Endocrine Abstracts

Some literary data demonstrate that the twin defect of beta-cell failure and insulin resistance that underline T2DM can be reversed by acute negative energy balance alone. The aim of the present work was to assess treatment outcomes in women with new onset T2DM, who were previously diagnosed with GDM treated with acute dietary restriction or conventionally at 32 weeks postpartum (PP).

Methods: In total 174 women with T2DM at 32 weeks PP, were enrolled in the study. Patients were tested at 32, 40 and 48 weeks PP. Patients were divided into two groups (Gr.): Gr.1 - Acute Dietary Energy Restriction - 61 women - 600kcal/day for 8 weeks, during next 8 weeks- 1 200 – 1 400kcal/day. Gr.2 - Conventional Therapy - 113 women - 1 400 – 1800 kcal/day and Metformin.

Results: At entry levels of HbA1c, fasting plasma glucose (FPG), insulin, triglycerides and BMI statistically did not differ in Gr.1 and Gr.2. At week 33 PP (one-week post treatment) FPG decreased: Gr.1 – 170.5 ±18.6 vs. 96.4±9.1;P=0.000 and Gr.2– 169.9± 18.8 vs. 145.7± 14.9;P=0.32, and at week 48 PP- FPG levels decreased in both groups, but in Gr.1 decrease was statistically more evident, than in Gr.2 (P=0.004). At week 40 PP HbA1c levels decreased in both groups (Gr.1 – by 1.42 ±0.12 and Gr.2 – 0.68± 0.08;P=0.000), and at week 48 PP HbA1c levels were statistically lower in Gr.1 (P=0.000). At week 40 PP fasting plasma insulin fell from 16.1 ±3.6 to 5.2± 1.7 (Gr.1 – P=0.000), and 15.9 ±3.1 to 12.1 ±2.3 (Gr.2 -P=0.3); and at week 48 PP these indices were statistically lower in Gr.1 when compared to Gr.2 (P=0.000). After 16 weeks of treatment BMI also reduced in both groups (Gr.1 – by 7.8±0.08kg/m₂ and Gr.2 – by 2.61 ±0.1%) while at week 48 PP statistically lower BMI was observed in Gr.1 (P=0.055). Triglyceride levels have dropped in Gr.1 and 2 (by 0.60 ±0.05 and 0.68 ±0.06 mg/dl, respectively) though this decrease was not statistically evident.

Conclusion: In women with T2DM, who were previously diagnosed with GDM acute dietary restriction at 32 weeks PP significantly reduced plasma fasting glucose, insulin levels, HbA1c, and BMI when compared to traditional dietary management and Metformin. Our data are in complete accordance, that abnormalities underlying T2DM are reversible by reduced dietary energy intake, that is of an utmost importance for young women after pregnancy and breastfeeding.