623-P: Remission of Type 2 Diabetes by Low-Calorie Meal Replacement and Real Food–Based Diets—A Six-Month Pilot Intervention in China

Objective: To determine the feasibility of achieving type 2 diabetes (T2D) remission by low calorie meal replacement diet (LCMRD) and real food-based diet (LCRFD) in Chinese people with T2D. Methods: This 6-month intervention consisted of a 3-month isocaloric intensive weight loss phase (815-835 kcal/d) and a 3-month weight maintenance phase (supervised transition to normal diet). Enrolled patients with T2D had BMI 24-45 kg/m2 and (HbA1c 6.5-12.0% or taking diabetes drugs). Everyone stopped diabetes drugs on day 1 and were non-randomly assigned to receive LCMRD (n=21) or LCRFD (n=20). Both diets had similar macronutrient compositions. LCMRD used Quaker’s Smart Calories. LCRFD was prepared by central kitchen daily. The primary outcomes were weight loss and T2D remission (HbA1c <6.5%, no drugs for ≥3 months). Intention to treat analysis was performed. Results: The 41 participants had a mean age of 40.4 years, BMI of 29.8 kg/m2, HbA1c of 8.0% and diabetes duration of 2.7 years. Three people in LCMRD and 6 in LCRFD quit the intervention. At 6 months, the mean ± SD weight loss was 10.2 ± 8.0 kg in the LCMRD group and 8.9 ± 4.6 kg in the LCRFD group (P <0.001); ~80% of lost weight were fat mass in both groups. T2D remission rate was 62% in LCMRD and 50% in LCRFD. In those with ≥10% weight loss, T2D remission rate was 75% in both groups. Insulin sensitivity assessed by insulin tolerance test improved (P <0.001) whereas insulin secretory capacity assessed by arginine stimulation test did not change, in both groups. Significant improvement in cardiometabolic risk profiles were seen including blood pressure, serum lipids, inflammatory markers, among many other factors (all P <0.05). The most common adverse events were constipation and fatigue. No serious adverse event related to the intervention was reported. Conclusion: Both LCMRD and LCRFD reduced weight effectively, led to T2D remission in the majority, were feasible, and appeared safe in Chinese people with T2D and overweight/obesity. Disclosure V.W. Zhong: None. S. Wang: None. Y. Liu: None. N. Feng: None. J. Wang: None. X. Du: None. Y. Xu: None. F. Tao: None. Funding National Natural Science Foundation of China (82373551)