Introduction and Objective: Intermittent energy restriction (IER) and time-restricted eating (TRE) are two forms of intermittent fasting that may reduce diabetes medication needs in type 2 diabetes (T2D). However, head-to-head comparisons of IF approaches and trials using IF in T2D remain limited. We evaluated diabetes remission and pharmacologic de-intensification in a secondary analysis of a 12-month parallel intervention trial.Methods: Fifty-seven adults with T2D with overweight/obesity who were weight stable and stable on diabetes and weight-loss medications for ≥3 months were randomized 1:1 to IER (550-800 kcal/d on 2-3 d/week) or TRE (≤8-hr eating window). Both groups received diabetes education and dietitian support for 6 months, followed by 6 months of low-contact follow-up. Medication changes were guided by HbA1c, continuous glucose monitoring, and weight change. Outcomes were collected at 0, 3, 6 and 12 months, and included T2D remission (HbA1c <6.5% for ≥3 months without glucose-lowering therapy) and medication type, count, and intensity. Group differences were assessed using chi-square tests.Results: Baseline diabetes medication count was similar between IER (1.6 ± 0.7) and TRE (2.1 ± 1.3), and 12% used insulin (IER 2/29 [7%], TRE 5/28 [18%]; p=0.39. Among those on diabetes pharmacotherapy at baseline, 67% de-intensified therapy by 12 months (IER 18/27 [67%], TRE 19/28 [68%]; p=0.93), and 24% discontinued all diabetes medications (IER 6/27 [22%], TRE 7/28 [25%]; p=0.81). Eleven participants (19%) achieved remission by 6 months (IER 4/29 [14%], TRE 7/28 [25%]; p=0.28), though some regressed between 6 and 12 months. At 12 months, 14% met T2D remission criteria (IER 5/29 [17%], TRE 3/28 [11%]; p=0.48).Conclusion: Both IER and TRE led to substantial reductions in diabetes medication burden and produced similar T2D remission rates. These findings support either intermittent fasting approach as a potential strategy to reduce dependence on pharmacotherapy in T2D, though follow-up is needed to determine durability.
F. Steger: None. J.M. Miles: None. J. Thyfault: None. J. Donnelly: None. R. Montgomery: None. L. Clark: None. K. Grdinovac: None.
American Diabetes Association (7-22-JDFN-13), NIH NIGMS (P20GM144269; Sub-Project 8116), CTSA Award #UL1TR002366.
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