Emily Borgundvaag1, Jessica Mak1,2, Caroline K Kramer1,3,4. 1. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada. 2. Department of Internal Medicine, University of Toronto, Toronto, Canada. 3. Division of Endocrinology, University of Toronto, Toronto, Canada. 4. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
Abstract
CONTEXT: Intermittent fasting (IF) has been proposed as a weight-loss strategy with additional cardio-metabolic benefits in individuals with obesity. Despite its growing popularity, the effect of IF in patients with type 2 diabetes (T2DM) remains unclear. OBJECTIVE: We conducted a systematic review and meta-analysis to evaluate the metabolic impact of IF as compared to standard diet in patients with T2DM. DATA SOURCES: Embase, PubMed, and clinicaltrials.gov between 1950 and August-12-2020. STUDY SELECTION: Randomized, diet-controlled studies evaluating any IF intervention in adults with T2DM. DATA EXTRACTION: We examined the impact of IF on weight loss and glucose-lowering by calculating pooled estimates of the absolute differences in bodyweight and glycated hemoglobin (HbA1c) as compared to control group using random-effects model. DATA SYNTHESIS: Seven studies (n=338 participants; mean BMI 35.65kg/m 2, mean baseline HbA1c of 8.8%) met our inclusion criteria. IF induced greater decrease in bodyweight by -1.89kg (95%CI -2.91 to -0.86 kg) as compared to regular diet, with no significant between-study heterogeneity (I 221.0%, P=0.28). The additional weight loss induced by IF was greater in studies with heavier population (BMI >36kg/m 2) [-3.24kg (95%CI -5.72 to -1.15 kg)] and in studies of shorter duration (≤ 4 months) [-3.73kg (95%CI -7.11 to -0.36kg)]. IF was not associated with further reduction in HbA1c as compared to standard diet [HbA1c -0.11% (95%CI -0.38 to 0.17%)]. CONCLUSIONS: Current evidence suggests that IF is associated with greater weight loss in patients with T2DM as compared with standard diet, with similar impact on glycemic control.
CONTEXT: Intermittent fasting (IF) has been proposed as a weight-loss strategy with additional cardio-metabolic benefits in individuals with obesity. Despite its growing popularity, the effect of IF in patients with type 2 diabetes (T2DM) remains unclear. OBJECTIVE: We conducted a systematic review and meta-analysis to evaluate the metabolic impact of IF as compared to standard diet in patients with T2DM. DATA SOURCES: Embase, PubMed, and clinicaltrials.gov between 1950 and August-12-2020. STUDY SELECTION: Randomized, diet-controlled studies evaluating any IF intervention in adults with T2DM. DATA EXTRACTION: We examined the impact of IF on weight loss and glucose-lowering by calculating pooled estimates of the absolute differences in bodyweight and glycated hemoglobin (HbA1c) as compared to control group using random-effects model. DATA SYNTHESIS: Seven studies (n=338 participants; mean BMI 35.65kg/m 2, mean baseline HbA1c of 8.8%) met our inclusion criteria. IF induced greater decrease in bodyweight by -1.89kg (95%CI -2.91 to -0.86 kg) as compared to regular diet, with no significant between-study heterogeneity (I 221.0%, P=0.28). The additional weight loss induced by IF was greater in studies with heavier population (BMI >36kg/m 2) [-3.24kg (95%CI -5.72 to -1.15 kg)] and in studies of shorter duration (≤ 4 months) [-3.73kg (95%CI -7.11 to -0.36kg)]. IF was not associated with further reduction in HbA1c as compared to standard diet [HbA1c -0.11% (95%CI -0.38 to 0.17%)]. CONCLUSIONS: Current evidence suggests that IF is associated with greater weight loss in patients with T2DM as compared with standard diet, with similar impact on glycemic control.