Diabetes remission through intermittent calorie-restricted diet

At 12 months of follow-up, remission after discontinuing anti-diabetic drugs for at least three months was seen in 44% of the participants

Published - December 24, 2022 08:20 pm IST

Tailored: Anti-diabetic medication dosage was adjusted during the trial depending on blood glucose levels.

Tailored: Anti-diabetic medication dosage was adjusted during the trial depending on blood glucose levels.

A small randomised, control trial with intermittent calorie-restricted diet carried out in people with type-2 diabetes was able to achieve remission in nearly 50% of the participants in the intervention group at the end of three months of follow-up after the trial. The trial lasted for three months. Even at 12 months of follow-up, remission was seen in 44% of the participants. All participants who achieved remission had completely stopped taking any drug to control blood sugar, and the remission lasted at least one year.

Even with the more stringent criteria for complete remission, which describes a return to normal measures of glucose metabolism (HbA1c in the normal range, and fasting blood glucose of 100 mg/dL) of at least one year duration in the absence of any anti-diabetic drugs, 33.3% (12/36) of participants in the intervention group achieved complete remission.

While many studies have validated the effectiveness and benefits of intermittent fasting in people with type-2 diabetes, no clinical trials have so far investigated the effectiveness of intermittent fasting in achieving remission.  

For the trial, remission was defined as stable HbA1c levels less than 6.5% (48 mmol/mol) after discontinuing anti-diabetic medications for at least three months. During the trial, dosage of anti-diabetic medications was adjusted depending on blood glucose levels. 

The results of the trial have been published in The Journal of Clinical Endocrinology & Metabolism.

The trial was carried out on 72 participants, with 36 assigned to the intervention group and the remaining 36 participants being the control arm. The age of the participants was between 38 and 72 years with a duration of type-2 diabetes of one to 11 years. They had a body mass index (BMI) of 19.1 to 30.4, and were on anti-diabetic drugs and/or insulin. 

Participants in the intervention arm received the Chinese Medical Nutrition Therapy (CMNT) diet and underwent intermittent fasting for five days, followed by 10 days of ad libitum eating of everyday food items. The participants went through six cycles of intermittent fasting, followed by ad libitum eating during the three months of trial. The CMNT diet contains daily foods such as wheat, barley, rice, rye, and oat, and features low glycaemic loads, calories, and carbohydrates.

The authors found that participants who were prescribed fewer anti-diabetics drugs were more likely to achieve diabetes remission than those taking more drugs to control blood sugar. However, duration of type-2 diabetes did not influence diabetes remission in participants. 

In an email to The Hindu, Dr. Dongbo Liu from the Hunan Agricultural University, Changsha, China and one of the corresponding authors said, “Compared with any other low-calorie, low-carbohydrate diet which is difficult for patients to adhere to, the CMNT can be defined as periods of calorie restriction alternating with periods of ad libitum eating.” 

According to Dr. Liu, the potential mechanism of the CMNT in achieving remission is by improving islet cell function, intestinal flora and liver glucose metabolism show. This allows the participants to revert to normal diet after three-month trial period. Explaining why the remaining 56% of the participants in the intervention group did not achieve remission, Dr. Liu said, “As the experimental design, the intervention period was planned for three months, while the time of getting diabetes remission is inconsistent due to differences in individual physical condition. So, the intervention cycle can be flexibly applied in practical applications and extended to make more people to achieve remission.”

“Outside China, people who want to attain remission from type-2 diabetes through an intermittent low-calorie diet can follow a diet with five modified fasting days (about 840 kcal/day, 46% carbohydrate, 46% fat, 8% protein), in the following 10 days of the ad libitum diet period, he or she would consume ad libitum diets with their eating habits,” Dr. Liu said. 

Explaining how easy it was for participants and for people outside the trial to follow the CMNT diet, he said, “It was effortless for patients to complete the CMNT intervention cycles — nearly 89% (32/36) of the participants completed the clinical trial.” Citing the reasons why participants found it easy to adhere and complete the trial with CMNT diet, Dr. Liu says: “First, it is not necessary for patients to track calories every day when following a CMNT diet. Second, the CMNT diet is a food-based diet instead of meal-replacement diet that excludes virtually all usual foods. Finally, the CMNT diet is characterized by the ability to engage in habitual social eating patterns with preference time points.” 

While the published paper has data for only one year follow-up, participants are being continuously followed up. According to Dr. Liu, all participants have been followed up for two years by now, and a follow-up of five years or more is ongoing to explore the stability of the CMNT diet and its impact on complications. The scientists are planning further research and trial involving more participants living in a larger geographical area and a CMNT digital medical product for diabetes that combines biotechnology with information technology is under way.

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