific Focus Area: Genetics and Genomics

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