Original article
Quality of life in type 2 diabetes mellitus after a very low calorie diet and exercise

https://doi.org/10.1016/j.ejim.2011.07.004Get rights and content

Abstract

Objective

To evaluate whether the addition of exercise to a very low calorie diet (VLCD) has beneficial short- and long-term effects on health-related quality of life (QoL) in obese patients with type 2 diabetes mellitus (T2DM).

Methods

We included 27 obese, insulin-dependent T2DM patients in a 16-week VLCD study, of whom 13 participated simultaneously in an exercise program (VLCD + E). Before, immediately after and 18 months after the intervention anthropometric measurements, glucoregulation and QoL (SF-36, HADS, NHP and MFI-20) were assessed. Patients were compared to healthy lean and obese (matched for body mass index) controls matched for gender and age.

Results

At baseline, T2DM patients had significantly worse QoL scores in 18 and 14 of the 22 subscales of the QoL questionnaires, compared to lean and obese controls, resp. The 16-week VLCD (n = 27) decreased bodyweight (− 25.4 ± 1.3 kg, p < 0.0001, p = 0.179 between groups), and improved glucoregulation (HbA1c − 1.3 ± 0.3%, p < 0.0001, p = 0.488 between groups) and 9 (VLCD-only) and 11 (VLCD + E) of the 22 subscales of QoL.

After 18 months, in the VLCD + E group the QoL subscales did not differ from those in obese controls and only 4 of the 22 subscales were significantly worse compared to lean controls. However, in the VLCD-only group 17 and 13 of the 22 QoL subscales were significantly worse compared to the lean and obese controls, resp.

Conclusion

A 16-week VLCD induces considerable weight loss, metabolic amelioration, and major improvements in QoL in obese T2DM patients. The addition of exercise is of paramount importance for the maintenance of better QoL.

Introduction

The number of patients with type 2 diabetes (T2DM) is steadily increasing. Almost 90% of T2DM patients are overweight or obese. Medical attention is focused primarily on improving metabolic control to diminish long-term complications. However, patients with chronic diseases such as T2DM also have a poorer health-related quality of life (QoL) compared to healthy control subjects [1]. Reduced QoL not only affects individual happiness but may also have impact on participation in the working process, social functioning, compliance to therapy and hence socioeconomic costs.

Improvement of QoL in T2DM patients is associated with an increase in self-management, adherence to therapy and positive changes in lifestyle [2]. The magnitude of the effects on QoL is dependent on the type of intervention. Behavioral interventions have the smallest effect, but are nevertheless able to improve QoL, reduce the number of hospitalizations and use of medication [2], [3]. Bariatric surgery has the largest effect on QoL, mainly through the loss of excess weight and the waning of obesity-associated symptoms [2], [4]. However, surgery is expensive, invasive, and associated with substantial morbidity. Furthermore it is logistically impossible to operate all obese patients with T2DM. Therefore, diet and lifestyle interventions remain the mainstay of therapy for most obese T2DM patients.

Diet-induced weight loss improves QoL in the short-term but not in the long-term, mostly because of regain of bodyweight [3]. The effect of exercise on QoL in T2DM patients is less clear [5], [6].

Therefore, the aim of this study was to assess whether addition of exercise to a 16-week very low calorie diet (VLCD) in obese, insulin-dependent T2DM patients has greater effects on QoL than a VLCD-only, both immediately after the 16-week intervention and 18 months after the intervention. Secondary aims were to compare QoL in our T2DM patients with lean and obese healthy controls.

Section snippets

Patients and controls

Twenty-seven obese (body mass index (BMI) 37.2 ± 0.9 kg/m2), insulin-dependent T2DM patients (age 58.0 ± 1.6 years, duration of T2DM 8.9 ± 0.8 years, 58 ± 8 months on insulin therapy) participated in the study. Inclusion criteria were insulin-dependent T2DM patients (who used at least 20 EH of insulin per day) with or without oral glucose-lowering medication; at baseline a BMI above 30 kg/m2; remaining endogenous insulin secretion defined as a fasting plasma C-peptide level greater than 0.8 ng/mL and a

Baseline characteristics

Clinical characteristics of the patients and healthy controls are shown in Table 1. Baseline characteristics of the two patient groups (VLCD with exercise (VLCD + E) and VLCD-only) were not different. The lean and obese control groups had significantly lower levels of FPG, insulin and HbA1c compared to the patients. The obese controls were well matched with respect to weight, BMI and waist circumference to the T2DM patients.

Short- and long-term effect of a 16-week VLCD on bodyweight and glucoregulation

After the 16-week intervention both groups (VLCD + E and VLCD-only) showed

Discussion

This study demonstrates that QoL parameters are considerably impaired in obese, insulin-treated T2DM patients. Treatment with a 16-week VLCD with or without an exercise regimen considerably improved QoL, associated with major improvements in anthropometric characteristics and metabolic regulation. However, long-term follow-up shows that exercise is vital in maintaining the achieved anthropometric, biochemical and QoL improvements. Ultimately, in the VLCD with exercise group the total QoL score

Learning points

  • Diet induced weight reduction can improve Quality of life up to the level of healthy controls.

  • Exercise is very important to maintain long-term positive effect on Quality of life and glycemic control.

  • A 16-week very low calorie diet with exercise does have sustained effects even 18 months after start of the intervention on weight and Quality of life.

Conflict of interest statement

Authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding

This research did not receive any specific grant from any funding agency in the public or not-for-profit sector.

Acknowledgment

We are greatly indebted to E. J. M. Ladan-Eygenraam, Leiden University Medical Center, Leiden, The Netherlands, for technical assistance during the study. The authors would like to thank Roba Metals B.V. IJsselstein, The Netherlands for financial support and Nutrition and Santé, Antwerpen, Belgium, for the free supply of Modifast.

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