medwireNews: A randomized trial reveals benefits of intermittent fasting, without an increased risk for severe hypoglycemia, in people with insulin-treated type 2 diabetes.
“[F]or some individuals, [intermittent fasting] appears to be an easy to apply dietary intervention without the need for continuous caloric reductions, ultimately leading to reduced caloric intake through the time-restricted eating pattern without vigorous documentation or calorie counting,” say the researchers in Diabetes Care.
At baseline, the 22 participants assigned to the intermittent fasting group had an average glycated hemoglobin (HbA1c) level of 69 mmol/mol (8.5%). Over the course of 12 weeks, they fasted for 3 nonconsecutive days/week, reducing their calorie intake by 75% on these days, and ate as they wished on the remaining 4 days.
This resulted in an average 7.3 mmol/mol HbA1c reduction, which was significant versus the change in the 24 control group participants, who continued with their usual diet, and experienced an average 0.1 mmol/mol increase in HbA1c from a baseline of 66 mmol/mol (8.2%).
All participants used a flash glucose monitor for the duration of the trial, and those in the intermittent fasting group were instructed to reduce their basal insulin dose by 20% on fasting days and to use prandial insulin only if needed to correct hyperglycemia. They continued with any other medications bar sulfonylurea. There were no episodes of serious hypoglycemia during the study, and of the five serious adverse events (two in the fasting group), none were thought to be related to the intervention.
Harald Sourij (Medical University of Graz, Austria) and co-researchers note that on fasting days the study participants were permitted to spread 25% of their total daily calorie allowance across breakfast and/or lunch, rather than eating it during one meal, in order to minimize hypoglycemia risk and study dropout.
“With our study data we would feel confident to omit this caloric intake in further studies,” they observe.
All trial participants were switched to the same basal insulin (glargine U300) before randomization, which was taken in the morning. The average total daily insulin dose in the fasting group was 52 IU at baseline, and this declined to 45 IU during the 12-week intervention period, whereas it rose from 59 to 63 IU in the control group, with the difference between the two being statistically significant.
Bodyweight also decreased with intermittent fasting, by an average of 4.77 kg from a baseline of 96 kg, which was again a significant change relative to the average 0.27 kg increase observed in the control group from a baseline of 104 kg.
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Diabetes Care 2022; doi:10.2337/dc22-1622