Is a low-calorie diet combined with semaglutide the solution?

Type 2 diabetes is a significant and growing concern in the United States and elsewhere. The rapid increase in prevalence has prompted a wave of research in recent years.

It is now clear that increased levels of body fat increase the risk of developing this disease. Obesity is linked to a seven times increase in danger.

The link between obesity and type 2 diabetes is due, at least in part, to the fact that excess weight is linked to insulin resistance and reduced beta cell function.

It’s a double-edged sword: insulin resistance means the body’s tissues no longer respond properly to insulin, while dysfunctional beta cells mean the pancreas produces less insulin.

In other words, obesity means that there is less insulin available and the insulin that is available is no longer as effective.

Because excess weight plays a significant role in the risk of type 2 diabetes, weight loss is an important part of diabetes management.

Semgalutide was originally designed to treat type 2 diabetes. works by increasing the amount of insulin produced after eating, which helps keep blood sugar levels within healthy ranges.

It also suppresses the production of glucagon, a hormone that increases blood sugar levels and can improve beta cell function. More recently, semaglutide has become famous as a powerful weight loss drug.

Similarly, studies have shown that following a very low-calorie diet – 800 calories per day – can produce significant weight loss.

Studies also show that a very low-calorie diet can improve blood sugar control and even reverse type 2 diabetes. These improvements may be due to better beta cell function.

Low-calorie diets, however, are extremely difficult to follow. In some studies, a third Participants on a very low-calorie diet dropped out, unable to maintain low energy intake.

Although the evidence for both interventions is good, there is no direct comparison between the two approaches. Additionally, no studies have examined the effectiveness of a low-calorie diet and semaglutide in combination. The new study fills this gap.

To conduct their study, the scientists recruited 30 participants with type 2 diabetes. They were randomly divided into three groups:

1. semaglutide
2. very low calorie diet — 800 calories per day
3. semaglutide plus very low calorie diet.

The study lasted 12 weeks. Before and at the end of the study, scientists assessed:

• weight.
• Glycated hemoglobin (HbA1c) — a measure of blood sugar levels.
• Dual-energy X-ray absorptiometry — a method of measuring body composition.
• Intravenous glucose tolerance tests (IGTTs) — these assess the first phase of insulin release and are a marker of beta cell function.

“Insulin is secreted in a biphasic manner – in two waves, so to speak – by the pancreas. The first phase is the initial secretion of insulin in response to sugar in the body,” said Dr. Mir Ali. Today’s Medical News.

Ali is a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif. He was not involved in the study.

While the first phase is rapid and triggered by blood glucose, the second phase is longer and slower and does not depend on blood glucose.

At the end of the study, scientists found that a very low-calorie diet and the combination of a very low-calorie diet and semaglutide resulted in significantly greater reductions in body weight and fat mass than semaglutide alone.

HbA1c and fasting glucose decreased significantly in all three groups. Importantly, fasting insulin levels and insulin sensitivity were improved only in the very low-calorie diet group and the combination group.

The scientists also found that the first-phase insulin response increased in people taking semaglutide alone and in those in the combination group. This increase was more pronounced in the combination treatment than in the low-calorie diet.

In short, following a very low-calorie diet led to greater weight loss than semaglutide, but the combination of the two produced the best results. This combination also led to greater improvements in beta-cell function, an important marker of better diabetes control.

Franklin Joseph, MD, chief medical officer of Dr. Frank’s Weight Loss Clinic, who was not involved in this study, spoke with MNT He was surprised to find that “although the (very low-calorie) diet led to greater reductions in weight, fat mass, and insulin resistance, it did not appear to improve beta cell function.”

The authors suggest this is because the participants had been living with type 2 diabetes for a long time. According to Joesph, this highlights the fact that “aggressive weight loss interventions to try to achieve remission need to be implemented early in the diabetes journey.”

This study suggests that a combination of a low-calorie diet and semaglutide may be an effective way to manage type 2 diabetes. However, this was only a pilot study with a small group of participants, so much work remains to be done.

Additionally, 12 weeks is a relatively short period of time to assess weight loss and type 2 diabetes management. It is important to understand what happens over the long term.

Talk with MNTMegan Warnke, RDN, a registered dietitian nutritionist and certified diabetes care and education specialist, also not involved in this research, explained that a very low-calorie diet is not a viable approach beyond a short-term intervention:

“The key words in this study are ‘short-term results.’ As with any diet, this approach may work for a short period of time, but it is not sustainable for long-term results.”

Additionally, “semaglutide’s appetite suppression may help patients adhere to a low-calorie diet, but other factors such as stress, sleep, and food insecurity will also impact the ‘success’ of the diet, which this drug cannot address,” Warnke explained.

In agreement, Joseph said MNTthat “the use of semaglutide for its appetite-control effect would be an excellent adjunct to enable people to start and maintain a (very low-calorie) diet.”

But many questions remain. “Will appetite return with a vengeance due to hunger and lead to rapid weight regain?” Joseph said. “Would following the low-calorie diet for a set period of time and continuing semaglutide treatment longer-term maintain the weight loss and glycemic control achieved?”

Overall, Joseph believes this approach could prove useful in the future. “We are increasingly focused on getting patients into remission of diabetes as early as possible, and improvements in beta cell function suggest this approach may be more beneficial in achieving remission,” he noted.