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26-06-2024 | Type 2 Diabetes | News

5:2 Intermittent fasting meal replacement diet effective for early type 2 diabetes

Author: Laura Cowen

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medwireNews: A 5:2 intermittent fasting and meal replacement (5:2 MR) diet significantly improves glycemic control and results in greater weight loss than treatment with metformin or empagliflozin in people with overweight or obesity and newly diagnosed type 2 diabetes, Chinese research suggests.

“The 5:2 MR approach may serve as an effective initial lifestyle intervention instead of antidiabetic drugs for patients with type 2 diabetes,” write Lixin Guo (Chinese Academy of Medical Sciences, Beijing) and co-authors in JAMA Network Open.

Their multicenter EARLY study included 405 participants (mean age 45.5 years, 65.4% men) with overweight or obesity (mean BMI 29.5 kg/m2) who had been diagnosed with type 2 diabetes in the past year. They were randomly assigned to follow a 5:2 MR diet for 16 weeks (n=135) or to undergo treatment with metformin (n=134) or empagliflozin (n=136) for the same period.

The 5:2 MR plan consisted of 2 nonconsecutive days of fasting, where participants consumed one serving of a low energy (500 kcal for women, 600 kcal for men) MR product, and 5 days where they chose their own breakfast and lunch but had one serving of the MR product for dinner. They were also encouraged to monitor their calorie intake on these days.

At baseline, the mean glycated hemoglobin (HbA1c) level was 7.8% (62 mmol/mol) in the 5:2 MR group and 7.9% (63 mmol/mol) in both the metformin and empagliflozin groups.

After 16 weeks of treatment, the least squares mean (LSM) reduction in HbA1c was 1.9% in the 5:2 MR group, which was significantly greater that the LSM reductions of 1.6% and 1.5% that occurred in the metformin and empagliflozin groups, respectively.

Significantly more patients in the 5:2 MR group achieved an HbA1c level below 7.0% (53 mmol/mol) than did those in the metformin and empagliflozin groups, at 88.9% versus 73.9% and 70.6%, respectively. The proportion achieving an HbA1c level below 6.5% was also significantly greater in the 5:2 MR group, at a corresponding 80.0% versus 60.4% and 55.1%.

Furthermore, 76.6% of 94 patients who achieved an HbA1c level below 6.5% in the 5:2 MR group maintained this level during 8 weeks of post-treatment follow-up, “indicating that the 5:2 MR approach significantly and sustainably improves HbA1c levels in patients with early type 2 diabetes,” Guo et al remark.

LSM weight loss was significantly greater in the 5:2 MR group (9.7 kg) than in the metformin (5.5 kg) and empagliflozin (5.8 kg) groups and the investigators also report that patients in the 5:2 MR group had significantly greater reductions in waist and hip circumference, systolic and diastolic blood pressure, and triglyceride and high-density lipoprotein levels than those given the antidiabetic drugs.

They also had a significantly greater reduction in fasting plasma glucose level, but there were no significant differences among the groups for the reductions in fasting insulin, C-peptide levels, and insulin resistance.

Guo and colleagues note that “[t]he 2020 China Guidelines emphasize lifestyle intervention as the foundational treatment for type 2 diabetes, with medication initiated only if lifestyle intervention fails to achieve glycemic control.”

They say: “The EARLY study, for the first time to our knowledge, directly compared 5:2 MR with 2 widely used antidiabetic medications, providing evidence for the 5:2 MR approach as an effective initial lifestyle intervention for Chinese patients with early-stage type 2 diabetes.”

The authors also acknowledge that their 16-week intervention “was less than the recommended minimum of 6 months” meaning that “long-term efficacy […] remains to be confirmed.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Netw Open 2024; 7: e2416786

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