Addition of Very Low-Calorie Diet (VLCD) During Semaglutide Initiation in Type 2 Diabetes – Interim Results

🔗 Read the Full Study

Citation: Anyiam O, Quinn K, Phillips B, Wilkinson D, Smith K, Atherton P, Idris I. Addition of very low calorie diet (VLCD) during initiation of semaglutide in individuals with type 2 diabetes - interim results. Clin Med (Lond). 2023 Nov;23(Suppl 6):71. doi: 10.7861/clinmed.23-6-s71. PMID: 38182193; PMCID: PMC11046661.

---

Background

Obesity is a growing global health crisis, with 28% of UK adults classified as obese—a figure expected to rise to 60% by 2050. Obesity is also the primary risk factor for type 2 diabetes (T2D), which is increasing in prevalence. Weight reduction interventions are crucial for improving metabolic health and reducing diabetes-related morbidity.

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has been widely used to promote weight loss in T2D. It requires an 8-week dose escalation period and has shown an average weight loss of 4.5 kg over 30 weeks. This study investigates whether combining semaglutide with a very low-calorie diet (VLCD) during the initial dose escalation period enhances weight loss and glycaemic control.

---

Methods

📌 Study Type: Randomized, 12-week trial with 19 individuals with T2D (BMI > 27 kg/m²).

Participants were divided into three intervention groups:

• Semaglutide-only group (n = 7) – Gradual titration up to 1mg.
• VLCD-only group (n = 7) – 800 kcal/day total meal replacement.
• Combination group (n = 5) – Semaglutide + VLCD.

📊 Data Collection & Analysis:

• Weekly weight measurements
• HbA1c, fasting glucose, and fasting insulin measured at baseline & follow-up
• Statistical analysis performed using GraphPad Prism v9.5.0

---

Results

📉 Weight Loss Outcomes:
✅ Combination (Semaglutide + VLCD): 14.9 kg weight loss (14.2% TWL, p<0.01)
✅ VLCD-Only Group: 14.0 kg weight loss (11.6% TWL, p<0.05)
✅ Semaglutide-Only Group: 6.4 kg weight loss (6.3% TWL, p<0.01)

Key Findings:
✔ Combination therapy resulted in the greatest weight loss, significantly more than semaglutide alone (p < 0.01).
✔ VLCD alone also outperformed semaglutide alone in percentage weight loss (p < 0.05).
✔ HbA1c levels decreased across all groups, with a greater trend toward reduction in the combination group vs. semaglutide alone (21.2 mmol/mol vs. 11.3 mmol/mol, p = 0.065).
✔ Fasting glucose reduced significantly in all groups, with no major differences between groups.
✔ Fasting insulin and HOMA-IR significantly decreased in the VLCD-only group (p < 0.01).

---

Conclusion

📢 Combining an 800 kcal/day VLCD with semaglutide during the first 12 weeks may enhance weight loss and glycaemic control in individuals with type 2 diabetes. This strategy could potentially increase diabetes remission rates and improve long-term metabolic health.

🔬 Future Research Needed: Further studies should investigate long-term outcomes of this combined approach in managing both T2D and obesity.

🔗 Read More on PMC