6730 The Effect Of Intermittent Very Low-Calorie Diet On The Levels Of Angiopoietin-Like Protein 2 And Angiopoietin-Like Protein 6 In Obese Patients With Type 2 Diabetes
Authors: Umphonsathien M 
Published: October 2024

Abstract
Disclosure: M. Umphonsathien: None.
Aim: We had previously shown that intermittent very low-calorie diet (VLCD), either 2 days/week or 4 days/week, were highly effective in improving glycemic control, reducing body weight, and inducing diabetes remission in patients with type 2 diabetes and obesity (Umphonsathien et al. J Diabetes Investig 2022; 13: 156–166). Various angiopoietin-like proteins (ANGPTLs) are involved in the pathophysiology of type 2 diabetes. While an increased ANGPTL2 level is associated with a higher risk of developing type 2 diabetes, a high ANGPTL6 level is associated with a low incidence of diabetes. In this study, we evaluated the changes in ANGPTL2 and ANGPTL6 levels in patients with type 2 diabetes and obesity who received intermittent VLCD for 20 weeks. Methods: Plasma samples were obtained from 3 groups of subjects, consisting of the control, the 2 and the 4 non-consecutive days per week of intermittent VLCD (600 Kcal/day) groups for 20 weeks. Levels of ANGPTL2 and ANGPTL6 were measured using ELISA at baseline and week 20. Results: At baseline, the levels of ANGPTL2 and ANGPTL6 were not significantly different among the 3 groups, but significant positive correlations were observed between ANGPTL6 levels and body mass index (BMI, r = 0.370, p-value 0.019), fat mass (r = 0.350, p-value 0.027), and HOMA-IR (r = 0.483, p-value 0.005) in all subjects. However, such a correlation was not observed with ANGPTL2.At week 20, there was an improvement in BMI and glycemic control in both intermittent VLCD groups, resulting in a higher rate of diabetes remission. Significant increases in ANGPTL2 levels were also found in all three groups at week 20, but the level was significantly lower only in the 4 days/week VLCD group compared with that of the control subjects. The mean ± SE of serum ANGPTL2 was 1.8 ± 0.5, 1.5 ± 0.7, and 1.5 ± 0.5 ng/ml at baseline, and 2.7 ± 0.7, 2.4 ± 0.8, and 1.9 ± 0.6 ng/ml at week 20 in the control, 2, and 4 days/week of intermittent VLCD groups, respectively.Serum ANGPTL6 levels were not affected by intermittent VLCD. The mean ± SE of serum ANGPTL6 was 49.0 ± 4.7, 48.4 ± 4.3, and 59.4 ± 4.3 ng/ml at baseline, and 53.1 ± 4.5, 51.9 ± 4.2, and 56.9 ± 4.2 ng/ml at week 20 in the control, 2, and 4 days/week of intermittent VLCD groups, respectively.A correlation was found between a change in ANGPTL2 levels (from week 0 to week 20) and a change in disposition index in all patients (r2 = 0.11, p-value 0.037). A change in serum ANGPTL6 concentrations was correlated not only with a change in fat mass but also showed a significant correlation with a change in HOMA-IR and insulinogenic index (R2 = 0.107, 0.138 and 0.220, p-value 0.039, 0.002, and 0.018, respectively).In binary logistic regression analyses, no significant correlation was found between the changes in ANGPTL2 and ANGPTL6 levels from baseline with diabetes remission. Conclusion: No significant correlation was found between the changes in ANGPTL2 and ANGPTL6 levels and diabetes remission.
Presentation: 6/2/2024