Effect of intermittent fasting intervention on type 2 diabetic patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CAI Yang , SHI Dongkai ,  CAO Jianmin

Department of Sport and Science, Beijing Sport University, Beijing 100084, P. R. China;

Corresponding author：

CAO Jianmin, Email: bsucaojianmin@aliyun.com

Keywords：

Intermittent fasting; Type 2 diabetes; Intervention effect; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202206091

Video：

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Objective To systematically review the effect of intermittent fasting on type 2 diabetes mellitus. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, The Cochrane Library and EMbase databases were electronically searched to collect randomized controlled trials (RCTs) on intermittent fasting intervention in the treatment of type 2 diabetes mellitus from inception to April 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. The RevMan 5.4 software and Stata 17.0 software were used for meta-analysis. Results A total of 17 RCTs comprising 1 428 patients with type 2 diabetes mellitus were included. The results of meta-analysis showed that intermittent fasting improved body weight (WMD=−2.84, 95%CI −3.79 to −1.88, P<0.05), body mass index (BMI) (WMD=−1.07, 95%CI −1.52 to −0.61, P<0.05), glycosylated hemoglobin levels (SMD=−0.78, 95%CI −1.19 to −0.38, P<0.05), and fasting glucose levels (SMD=−0.65, 95%CI −1.01 to −0.3, P<0.05). Conclusion The current evidence suggests that intermittent fasting improves body weight, BMI, glycated hemoglobin, and fasting blood glucose levels in patients with type 2 diabetes. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： CAI Yang, SHI Dongkai, CAO Jianmin. Effect of intermittent fasting intervention on type 2 diabetic patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(11): 1249-1255. doi: 10.7507/1672-2531.202206091 Copy

1.	Papamichou D, Panagiotakos DB, Itsiopoulos C. Dietary patterns and management of type 2 diabetes: a systematic review of randomised clinical trials. Nutr Metab Cardiovasc Dis, 2019, 29(6): 531-543.
2.	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版). 中国糖尿病杂志, 2014, 22(8): 2-42.
3.	Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9 th edition. Diabetes Res Clin Pract, 2019, 157: 107843.
4.	Bommer C, Sagalova V, Heesemann E, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care, 2018, 41(5): 963-970.
5.	王玉梅, 王楠, 刘雪梅, 等. 糖尿病患者90例饮食治疗知识的知晓程度调查. 职业与健康, 2012, 28(3): 343-345.
6.	何丽芸, 彭巧君. 饮食干预在减轻2型糖尿病病人氧化应激状态中的应用进展. 护理研究, 2016, 30(24): 2961-2964.
7.	Tinsley GM, La Bounty PM. Effects of intermittent fasting on body composition and clinical health markers in humans. Nutr Rev, 2015, 73(10): 661-674.
8.	王萍萍, 肖凌凤, 于成丽, 等. 成人2型糖尿病患者间歇性禁食的研究进展. 现代预防医学, 2021, 48(17): 3105-3109.
9.	Barnosky AR, Hoddy KK, Unterman TG, et al. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Transl Res, 2014, 164(4): 302-311.
10.	Jia SS, Liu Q, Allman-Farinelli M, et al. The use of portion control plates to promote healthy eating and diet-related outcomes: a scoping review. Nutrients, 2022, 14(4): 892.
11.	Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, et al. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr, 2022, 116(1): 40-56.
12.	Sarsangi P, Salehi-Abargouei A, Ebrahimpour-Koujan S, et al. Association between adherence to the mediterranean diet and risk of type 2 diabetes: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr, 2022, 13(5): 1787-1798.
13.	Borgundvaag E, Mak J, Kramer CK. Metabolic impact of intermittent fasting in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of interventional studies. J Clin Endocrinol Metab, 2021, 106(3): 902-911.
14.	Malinowski B, Zalewska K, Węsierska A, et al. Intermittent fasting in cardiovascular disorders-an overview. Nutrients, 2019, 11(3): 673.
15.	张渊, 杨智荣, 孙凤, 等. 偏倚风险评估系列: (九)如何应用偏倚风险评估的结果. 中华流行病学杂志, 2018, 39(12): 1648-1654.
16.	杨克虎. 系统评价指导手册. 北京: 人民卫生出版社, 2010.
17.	陈鲁曼. 限食联合二甲双胍治疗2型糖尿病的临床观察. 中外女性健康研究, 2018, (8): 3-4, 30.
18.	王新民, 崔艳凤, 谭坤能, 等. 中低热量饮食对超重和肥胖2型糖尿病患者治疗的影响. 中国糖尿病杂志, 2003, (2): 20-23.
19.	栗晓华. 轻断食对改善超重肥胖型2型糖尿病糖脂代谢异常的临床观察. 长春: 长春中医药大学, 2019.
20.	Bartholomew C, Muhlestein JB, May HT, et al. Randomized controlled trial of once-per-week intermittent fasting for the reduction of low-density lipoprotein cholesterol. Circulation, 2020, 142: A14607.
21.	Che T, Yan C, Tian D, et al. Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial. Nutr Metab (Lond), 2021, 18(1): 88.
22.	Chowdhury A, Khan H, Lasker SS, et al. Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: the East London diabetes in Ramadan survey. Diabetes Res Clin Pract, 2019, 152: 166-170.
23.	Ghalandari H, Kamalpour M, Alimadadi A, et al. Comparison of two calorie-reduced diets of different carbohydrate and fiber contents and a simple dietary advice aimed to modify carbohydrate intake on glycemic control and inflammatory markers in type 2 diabetes: a randomized trial. Int J Endocrinol Metab, 2017, 16(1): e12089.
24.	Li 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.
25.	Lum ZK, Khoo ZR, Toh WYS, et al. Efficacy and safety of use of the fasting algorithm for Singaporeans with type 2 diabetes (FAST) during ramadan: a prospective, multicenter, randomized controlled trial. Ann Fam Med, 2020, 18(2): 139-147.
26.	Redmon JB, Raatz SK, Reck KP, et al. One-year outcome of a combination of weight loss therapies for subjects with type 2 diabetes: a randomized trial. Diabetes Care, 2003, 26(9): 2505-2511.
27.	Sulaj A, Kopf S, von Rauchhaupt E, et al. Six-month periodic fasting in patients with type 2 diabetes and diabetic nephropathy: a proof-of-concept study. J Clin Endocrinol Metab, 2022, 107(8): 2167-2181.
28.	Umphonsathien M, Rattanasian P, Lokattachariya S, et al. Effects of intermittent very-low calorie diet on glycemic control and cardiovascular risk factors in obese patients with type 2 diabetes mellitus: a randomized controlled trial. J Diabetes Investig, 2022, 13(1): 156-166.
29.	Williams KV, Mullen ML, Kelley DE, et al. The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes. Diabetes Care, 1998, 21(1): 2-8.
30.	Wing RR, Marcus MD, Salata R, et al. Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects. 1991, 151(7): 1334-1340.
31.	Paisey RB, Harvey P, Rice S, et al. Short-term results of an open trial of very low calorie diet or intensive conventional diet in Type 2 diabetes. Practical Diabetes International, 1995, 12(6): 263-267.
32.	Ruggenenti P, Abbate M, Ruggiero B, et al. Renal and systemic effects of calorie restriction in patients with type 2 diabetes with abdominal obesity: a randomized controlled trial. Diabetes, 2017, 66(1): 75-86.
33.	Kahleova H, Belinova L, Malinska H, et al. Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia, 2014, 57(8): 1552-1560.
34.	Cradock KA, ÓLaighin G, Finucane FM, et al. Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: a systematic review and meta-analysis. Int J Behav Nutr Phys Act, 2017, 14(1): 18.
35.	Gray KL, Clifton PM, Keogh JB. The effect of intermittent energy restriction on weight loss and diabetes risk markers in women with a history of gestational diabetes: a 12-month randomized control trial. Am J Clin Nutr, 2021, 114(2): 794-803.
36.	Carter S, Clifton PM, Keogh JB. The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial. Diabetes Res Clin Pract, 2016, 122: 106-112.
37.	Ganesan K, Habboush Y, Sultan S. Intermittent fasting: the choice for a healthier lifestyle. Cureus, 2018, 10(7): e2947.
38.	Antoni R, Johnston KL, Collins AL, et al. Effects of intermittent fasting on glucose and lipid metabolism. Proc Nutr Soc, 2017, 76(3): 361-368.
39.	Liu H, Javaheri A, Godar RJ, et al. Intermittent fasting preserves beta-cell mass in obesity-induced diabetes via the autophagy-lysosome pathway. Autophagy, 2017, 13(11): 1952-1968.
40.	汪俊宇, 张安仁. 肠道菌群在间歇性禁食治疗肥胖中的作用研究. 中国全科医学, 2019, 22(27): 3308-3311.
41.	李凌浩. 不同禁食时间对健康小鼠肠道菌群的影响. 兰州: 西北民族大学, 2020.
42.	Carter 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.
43.	Horne BD, Grajower MM, Anderson JL. Limited evidence for the health effects and safety of intermittent fasting among patients with type 2 diabetes. JAMA, 2020, 324(4): 341-342.

1. Papamichou D, Panagiotakos DB, Itsiopoulos C. Dietary patterns and management of type 2 diabetes: a systematic review of randomised clinical trials. Nutr Metab Cardiovasc Dis, 2019, 29(6): 531-543.
2. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版). 中国糖尿病杂志, 2014, 22(8): 2-42.
3. Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9 th edition. Diabetes Res Clin Pract, 2019, 157: 107843.
4. Bommer C, Sagalova V, Heesemann E, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care, 2018, 41(5): 963-970.
5. 王玉梅, 王楠, 刘雪梅, 等. 糖尿病患者90例饮食治疗知识的知晓程度调查. 职业与健康, 2012, 28(3): 343-345.
6. 何丽芸, 彭巧君. 饮食干预在减轻2型糖尿病病人氧化应激状态中的应用进展. 护理研究, 2016, 30(24): 2961-2964.
7. Tinsley GM, La Bounty PM. Effects of intermittent fasting on body composition and clinical health markers in humans. Nutr Rev, 2015, 73(10): 661-674.
8. 王萍萍, 肖凌凤, 于成丽, 等. 成人2型糖尿病患者间歇性禁食的研究进展. 现代预防医学, 2021, 48(17): 3105-3109.
9. Barnosky AR, Hoddy KK, Unterman TG, et al. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Transl Res, 2014, 164(4): 302-311.
10. Jia SS, Liu Q, Allman-Farinelli M, et al. The use of portion control plates to promote healthy eating and diet-related outcomes: a scoping review. Nutrients, 2022, 14(4): 892.
11. Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, et al. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr, 2022, 116(1): 40-56.
12. Sarsangi P, Salehi-Abargouei A, Ebrahimpour-Koujan S, et al. Association between adherence to the mediterranean diet and risk of type 2 diabetes: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr, 2022, 13(5): 1787-1798.
13. Borgundvaag E, Mak J, Kramer CK. Metabolic impact of intermittent fasting in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of interventional studies. J Clin Endocrinol Metab, 2021, 106(3): 902-911.
14. Malinowski B, Zalewska K, Węsierska A, et al. Intermittent fasting in cardiovascular disorders-an overview. Nutrients, 2019, 11(3): 673.
15. 张渊, 杨智荣, 孙凤, 等. 偏倚风险评估系列: (九)如何应用偏倚风险评估的结果. 中华流行病学杂志, 2018, 39(12): 1648-1654.
16. 杨克虎. 系统评价指导手册. 北京: 人民卫生出版社, 2010.
17. 陈鲁曼. 限食联合二甲双胍治疗2型糖尿病的临床观察. 中外女性健康研究, 2018, (8): 3-4, 30.
18. 王新民, 崔艳凤, 谭坤能, 等. 中低热量饮食对超重和肥胖2型糖尿病患者治疗的影响. 中国糖尿病杂志, 2003, (2): 20-23.
19. 栗晓华. 轻断食对改善超重肥胖型2型糖尿病糖脂代谢异常的临床观察. 长春: 长春中医药大学, 2019.
20. Bartholomew C, Muhlestein JB, May HT, et al. Randomized controlled trial of once-per-week intermittent fasting for the reduction of low-density lipoprotein cholesterol. Circulation, 2020, 142: A14607.
21. Che T, Yan C, Tian D, et al. Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial. Nutr Metab (Lond), 2021, 18(1): 88.
22. Chowdhury A, Khan H, Lasker SS, et al. Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: the East London diabetes in Ramadan survey. Diabetes Res Clin Pract, 2019, 152: 166-170.
23. Ghalandari H, Kamalpour M, Alimadadi A, et al. Comparison of two calorie-reduced diets of different carbohydrate and fiber contents and a simple dietary advice aimed to modify carbohydrate intake on glycemic control and inflammatory markers in type 2 diabetes: a randomized trial. Int J Endocrinol Metab, 2017, 16(1): e12089.
24. Li 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.
25. Lum ZK, Khoo ZR, Toh WYS, et al. Efficacy and safety of use of the fasting algorithm for Singaporeans with type 2 diabetes (FAST) during ramadan: a prospective, multicenter, randomized controlled trial. Ann Fam Med, 2020, 18(2): 139-147.
26. Redmon JB, Raatz SK, Reck KP, et al. One-year outcome of a combination of weight loss therapies for subjects with type 2 diabetes: a randomized trial. Diabetes Care, 2003, 26(9): 2505-2511.
27. Sulaj A, Kopf S, von Rauchhaupt E, et al. Six-month periodic fasting in patients with type 2 diabetes and diabetic nephropathy: a proof-of-concept study. J Clin Endocrinol Metab, 2022, 107(8): 2167-2181.
28. Umphonsathien M, Rattanasian P, Lokattachariya S, et al. Effects of intermittent very-low calorie diet on glycemic control and cardiovascular risk factors in obese patients with type 2 diabetes mellitus: a randomized controlled trial. J Diabetes Investig, 2022, 13(1): 156-166.
29. Williams KV, Mullen ML, Kelley DE, et al. The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes. Diabetes Care, 1998, 21(1): 2-8.
30. Wing RR, Marcus MD, Salata R, et al. Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects. 1991, 151(7): 1334-1340.
31. Paisey RB, Harvey P, Rice S, et al. Short-term results of an open trial of very low calorie diet or intensive conventional diet in Type 2 diabetes. Practical Diabetes International, 1995, 12(6): 263-267.
32. Ruggenenti P, Abbate M, Ruggiero B, et al. Renal and systemic effects of calorie restriction in patients with type 2 diabetes with abdominal obesity: a randomized controlled trial. Diabetes, 2017, 66(1): 75-86.
33. Kahleova H, Belinova L, Malinska H, et al. Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia, 2014, 57(8): 1552-1560.
34. Cradock KA, ÓLaighin G, Finucane FM, et al. Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: a systematic review and meta-analysis. Int J Behav Nutr Phys Act, 2017, 14(1): 18.
35. Gray KL, Clifton PM, Keogh JB. The effect of intermittent energy restriction on weight loss and diabetes risk markers in women with a history of gestational diabetes: a 12-month randomized control trial. Am J Clin Nutr, 2021, 114(2): 794-803.
36. Carter S, Clifton PM, Keogh JB. The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial. Diabetes Res Clin Pract, 2016, 122: 106-112.
37. Ganesan K, Habboush Y, Sultan S. Intermittent fasting: the choice for a healthier lifestyle. Cureus, 2018, 10(7): e2947.
38. Antoni R, Johnston KL, Collins AL, et al. Effects of intermittent fasting on glucose and lipid metabolism. Proc Nutr Soc, 2017, 76(3): 361-368.
39. Liu H, Javaheri A, Godar RJ, et al. Intermittent fasting preserves beta-cell mass in obesity-induced diabetes via the autophagy-lysosome pathway. Autophagy, 2017, 13(11): 1952-1968.
40. 汪俊宇, 张安仁. 肠道菌群在间歇性禁食治疗肥胖中的作用研究. 中国全科医学, 2019, 22(27): 3308-3311.
41. 李凌浩. 不同禁食时间对健康小鼠肠道菌群的影响. 兰州: 西北民族大学, 2020.
42. Carter 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.
43. Horne BD, Grajower MM, Anderson JL. Limited evidence for the health effects and safety of intermittent fasting among patients with type 2 diabetes. JAMA, 2020, 324(4): 341-342.

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