A Hypocaloric High-Protein Diet as Primary Therapy for Adults with Obesity-related Diabetes: Effective Long-Term Use in a Community Hospital

The use of reducing diets as the sole therapy for the long-term management of obese diabetic patients has been generally unsuccessful. Most previous attempts took place with a few patients in university hospital clinical research centers. We placed 36 such patients on a hypocaloric high-protein food diet, consisting of 1.7–2.0 g protein/kg ideal body wt, during admission to a community hospital. After beginning this diet, patients could be weaned from sliding-scale regular insulin in an average of 1.9 days. Patients remained on this diet after discharge (mean hospital stay = 4.3 days), and complex carbohydrates were gradually added up to 80 g daily. Outpatient long-term management consisted of alternating biweekly visits to a sole nurse practitioner or physician or to a group discussion meeting. Follow-up averaged 41 wk, during which eight patients (22%) had sustained weight loss throughout and remained euglycemic. Twenty patients (56%) initially lost weight (average: 23% of ideal body weight), then plateaued weight, but have also remained euglycemic. Only eight patients, (22%) required insulin. Side effects of the diet were not serious in any patient; no one had myocardial irritability or serum potassium < 2.9 meq/L. This hypocaloric high-protein diet thus appears to be a generally successful means of weaning obese diabetic adult patients from insulin. This can be done rapidly, safely, and permanently in the community. Such diet therapy appears to require minimal laboratory and hospital resources that are available to all health care providers.