medwireNews: The pilot MIDDAS study suggests that a 2-day per week very-low-calorie diet could be a viable alternative to a continuous diet for people with type 2 diabetes who struggle with this approach.
Recognizing the success, but also the challenges, of the 800-kcal/day total meal replacement diet used in the DiRECT study, the researchers tested this against the same diet but delivered just 2 days/week over a longer period of 28 weeks, with participants following a portion-controlled Mediterranean diet for the other 5 days.
During this period, the 39 study participants randomly assigned to follow this approach lost an average of 7.1% of their bodyweight, from an average starting BMI of 35.8 kg/m2.
The other 40 participants, who undertook a continuous 800 kcal/day diet for 8 weeks, followed by 4 weeks of stepped food reintroduction, lost 9.7% of their baseline bodyweight by week 12, from an average starting BMI of 36.9 kg/m2. They then moved on to a portion-controlled Mediterranean diet and by week 28 had regained weight so that their weight loss from baseline was similar to that of the intermittent fasters, at 7.6%.
During the trial, the study participants were given remote but high-frequency support from a diabetes dietician, a diabetes nurse, an exercise specialist, and a psychologist if needed (approximately 40% did so), all delivered through an app. The participants could also log food, photos, weight, blood glucose, and physical activity through the app, and 51% participated in the group forum.
Sara McDiarmid (Manchester University NHS Foundation Trust, UK), who presented the findings at the virtual 56th EASD Annual Meeting, noted that the team recruited a broader study population than participated in DiRECT, including people with diabetes of up to 8 years’ duration and those requiring insulin. They were aged around 55 years, just over half were men, and most were White British.
People undertaking the continuous diet stopped all glucose-lowering medications, whereas those on the intermittent diet suspended only those liable to cause hypoglycemia and only on their diet days.
The weight loss phase of the trial was followed by a weight maintenance phase during which the intermittent diet group followed an 800 kcal/day food-based diet on 1 or 2 days per week with a portion-controlled Mediterranean diet on the other days, and the continuous diet group followed a portion-controlled Mediterranean diet on all days. Both groups could return to their total meal replacement diet for a time if their weight regain exceeded 2 kg, and remote support via the app continued, although at a lower frequency.
After 52 weeks, weight loss relative to baseline was 5.4% and 6.0% in the intermittent and continuous diet groups, respectively, with no significant difference between the two. An identical proportion of both groups (42%) had achieved glycated hemoglobin below 48 mmol/mol (6.5%) at this point.
McDiarmid noted that only 33% of people in the intermittent diet group continued with the food-based low-calorie days during the weight maintenance phase, potentially explaining why this group regained weight over this period.
“Also, anecdotally, participants in both groups reported reduced motivation over the final 6 months due to a reduction in dietetic support over this time,” she said, adding that more research is needed to investigate the role of intense remote support in weight maintenance.
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