The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial
Abstract
Aims Weight loss improves glycaemic control in type 2 diabetes mellitus (T2DM). However, as achieving and maintaining weight loss is difficult, alternative strategies are needed. Our primary aim was to investigate the effects of intermittent energy restriction (IER) compared to continuous energy restriction (CER) on glycated haemoglobin A1c (HbA1c). Secondary aims were to assess effects on weight loss, body composition, medication changes and subjective measures of appetite. Using a 2-day IER method, we expected equal improvements to HbA1c and weight in both groups.Method Sixty-three overweight or obese participants (BMI 35.2±5kg/m 2) with T2DM (HbA1c 7.4±1.3%) (57mmol/mol) were randomised to a 2-day severe energy restriction (1670-2500kJ/day) with 5days of habitual eating, compared to a moderate CER diet (5000-6500kJ/day) for 12weeks.Results At 12weeks HbA1c (-0.7±0.9% P<0.001) and percent body weight reduction (-5.9±4% P<0.001) was similar in both groups with no group by time interaction. Similar reductions were also seen for medication dosages, all measures of body composition and subjective reports of appetite.Conclusions In this pilot trial, 2days of IER compared with CER resulted in similar improvements in glycaemic control and weight reduction offering a suitable alternative treatment strategy.
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One study showed similar reductions in A1C, weight, and medication doses when 2 days of severe energy restriction were compared with chronic energy restriction.
“One of the studies (127) showed similar reductions in A1C, weight, and medication doses when 2 days of severe energy restriction were compared with chronic energy restriction.”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [127]
Two RCTs of 5:2 diets reported no difference in weight loss compared with conventional energy restriction (high risk of bias).
“two for 5:2 diets reported no difference in weight loss (high-risk-of-bias RCTs) [46, 47]”
In a study of 63 overweight and obese T2DM subjects randomized to consume 400-600 kcal/day 2 days/week and typical energy intake for 5 days/week vs whole day energy restriction to 1200-1550 kcal/day, after 12 weeks there were similar reductions in HbA1c, body weight, antidiabetic medications, body composition, and appetite in both groups.
“after 12 weeks there were similar reductions in HbA1c, body weight, antidiabetic medications, body composition, and appetite in both groups [364].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [364]
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- Authors
- Carter, S., Clifton, P. M., & Keogh, J. B.
- Affiliations
- University of South Australia (AU)
- Corresponding author
- Clifton, P.M.
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 122
- Pages
- 106-112
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W2538540245
- Cited by
- 225
- References
- 25
- Citations by year
- 2026: 7 · 2025: 24 · 2024: 28 · 2023: 24 · 2022: 25 · 2021: 50 · 2020: 31 · 2019: 13 · 2018: 15 · 2017: 6 · 2016: 1 · 2012: 1
- FWCI
- 9.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- intermittent energy restriction, continuous energy restriction, type 2 diabetes, glycemic control, HbA1c, weight loss, body composition, appetite, diabetes medication reduction, dietary intervention
- MeSH terms
- Blood Glucose, Body Composition, Diabetes Mellitus, Type 2, Energy Metabolism, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Obesity, Pilot Projects, Weight Loss, Caloric Restriction
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