New 5:2 intermittent fasting diet bests metformin, empagliflozin in patients with early-stage type 2 diabetes
A new intermittent fasting technique is associated with significant benefits for obese and overweight adults diagnosed with type 2 diabetes, according to new data published in JAMA Network Open.[1]
“Appropriate weight loss can improve glycemic control and reduce the dosage of antidiabetic drugs among patients with type 2 diabetes,” wrote first author Lixin Guo, MD, a researcher with the department of endocrinology at Beijing Hospital, and colleagues. “However, achieving weight loss is often challenging, necessitating the implementation of strategies such as meal replacement or dietary restriction.”
The 5:2 meal replacement diet involves consuming limited calories—in the form of meal replacement shakes—for two nonconsecutive days each week. On the other days, the person then eats a normal breakfast and lunch, followed by a meal replacement for dinner.
The study’s authors recruited more than 400 overweight or obese Chinese adults with type 2 diabetes, randomizing them to one of three treatment strategies for 16 weeks: the 5:2 meal replacement diet, metformin twice per day or empagliflozin once per day. The group’s mean age was 45.5 years old, 65% were men and the mean hemoglobin A1C (HbA1C) was 7.9%.
Overall, after 16 weeks, the most significant mean reduction in HbA1C level (1.9%) was seen in patients who followed the 5:2 meal replacement diet. This was 0.3% greater than the reduction seen with metformin and 0.4% greater than the reduction seen with empagliflozin. The same trend was seen when focused specifically on the study’s oldest patients, who were 60 years old and older.
Weight loss was also the most significant among participants following the 5:2 meal replacement diet.
When tracking safety outcomes, Guo et al. found that a single patient in the 5:2 meal replacement diet group experienced constipation and 5.9% patients experienced “hypoglycemic symptoms, likely related to the low-energy diet.” In the metformin group, 19.4% of patients experienced “mild gastrointestinal symptoms” and 6% had hypoglycemia. In the empagliflozin group, 2.2% patients reported “urinary symptoms,” 3.7% had hypoglycemia and a single patient reported being especially thirsty.
“The incidence of hypoglycemia was comparable across all three groups,” the authors wrote. “When implementing a 5:2 meal replacement intervention, it is essential to prevent hypoglycemia associated with low-energy diet. However, compared with medications, the 5:2 meal replacement diet demonstrates favorable safety.”
Serious adverse safety events, meanwhile, were seen in just two patients from the empagliflozin group. The issues, which included a severe rash and hospitalization, “resolved with treatment.”
Reviewing these findings, the researchers concluded that following a 5:2 meal replacement diet showed potential as a new way to help patients with early-stage type 2 diabetes, “providing an alternative to the use of metformin and empagliflozin.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.