Intermittent fasting outperforms conventional medicines in managing early stage type 2 diabetes

A randomized clinical trial was conducted in Chinese adults with early stage type 2 diabetes to determine whether intermittent fasting (IFF) was effective in controlling blood glucose levels.

This study JAMA Network Open.

study: The 5:2 Intermittent Fasting Meal Replacement Diet and Blood Glucose Control for Adults with Diabetes

background

Type 2 diabetes has become a major public health crisis around the world. According to a 2021 report from the International Diabetes Federation, approximately 537 million adults are living with the condition. Living with Type 2 Diabetes World wide.

China has the highest prevalence of diabetes in the world. Between 2011 and 2021, the number of adults with diabetes in China increased by 56.6%. The current prevalence of diabetes in China is 12.4%. In addition, approximately 50% of the general population in China is overweight or obese.

Obesity and being overweight are major risk factors for the development of diabetes. Weight loss has been shown to improve glycemic control and reduce the dosage of antidiabetic drugs.

Meal replacement is an effective weight loss strategy in which one or more meals are replaced with a prepackaged food or drink. Existing randomized clinical trials have shown that meal replacements are more effective than other diets in achieving weight loss.

In this randomized clinical trial, scientists investigated whether a combination of a 5:2 intermittent fasting diet and a meal replacement diet could effectively control blood sugar levels and reduce weight in obese or overweight Chinese adults with early stage type 2 diabetes.

The 5:2 intermittent fasting diet involves two discontinuous days of fasting (one-quarter of your normal dietary energy intake) followed by five days of habitual eating per week.

Study design

The randomized clinical trial was conducted in 405 Chinese adults with newly diagnosed type 2 diabetes who had not used any antidiabetic or weight-loss medication in the past three months.

Participants were randomly assigned to one of three groups to receive metformin, empagliflozin, or the 5:2 meal replacement diet for 16 weeks.

Participants in the 5:2 meal replacement group consumed one serving of the reduced-energy product instead of all three of their usual meals for two non-consecutive days. For the remaining five days, they consumed breakfast and lunch ad libitum but consumed one serving of the meal replacement product for dinner.

Parameters analyzed at the end of the 16-week treatment period included glycated hemoglobin (an indicator of glycemic control), weight, anthropometric parameters, and biochemical parameters.

Important Observations

The reduction in glycated hemoglobin was most pronounced in the 5:2 meal replacement group compared with the metformin and empagliflozin groups, but no significant differences in glycated hemoglobin were observed between patients receiving metformin and empagliflozin.

Improved glycemic control was observed with 5:2 meal replacement in all participants, including those who were obese or overweight, except for those aged 60 years or older.

The proportion of patients who achieved glycated hemoglobin levels <7% or <6.5% was significantly higher in the 5:2 meal replacement group compared with the metformin and empagliflozin groups.

About 76% of participants in the 5:2 meal replacement group maintained glycated hemoglobin levels below 6.5% eight weeks after treatment. The 5:2 meal replacement group also saw a reduction in fasting blood glucose levels of 30.3 mg/dL.

Significantly greater reductions in body weight, waist and hip circumference, systolic blood pressure and diastolic blood pressure were observed in the 5:2 meal replacement group compared to the other two groups.

Regarding the safety profile, the 5:2 meal replacement was found to cause constipation in one patient and hypoglycemia in eight patients, likely due to the low-energy diet.

In the metformin group, 26 patients experienced mild gastrointestinal symptoms and 8 patients experienced hypoglycemia. In the empagliflozin group, 3 patients experienced urinary symptoms, 5 patients experienced hypoglycemia, and 1 patient reported feeling thirsty.

Two patients in the empagliflozin group experienced serious adverse events, including a severe rash and hospitalization for elevated blood ketone levels, although these complications resolved after treatment.

Significance of the study

The study found that a 5:2 meal replacement strategy over 16 weeks effectively improved glycemic control and reduced body weight in obese or overweight Chinese people with newly diagnosed type 2 diabetes.

This dietary intervention has shown greater effectiveness in managing diabetes and obesity than two antidiabetic drugs, metformin and empagliflozin.

This study was conducted in diabetic patients who were not taking diabetes medication and had a baseline glycated hemoglobin level of less than 9%. Furthermore, the study intervention was short-term. Therefore, future studies are needed to determine the long-term effects. Efficacy 5:2 meal replacement diet for patients taking antidiabetic drugs and with high baseline glycated hemoglobin levels.

Overall, the study findings suggest that the 5:2 meal replacement strategy may be an effective early lifestyle intervention for the early management of type 2 diabetes.