Acceptability of a very‐low‐energy diet in Type 2 diabetes: patient experiences and behaviour regulation

Aims To evaluate the acceptability of an 8‐week very‐low‐energy diet for remission of Type 2 diabetes, and to identify barriers and facilitators of adherence and behaviour‐regulation strategies used by participants in the Counterbalance study. Methods Eighteen of 30 participants in the Counterbalance study (ISRCTN88634530) took part in semi‐structured interviews. Of these, 15 participants were interviewed before and after the 8‐week very‐low‐energy diet intervention. Thematic analysis was used to analyse the narratives. Results The prospect of diabetes remission, considerable weight loss, and long‐term health improvement provided participants with substantial initial motivation. This motivation was sustained through the experience of rapid weight loss, improvements in blood glucose levels, social support and increased physical and psychological well‐being. Overall, adherence to the very‐low‐energy diet for 8 weeks was perceived as much easier than anticipated, but required personal effort. Participants addressed challenges by removing food from the environment, planning, avoidance of tempting situations or places, and self‐distraction. Weight loss and improvements in blood glucose levels lead to a sense of achievement and improvements in physical and psychological wellbeing. Conclusions Dietary treatment for reversal of Type 2 diabetes is acceptable and feasible in motivated participants, and the process is perceived as highly gratifying. Research outside of controlled trial settings is needed to gauge the generalisability of these findings. What's new? This is the first qualitative study to explore the acceptability of and patient experiences with very‐low‐energy diets (VLEDs), conducted within a diabetes remission study. ‘Before and after’ interviews identified barriers, facilitators and behaviour‐regulation strategies used by the participants and others. These findings can be used to support people on such programmes in the future. The findings dispel concerns about the acceptability of VLEDs under clinical supervision, and highlight opportunities to further optimize support during dietary diabetes remission.