Abstracts Category : Other

A feasibility study to investigate the effectiveness and safety of an intermittent fasting diet for weight reduction in adults with Type 2 Diabetes treated with insulin

by Katrina Anne Pace

Background: Type 2 diabetes (T2DM) is the most common form of diabetes.Obesity is associated with both the development of T2DM and also thedevelopment of the complications of diabetes; increasing health care costs andmorbidity and mortality. Weight loss and control of blood glucose levels should bemanaged with a tailored eating plan developed in negotiation between the personwith diabetes and their health care team. It is essential that health careprofessionals are familiar with different strategies that achieve weight reduction,glycaemic and cardiovascular risk reduction goals. One emerging weight reductionstrategy is fasting diets. There is currently a gap in the knowledge of whetherfasting diets are an effective and safe weight reduction strategy for people withT2DM on insulin.Aim: To investigate the effectiveness and safety of an intermittent fasting diet (twoday per week) as an alternative to standard dietary advice (portion control diet) forweight reduction in obese adults with insulin dependent T2DM attending a 12-weekgroup based intervention at Waitemata District Health Board (DHB).Methods:Obese patients with T2DM treated with insulin who were attending WaitemataDHB Diabetes Service were recruited for this two arm open-label designintervention feasibility study. Both dietary strategies were implemented during a12-week intervention at which participants received monthly dietitian-led groupeducation and support. The intermittent fasting diet (IFD) intervention (n=8)investigated was a two day per week reduced energy intake (550-650kcal / 2300-2700kJ per day) and five days usual intake making low fat choices. The portioncontrol diet (PCD) was the comparison group (n=7) and focused on daily energyrestriction through reduction in portion sizes and low fat food choices in line withcurrent New Zealand dietary recommendations for management of T2DM.Results: Similar weight loss was achieved in both groups (IFD: 2.7 3.0 kg, PCD:1.7 2.5 kg). This reduction was not significant between groups. There was asignificant difference between groups in reduction in HbA1c. (P=0.003) (IFD:-11 mmol/mol, PCD: -3 mmol/mol). This decrease was significant in the IFD grouponly (P=0.018). Reported hypoglycaemic events were low in both groups (8 eventsin IFD; 21 events in PCD). Non-significant between group reductions in waistcircumference (P=0.402), waist: height ratio (P=0.455), diastolic (P=0.189) andsystolic blood pressure (P=0.443) were observed. Lipid profile remained stable inboth groups.Conclusion: This feasibility study showed that an intermittent fasting diet canachieve similar weight loss to current standard practice dietary advice in peoplewith T2DM. However, it is the significant reductions in HbA1c compared to a dailyenergy restriction diet over a three-month period seen in this study that warrantfurther investigation. With education from health care professionals andmodification of insulin on pre-fasting and fasting day this diet may be