Fasting Helps Type II Diabetes Patients Enter Remission
A new study suggests that a form of intermittent fasting (IF) can help patients with Type II diabetes enter remission. The work is published in the Journal of Clinical Endocrinology & Metabolism.
Intermittent fasting and health
IF has increased in popularity over recent years, as growing research points to its effectiveness in preventing disease and improving health more generally. IF is an umbrella term that includes dietary practices where food consumption is restricted for specific periods of time, which vary depending on the regimen adopted.
Examples of IF regimens
5:2 fasting – a normal diet is consumed five days of the week, and two days are spent fasting.
Alternate-day fasting – a normal diet is consumed one day, followed by a complete fast or restricted calories the following day.
Time-restricted eating (TRE) – a normal diet is consumed within a specific timeframe, such as 12pm–8pm. No food is consumed outside of that time.
To date, research has shown IF may support long-term memory retention, improve cardiac health and aid weight loss efforts. Now, a new study by researchers in China suggests IF practices could help to reverse Type II diabetes.
Can diabetic patients experience remission? Evidence suggests so
Type II diabetes is a progressive disease where patients are either unable to make insulin or cannot produce sufficient insulin to maintain their blood sugar levels. Consequently, the risk of hyperglycemia increases, with adverse side effects such as excessive thirst, tiredness and potential nerve damage.
“Despite a widespread public consensus that Type II diabetes is irreversible and requires drug treatment escalation, there is some evidence for the possibility of remission,” says Dr. Dongbo Liu from the Hunan Agricultural University in Changsha, who is the study’s lead author.
“The randomized controlled Diabetes Remission Clinical Trial (DiRECT) conducted in the UK showed that 46% of non-insulin-taking participants achieved remission through energy restriction. An intensive lifestyle intervention led to diabetes remission in over 60% of Middle Eastern participants who were younger (18–50 years) and had a shorter duration of diabetes (0–3 years),” he adds. Collectively, this evidence suggests remission is a possibility for Type II diabetes, which inspired the current study.
Testing Chinese Medical Nutrition Therapy in type II diabetes
Liu and colleagues recruited 72 patients with Type II diabetes for the study, 36 of which were randomly assigned to undergo Chinese Medical Nutrition Therapy (CMNT), a food-based diet as opposed to a meal replacement diet. The remaining participants were assigned to the control group. All participants were aged between 38–72 years and had experienced Type II diabetes for a period of 1–11 years.
“The CMNT group entered a 3-month intervention period that included 6 cycles of 15 intervention days. They were assigned a diet with 5 modified fasting days (consuming ~840 kcal/day), during which patients were given CMNT kits at their regular meal schedule,” Liu explains.
During the fasting period, study participants were instructed to select a habitual time between 6:30am and 8:30am to start eating breakfast, and to eat their lunch between 11am and 1pm, before consuming dinner between 5pm and 7pm. In the following 10 days of the ad libitum diet period, the participants followed the Dietary Guidelines for Diabetes in China (2017 Edition) consuming foods of their choice during the 10 days.
“The primary outcome was diabetes remission, defined as a stable glycated hemoglobin A1c (HbA1c) level of less than 48 mmol/mol (< 6.5%) for at least 3 months after discontinuing all antidiabetic medications. The secondary outcomes included HbA1c level, fasting blood glucose level, blood pressure, weight, quality of life and medication costs. We conducted a 12-month follow-up to assess the continuation of remission,” the authors write in the paper.
Fasting intervention leads to diabetes remission
After 3 months, the researchers found that ~47% of participants in the CMNT group achieved diabetes remission, compared to 2.8% in the control group. After the 12-month follow-up, 44.4% of the CMNT participants achieved sustained remission, with an HbA1c level of 6.33%.
The researchers say that this study challenges the conventional view that diabetes remission is only achievable in patients that have not had diabetes for a long period of time (described as 0–6 years). Liu explains, “In our study, the average duration of Type II diabetes in the CMNT group was 6.63 years, with the longest duration being 11 years. Sixty-five percent of the participants who achieved diabetes remission had a diabetes duration of more than six years. This suggests that remission for patients with longer durations of diabetes is possible.”
When analyzing medication use, the researchers found that medication costs were 77.2% lower in the CMNT group versus the control group, suggesting IF could be a cost-effective approach to managing Type II diabetes. It may also be a more practical regimen too, as Liu describes: “This study was performed under real-life conditions, and the intervention was delivered by trained nurses in primary care rather than by specialized staff at a research institute, making it a more practical and achievable way to manage Type II diabetes,” he says. “It could be a shift in the paradigm of management goals in diabetes care.”
Extended follow-up to assess stability of food regimen
Liu acknowledges that any study conducted in a real-life setting faces limitations, including this work. “Because of the nature of the dietary intervention, it was not possible to blind participants, physicians or some of the research staff after participants were allocated to their groups,” he says.
While this publication summarizes data from one year of follow-up, the researchers plan to continue their follow-up for a period of five years or more, exploring the stability of the CMNT diet and its impact on Type II diabetes complications.
Dr. Dongbo Liu was speaking to Molly Campbell, Senior Science Writer for Technology Networks.
Reference: Yang X, Zhou J, Shao H, et al. Effect of an intermittent calorie-restricted diet on type 2 diabetes remission: A randomized controlled trial. J Clin Endocr. 2022. doi: 10.1210/clinem/dgac661.