Why This Study Matters

Management of Type 2 Diabetes Mellitus (T2DM) after failure of triple oral therapy remains challenging, often requiring escalation to insulin or GLP-1 receptor agonists. While effective, these options can be costly, complex, and associated with side effects such as weight gain and hypoglycemia.

Very low calorie diets (VLCDs) have shown potential for improving glycemic control and inducing remission by targeting the underlying pathophysiology of diabetes. However, their role in patients with long-standing T2DM and triple OHA failure remains insufficiently studied

Objectives

• Compare the effectiveness of VLCD with GLP-1 receptor agonists and insulin therapy
• Evaluate changes in HbA1c and glycemic control
• Assess weight loss, metabolic outcomes, and body composition
• Determine remission potential and reduction in medication dependence

Expected Outcomes

• Evidence on VLCD as a viable alternative to pharmacological escalation
• Improved glycemic control and potential diabetes remission
• Reduction in medication burden
• Practical, cost-effective strategy for managing advanced T2DM