bdawg
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JAMA editorial viewpoint: Limited Evidence for the Health Effects and Safety of Intermittent Fasting in Type 2 Diabetes
During intermittent fasting, insulin resistance increases substantially as the body switches its energy source from glucose to ketones and fatty acids, but insulin resistance returns to baseline on refeeding after intermittent fasting.7 Repeated fasting episodes have been linked to improved insulin sensitivity and reduced insulin levels, and these changes were similar to those with caloric restriction.6
Further, intermittent fasting in general poses risks due to dehydration, hypotension, and other safety issues, but in patients with type 2 diabetes, these risks may be increased.
However, the study showed only noninferiority in hemoglobin A1c level change for intermittent fasting compared with caloric restriction (−0.3% for intermittent fasting vs −0.5% for caloric restriction).4 A major implication was that intermittent fasting may be less safe than caloric restriction although approximately equivalently effective. Therefore, until intermittent fasting is shown to be more effective than caloric restriction for reducing hemoglobin A1c level or otherwise controlling diabetes, that study and the limited other high-quality data suggest that intermittent fasting regimens for patients with type 2 diabetes recommended by health professionals or promoted to the public should be limited to individuals for whom the risk of hypoglycemia is closely monitored and medications are carefully adjusted to ensure safety.8
The value of intermittent fasting compared with other dietary regimens is unclear given the potentially higher risk of adverse events during intermittent fasting, whereas the best, but limited, evidence suggests that the efficacy of intermittent fasting was only noninferior to caloric restriction for hemoglobin A1c improvement and weight loss. Whether the benefits seen with intermittent fasting are sustained after cessation of a regimen is unknown. The message to the public, given the current popularity of intermittent fasting, is that people with type 2 diabetes should not undertake it without the involvement of their physician.
JAMA editorial viewpoint: Limited Evidence for the Health Effects and Safety of Intermittent Fasting in Type 2 Diabetes
During intermittent fasting, insulin resistance increases substantially as the body switches its energy source from glucose to ketones and fatty acids, but insulin resistance returns to baseline on refeeding after intermittent fasting.7 Repeated fasting episodes have been linked to improved insulin sensitivity and reduced insulin levels, and these changes were similar to those with caloric restriction.6
Further, intermittent fasting in general poses risks due to dehydration, hypotension, and other safety issues, but in patients with type 2 diabetes, these risks may be increased.
However, the study showed only noninferiority in hemoglobin A1c level change for intermittent fasting compared with caloric restriction (−0.3% for intermittent fasting vs −0.5% for caloric restriction).4 A major implication was that intermittent fasting may be less safe than caloric restriction although approximately equivalently effective. Therefore, until intermittent fasting is shown to be more effective than caloric restriction for reducing hemoglobin A1c level or otherwise controlling diabetes, that study and the limited other high-quality data suggest that intermittent fasting regimens for patients with type 2 diabetes recommended by health professionals or promoted to the public should be limited to individuals for whom the risk of hypoglycemia is closely monitored and medications are carefully adjusted to ensure safety.8
The value of intermittent fasting compared with other dietary regimens is unclear given the potentially higher risk of adverse events during intermittent fasting, whereas the best, but limited, evidence suggests that the efficacy of intermittent fasting was only noninferior to caloric restriction for hemoglobin A1c improvement and weight loss. Whether the benefits seen with intermittent fasting are sustained after cessation of a regimen is unknown. The message to the public, given the current popularity of intermittent fasting, is that people with type 2 diabetes should not undertake it without the involvement of their physician.
