Background South Asians (SA) constitute a quarter of the global population and are disproportionally affected by both type 2 diabetes (T2D) and heart failure. There remains limited data of the acceptability and efficacy of low-energy meal replacement plans to induce remission of T2D in SA. Objectives The objective of this exploratory secondary analysis of the DIASTOLIC study was to determine if there was a differential uptake, glycometabolic and cardiovascular response to a low-energy meal replacement plan (MRP) between SA and White European (WE) people with T2D. Methods Obese adults with T2D without symptomatic cardiovascular disease were allocated a low-energy (~810 kcal/day) MRP as part of the DIASTOLIC study (NCT02590822). Comprehensive multiparametric cardiovascular magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing and metabolic profiling were undertaken at baseline and 12 weeks. A comparison of change at 12 weeks between groups with baseline adjustment was undertaken. Results Fifteen WE and 12 SAs were allocated the MRP. All WE participants completed the MRP versus 8/12 (66%) SAs. The degree of concentric left ventricular remodelling was similar between ethnicities. Despite similar weight loss and reduction in liver fat percentage, SA had a lower reduction in Homeostatic Model Assessment for Insulin Resistance [-5.7 (95% CI: -7.3, -4.2) versus -8.6 (-9.7, -7.6), p = 0.005] and visceral adiposity compared to WE [-0.43% (-0.61, -0.25) versus -0.80% (-0.91, -0.68), p = 0.002]. Exercise capacity increased in WE with no change observed in SA. There was a trend towards more reverse remodelling in WE compared to SAs. Conclusions Compliance to the MRP was lower in SA versus WE. Overall, those completing the MRP saw improvements in weight, body composition and indices of glycaemic control irrespective of ethnicity. Whilst improvements in VAT and insulin resistance appear to be dampened in SA versus WE, given the small sample, larger studies are required to confirm or challenge this potential ethnic disparity. Trail registration NCT02590822.

中文翻译：

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低能量代餐计划对 2 型糖尿病糖代谢特征和逆转心脏重塑的反应：南亚人和欧洲白人的比较。

背景 南亚人 (SA) 占全球人口的四分之一，并且受 2 型糖尿病 (T2D) 和心力衰竭的影响尤为严重。关于低能量代餐计划在 SA 中诱导 T2D 缓解的可接受性和有效性的数据仍然有限。目的 这项 DIASTOLIC 研究的探索性二次分析的目的是确定 SA 和欧洲白人 (WE) 2 型糖尿病患者对低能量代餐计划 (MRP) 的摄取、糖代谢和心血管反应是否存在差异。方法 作为 DIASTOLIC 研究 (NCT02590822) 的一部分，患有 T2D 且无心血管疾病症状的肥胖成人被分配低能量（约 810 kcal/天）MRP。在基线和 12 周时进行了全面的多参数心血管磁共振成像、超声心动图、心肺运动测试和代谢分析。通过基线调整对各组之间 12 周时的变化进行了比较。结果 15 个 WE 和 12 个 SA 分配了 MRP。所有 WE 参与者都完成了 MRP，而 SA 的比例为 8/12 (66%)。不同种族之间的同心左心室重构程度相似。尽管体重减轻和肝脏脂肪百分比降低相似，但 SA 的胰岛素抵抗稳态模型评估降低幅度较小 [-5.7 (95% CI: -7.3, -4.2) 对比 -8.6 (-9.7, -7.6)，p = 0.005]和内脏肥胖与WE相比[-0.43％（-0.61，-0.25）与-0.80％（-0.91，-0.68），p = 0.002]。WE 中的运动能力有所提高，而 SA 中没有观察到变化。与 SA 相比，WE 存在更多反向重塑的趋势。结论 与 WE 相比，SA 对 MRP 的依从性较低。总体而言，完成 MRP 的人无论种族如何，体重、身体成分和血糖控制指数均有所改善。虽然南澳州与西澳州相比，增值税和胰岛素抵抗的改善似乎受到抑制，但鉴于样本较小，需要进行更大规模的研究来证实或挑战这种潜在的种族差异。试用注册NCT02590822。