Methods

Eleven people with type 2 diabetes (49.5±2.5 years, BMI 33.6±1.2 kg/m 2, nine male and two female) were studied before and after 1, 4 and 8 weeks of a 2.5 MJ (600 kcal)/day diet. Basal hepatic glucose output, hepatic and peripheral insulin sensitivity and beta cell function were measured. Pancreas and liver triacylglycerol content was measured using three-point Dixon magnetic resonance imaging. An age-, sex-and weight-matched group of eight non-diabetic participants was studied.

Results

After 1 week of restricted energy intake, fasting plasma glucose normalised in the diabetic group (from 9.2±0.4 to 5.9±0.4 mmol/l; p= 0.003). Insulin suppression of hepatic glucose output improved from 43±4% to 74±5%(p= 0.003 vs baseline; controls 68±5%). Hepatic triacylglycerol content fell from 12.8±2.4% in the diabetic group to 2.9±0.2% by week 8 (p= 0.003). The first-phase insulin response increased during the study period (0.19±0.02 to 0.46±0.07 nmol min− 1 m− 2; p< 0.001) and approached control values (0.62±0.15 nmol min− 1 m− 2; p= 0.42). Maximal insulin response became supranormal at 8 weeks (1.37±0.27 vs controls 1.15±0.18 nmol min− 1 m− 2). Pancreatic triacylglycerol decreased from 8.0±1.6% to 6.2±1.1%(p= 0.03).