Efficacy of low- and very-low-energy diets in people with type 2 diabetes mellitus: A systematic review and meta-analysis of interventional studies
Open accessAbstract
Aims: To review systematically and quantify the weight loss achieved through low‐ (LEDs) and very‐low‐energy diets (VLEDs) in people with type 2 diabetes mellitus (T2DM). Materials and methods: Studies reporting the effects of diet‐only interventions of up to 1600 kcal/d in people with T2DM were searched in MEDLINE, EMBASE and CINAHL up to July 2018. Changes in the primary (body weight and body mass index [BMI]) and secondary outcomes (glycated haemoglobin, blood lipids) according to energy restriction and duration of diet were modelled using restricted cubic splines. Results: Forty‐four studies (3817 participants) were included. The overall quality of the evidence was moderate and limited to short‐term interventions up to 4 months. Baseline mean weight and BMI were 92.1 kg and 36.6 kg/m 2 . VLEDs of 400 kcal/d led to 5.4% weight loss at 2 weeks, increasing to 17.9% at 3 months. More modest reductions of 7.3% were observed on LEDs of 1200 kcal/d and 2.0% on 1600 kcal/d after 3 months. No clear patterns emerged for secondary outcomes. Publication bias was significant for primary outcomes. Conclusions: Through modelling, we were able to describe effective dietary deficit strategies to achieve weight reduction up to 4 months in people with T2DM. High‐quality studies are required to further support clinical practice with evidence‐based dietary interventions.
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Very low calorie diets (VLCD/VLED) and very low calorie ketogenic diets (VLCKD) are primarily used in patients with severe obesity or metabolic complications, especially when rapid and substantial weight loss is required.
“Very low calorie diets (VLCD/VLED) and very low calorie ketogenic diets (VLCKD) are primarily used in patients with severe obesity or metabolic complications, especially in situations that require rapid and substantial weight loss.”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [19]
In very low calorie protocols providing about 400 kcal per day, reported losses ranged from approximately 5 kg after two weeks to more than 25 kg after several months, whereas interventions providing about 800 kcal produced smaller but directionally comparable effects.
“In protocols providing about 400 kcal per day, reported losses ranged from approximately 5 kg after two weeks to more than 25 kg after several months, whereas interventions providing about 800 kcal produced smaller but directionally comparable effects [19].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [19]
VLCD/VLED protocols provide fewer than 800 kcal per day, while VLCKD additionally limits carbohydrate intake to 30 to 50 g per day, inducing a state of ketosis.
“VLCD/VLED protocols provide fewer than 800 kcal per day, while VLCKD additionally limits carbohydrate intake to 30 to 50 g per day, inducing a state of ketosis.”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [19]
Very low calorie dietary interventions remain one of the few approaches capable of producing rapid and substantial reductions in body weight.
“Very low calorie dietary interventions remain one of the few approaches capable of producing rapid and substantial reductions in body weight [18,19,21].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [19]
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- Zaccardi, F;Baldry, E;Davies, MJ;Khunti, K;Webb, DR Title: Efficacy of low-and very-low-energy diets in people with type 2 diabetes mellitus: A systematic review and meta-analysis of interventional studies Date: 2019-07 Citation:
- Kloecker, D. E., Zaccardi, F., Baldry, E., Davies, M. J., Khunti, K. & Webb, D. R. (2019). Efficacy of low-and very-low-energy diets in people with type 2 diabetes mellitus: A systematic review and meta-analysis of interventional studies. DIABETES OBESITY & METABOLISM, 21 (7), pp.1695-1705. https://doi.org/10.1111/dom.13727. Persistent Link: http://hdl.handle.net/11343/285712
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- Authors
- Kloecker, D. E., Zaccardi, F., Baldry, E., Davies, M. J., Khunti, K., & Webb, D. R.
- Affiliations
- University of Leicester (GB)
- Corresponding author
- Kloecker, David E.
- ORCID
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2019-04-29
- Volume
- 21
- Issue
- 7
- Pages
- 1695-1705
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2935086721
- Cited by
- 25
- References
- 67
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 3
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Funders
- University Hospitals of Leicester NHS Trust
- National Institute for Health and Care Research
- University of Leicester
- University of Glasgow
- Loughborough University
- Topics
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- type 2 diabetes, very low calorie diet, hypocaloric diet, weight loss, caloric restriction, body mass index, HbA1c, serum lipids, dietary intervention, publication bias
- MeSH terms
- Adult, Body Weight, Diabetes Mellitus, Type 2, Diet, Reducing, Female, Humans, Male, Middle Aged, Obesity, Weight Loss, Body Mass Index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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