Adjusted: Doses of anti-diabetic drugs were adjusted during the trial depending on blood glucose levels.
A A small randomized controlled trial with an intermittent calorie-restricted diet conducted in type-2 diabetics was able to achieve remission in nearly 50% of participants in the intervention group at the end of three months of post-trial follow-up. The trial lasted for three months. Even at 12 months of follow-up, remission was seen in 44% of participants. All participants who achieved remission had completely stopped taking any medication to control blood sugar, and the remission lasted at least one year.
Even with the stricter criteria for complete remission, which describes a return to normal measurements of glucose metabolism (HbA1c in the normal range, and fasting blood glucose of 100 mg/dL) for at least one year without the presence of any anti-diabetic medication, 33.3% (12/36) participants in the intervention group achieved complete remission.
Although many studies have confirmed the effectiveness and benefits of intermittent fasting in people with type-2 diabetes, no clinical trials have yet investigated the effectiveness of intermittent fasting in achieving remission.
For the trial, remission was defined as a stable HbA1c level of less than 6.5% (48 mmol/mol) after stopping anti-diabetic medication for at least three months. During the trial, the dose of anti-diabetic drugs was adjusted depending on the blood glucose level.
The results of the trial were published in Journal of Clinical Endocrinology & Metabolism.
The trial was conducted on 72 participants, with 36 assigned to the intervention group and the remaining 36 participants being the control group. The age of the participants was between 38 and 72 years with a duration of type-2 diabetes between one and 11 years. They had a body mass index (BMI) of 19.1 to 30.4, and were using anti-diabetic medication and/or insulin.
Participants in the intervention arm received a Chinese Medical Nutrition Therapy (CMNT) diet and underwent five days of intermittent fasting, followed by 10 days of ad libitum daily food intake. The participants underwent six cycles of intermittent fasting, followed by ad libitum eating during the three-month trial. The CMNT diet contains everyday foods such as wheat, barley, rice, rye and oats, and has a low glycemic load, calories and carbohydrates.
The authors found that participants who were given fewer anti-diabetic drugs were more likely to achieve diabetes remission than those who took more drugs to control blood sugar. However, the duration of type-2 diabetes did not influence diabetes remission in the participants.
In an email to HinduDr. Dongbo Liu from Hunan Agricultural University, Changsha, China and one of the corresponding authors said, “Compared to other low-calorie, low-carbohydrate diets that are difficult for patients to adhere to, CMNT can be defined as periods of caloric restriction alternating with periods of ad libitum eating .”
According to Dr. Liu, CMNT’s potential mechanism in achieving remission is by improving islet cell function, intestinal flora and liver glucose metabolism. This allowed the participants to return to their normal diet after the three-month trial period. Explaining why the remaining 56% of participants in the intervention group did not achieve remission, Dr. Liu said, “As an experimental design, the intervention period was planned for three months, while the time to obtain diabetes remission was inconsistent due to differences in individual physical conditions. So, the intervention cycle can be used flexibly in practical applications and extended to make more people achieve remission.”
“Outside of China, people who want to achieve remission from type-2 diabetes through an intermittent low-calorie diet can follow a diet with five days of modified fasting (about 840 kcal/day, 46% carbohydrates, 46% fat, 8% protein) , within 10 days after the ad libitum diet period, he will take the ad libitum diet with their eating habits,” said Dr Liu.
Explaining how easy it was for participants and people outside the trial to follow the CMNT diet, he said, “It was easy for patients to complete the CMNT intervention cycle – almost 89% (32/36) of the participants completed the clinical trial. .” Citing why participants found it easy to adhere to and complete the trial with the CMNT diet, Dr. Liu said: “First, patients do not need to track calories every day when following the CMNT diet. Second, the CMNT diet is a food-based diet rather than a meal replacement diet that excludes almost all common foods.Finally, the CMNT diet is characterized by the ability to engage in common social eating patterns with preferred time points.
Although the published paper had data for only one year of follow-up, participants were being followed up continuously. According to Dr. Liu, all participants have been followed for two years now, and a follow-up of five or more years is underway to explore the stability of the CMNT diet and its effect on complications. Scientists are planning further research and trials involving more participants living in a larger geographic area and CMNT’s digital medicine product for diabetes that combines biotechnology with information technology is underway.