Michael Itschner II PharmD Candidate Contents Scope of this presentation Intro in biochemistry Randomized control trials Systematic review Student assessment Scope Intermittent fasting in type 2 diabetes or prediabetes ID: 1047762
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1. Intermittent Fasting and Type 2 DiabetesMichael Itschner II, PharmD Candidate
2. ContentsScope of this presentation Intro in biochemistry Randomized control trials Systematic reviewStudent assessment
3. ScopeIntermittent fasting in type 2 diabetes or prediabetes Looking directly at clinical trials and assessing their results and conclusions from measured values Finding and answer to the question: “Is intermittent fasting safe and effective for patients with type 2 diabetes?”
4. A Review of Metabolism
5. Metabolic Fuel Conversion https://step1.medbullets.com/biochemistry/102019/metabolism-of-exercise-and-starvation
6. Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even Without Weight Loss in Men with Prediabetes (2018)Population Size8 menStudy Design Randomized control crossover study Study Duration 5 weeks of intervention followed by 7-week washout then crossover to the other interventionComorbidities PrediabetesKey ResultsLower insulin levels post glucose tolerance test and lower overall insulin level after 7-week washout period, improved insulin sensitivity Drop in BP 5-10 mmHg, increase in triglycerides, no change in cholesterol panel, lower oxidative stress due to lipids Adverse EventsNo serious adverse eventsAuthors Conclusions eTRF in men with prediabetes led to improvements is insulin levels, sensitivity, blood pressure and oxidative stress
7. Effects of A One-week Fasting Therapy in Patients with Type-2 Diabetes Mellitus and Metabolic Syndrome – A Randomized Controlled Explorative Study (2016)Population Size32 people, 16 each group Study Design Randomized controlled explorative study, fasting group and control groupStudy Duration 7 daysComorbidities Type 2 diabetes, metabolic syndrome, hypertriglyceridemia, hypertension Key ResultsDecrease in BP ~10 mmHg Improved quality of life as assessed with the WHO-5Adverse EventsNo serious adverse events Authors Conclusions Beneficial metabolic effects observed over a 4-month period for patients with type 2 diabetes
8. Intermittent fasting in Type 2 diabetes mellitus and the risk of hypoglycemia: a randomized controlled trial (2018)Population Size37 peopleStudy Design Two groups following a 5/2 schedule, 19 non-consecutive fasting, 18 consecutive fastingStudy Duration 12 weeksComorbidities Type 2 diabetes Key Results2-fold greater risk of hypoglycemia on fasting days compared to non fasting days, consecutive > non-consecutive Decreased total cholesterol and LDL were the only statistically significant lab results from the study Adverse EventsHypoglycemia Authors Conclusions Hypoglycemic events seemed to be based on more individual characteristics opposed to the whole population. Lower than expected rates of hypoglycemia within the clinically acceptable limits.
9. Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes (JAMA 2017)Population Size97 completed the studyStudy Design Randomized noninferiority trial, two groups1. 5/2 intermittent energy restriction (IER) 2. continuous energy restriction (CER)Study Duration 12 months (52 weeks)Comorbidities Type 2 diabetes, hypertension Key ResultsStatistically significant decrease in:A1C, weight, BMI, and fat massNo difference detected b/t fasting and CER group in lab values after 12 monthsAdverse Events/LimitationsNo statistical difference between groups in rate of hypoglycemic eventsAuthors Conclusions 5/2 IER noninferior compared to CER in A1C lowering and weight loss. IER is clinically acceptable for patient using hypoglycemic medication with frequent monitoring and dose adjustments. Greater reduction in insulin in the IER group compared to CER.
10. Intermittent fasting and ‘metabolic switch’: Effects on metabolic syndrome, prediabetes and type 2 diabetes IER by nature can lower average daily calorie intake, attributing benefits from lower calories or the time frame is difficult at this time Close monitoring of blood glucose, staying hydrated, and consultation with a dietitian and diabetes educator are highly recommended IER can significantly lower overall insulin and sulfonylurea doses For prediabetic and metabolic syndrome patients, IER will be safer to use due to lower risk on hypoglycemia
11. Student Assessment Any modification that involves changing a habit will be difficult and compliance will not be 100% IER (5/2, QOD, 16/8) can be an alternative to CERPossible benefits to IER can be the need for lower doses of insulin and sulfonylureas Other benefits include a drop of serum insulin and improved insulin sensitivity, but the evidence is less robust Need for large RCT looking at adipose tissue mobilization in a truly fasted state for patients with type 2 diabetes
12. Questions
13. References https://step1.medbullets.com/biochemistry/102019/metabolism-of-exercise-and-starvation Sutton EF, Beyl R, Early KS, Cefalu WT, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes. Cell Metab. 2018;27(6):1212-1221.e3. doi:10.1016/j.cmet.2018.04.010Li C, Sadraie B, Steckhan N, et al. Effects of A One-week Fasting Therapy in Patients with Type-2 Diabetes Mellitus and Metabolic Syndrome - A Randomized Controlled Explorative Study. Exp Clin Endocrinol Diabetes. 2017;125(9):618-624. doi:10.1055/s-0043-101700Corley BT, Carroll RW, Hall RM, Weatherall M, Parry-Strong A, Krebs JD. Intermittent fasting in Type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial. Diabet Med. 2018;35(5):588-594. doi:10.1111/dme.13595Carter S, Clifton PM, Keogh JB. Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open. 2018;1(3):e180756. Published 2018 Jul 6. doi:10.1001/jamanetworkopen.2018.0756Rajpal A, Ismail-Beigi F. Intermittent fasting and 'metabolic switch': Effects on metabolic syndrome, prediabetes and type 2 diabetes. Diabetes Obes Metab. 2020;22(9):1496-1510. doi:10.1111/dom.14080https://www.youtube.com/watch?v=RlLrvnnTDDUhttps://www.youtube.com/watch?v=Id2E72P8Fe0https://www.youtube.com/watch?v=acA5iF1zrDIhttps://www.youtube.com/watch?v=epABNPUtkVc