5:2 How intermittent fasting can help people with type 2 diabetes

The new study included 405 Chinese adults who were overweight or obese and recently diagnosed with type 2 diabetes. Nearly two-thirds of participants were men, with an average age of 46 and an average HbA1c level of 7.9%.

HbA1c level 6.5% or more Within the Diabetes Range: Most people with diabetes aim to keep their HbA1c below 7%.

The researchers randomly assigned participants to receive treatment with diabetes medications (metformin (Glucophage) or empagliflozin (Jardiance)) or to follow a 16-week intermittent fasting plan. A total of 332 people completed the 16-week treatment.

All participants received instruction every four weeks from a nutritionist and study staff about healthy eating and regular exercise.

The researchers continued to monitor participants for eight weeks after the treatment period, including measuring HbA1c, weight, waist and hip circumference, blood pressure, and other metabolic markers.

Those assigned to the intermittent fasting plan fasted two non-consecutive days per week and ate mostly their usual foods in the usual amounts on the other days — known as 5:2 intermittent fasting.

To control the amount of calories and nutrients consumed on fasting days, the researchers provided participants with prepackaged meal replacements. Participants ate about a quarter of their usual calories on fasting days: 500 calories for women and 600 calories for men.

Vicki Pavlou, RDN, Registered Dietitian, PhD Student University of Illinois at Chicago He told Healthline that the approach used in the study was not a “true” 5:2 intermittent fasting diet.

Participants were asked to eat meal replacements for dinner on non-fasting days and to count the calories — a simpler and more sustainable approach than typically allowing them to eat whatever they want on non-fasting days, she said.

“The point of intermittent fasting in general is to give people very simple instructions,” she says. “Counting calories can be a burden for people.”

The researchers found that after 16 weeks, people who followed the intermittent fasting diet saw greater improvements in certain measures.

Those who participated in intermittent fasting lost an average of 21 pounds over the 16 weeks, while those taking one of the diabetes medications lost only 12 to 13 pounds.

The intermittent fasting group also saw significant reductions in waist and hip circumference, and systolic and diastolic blood pressure.

Additionally, the intermittent fasting group experienced a 1.9% reduction in HbA1c compared with a 1.6% reduction in the metformin group and a 1.5% reduction in the empagliflozin group.

According to the American Diabetes AssociationPeople with type 2 diabetes are considered to be in diabetes remission if they maintain their HbA1c at or below 6.5% for at least three months.

In the new study, 80% of the intermittent fasting group reached this goal at the end of 16 weeks, and 77% were still at that level after eight weeks of follow-up. Longer follow-up will be needed to confirm they met the American Diabetes Association's definition of remission.

Wilkinson said one of the study's strengths was its duration, but he believes additional studies with longer follow-up are needed.

“Medications like metformin and empagliflozin are expected to be long-term, possibly lifelong, treatments,” he said, “so when you compare those to 5:2 intermittent fasting with meal replacement, they're expected to be longer-term interventions.”

For it to work, “we need to better understand long-term adherence and long-term safety.” [of intermittent fasting],” He said.

In particular, meal replacements need to provide all the necessary vitamins, minerals and other nutrients, he said. Studies monitoring people's health and body composition, such as lean muscle mass, may also be needed to see whether long-term use of meal replacements is safe, he added.

Pavlou said there is less concern about nutritional deficiencies if people are replacing just one meal with a meal replacement, rather than using meal replacements for every meal.

Moreover, the meal replacements she uses in her clinic are designed to provide a wide range of nutrients and be safe for regular use over several months. Still, she said, patients prescribed meal replacements long-term are regularly monitored by their doctors.

Another concern Wilkinson raised about the new study is that all participants had been diagnosed with diabetes within the past year and had not been using diabetes medications in the three months prior to the study, so the results may not apply to other patient groups.

Collette Knight, MDChairman Closed Diabetes Research Institute Doctors at Hackensack University Medical Center echoed his concerns.

“This study focuses on patients who are newly diagnosed with diabetes, a group in which lifestyle interventions can be very helpful,” she told Healthline. [approach] It's not for someone who's had diabetes for 20 years.”

Additionally, “we need to look at more diverse patient populations who have had diabetes for a longer period of time,” she said.

And more research is needed to know “what happens when you add this restrictive diet to known diabetes medications that also promote weight loss,” she said.

Approximately 11% of Americans have diabetes, with 90-95% of those having type 2 diabetes. According to the Centers for Disease Control and Prevention.

Risk factors for type 2 diabetes include being overweight or obese, a family history of type 2 diabetes, physical inactivity, and being over 45 years old.

Lifestyle changes such as a healthy diet and exercise are recommended for people with type 2 diabetes, even those taking diabetes medications, but diet and exercise alone may not be enough to lower blood sugar levels.

However, intermittent fasting is designed to make it easier to reduce calories while still getting enough nutrients from your diet.

“Research suggests that intermittent fasting can be an effective strategy for managing type 2 diabetes and prediabetes,” Knight said. the study It has also been shown that intermittent fasting may lead to improved glycemic control, weight loss, and other metabolic parameters in people with these conditions.”

Similarly, research has shown that incorporating alternative diets as part of a lifestyle intervention without intermittent fasting may provide greater benefits. Weight loss and Reduction in HbA1cCompared to other dietary interventions and diabetes education.

Despite the benefits seen in this and previous studies, Knight said there is still no general agreement among doctors about who benefits most from intermittent fasting, and “the approach alone may not be enough,” he said.

There are many other types of intermittent fasting or time-restricted eating methods to choose from, including:

• 16/8 Hour Restricted Diet: Fast for 16 hours each day and restrict eating to an 8-hour window.
• Eat Stop Eat: Fast for 24 hours once or twice a week.

“Each has its pros and cons,” Knight says, “and the best approach for people with diabetes depends on their personal preferences, lifestyle and health.”

Knight recommends that people with diabetes consult with their doctor before beginning an intermittent fasting regimen to make sure it's safe and appropriate for their particular needs.

The researchers randomly assigned people who had recently been diagnosed with type 2 diabetes to receive 16 weeks of treatment with diabetes medication or intermittent fasting with meal replacement products.

Participants in the intermittent fasting group saw greater improvements in hemoglobin A1c, a measure of blood sugar control, and weight loss compared to the diabetes medication group.

Experts say additional studies with longer follow-up and more diverse participants are needed, including testing intermittent fasting in people who have had diabetes for a long time and those who take diabetes medications.