Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians

Intermittent fasting can be defined as eating patterns practiced with a principle of consuming minimum to no calories for time periods ranging from 12 h to several days constantly. In addition to the existing evidence where intermittent fasting is an effective non-medicinal treatment option for type 2 diabetes, further research is needed to set forth the effects of intermittent fasting from weight loss. Hence Michael Albosta and colleagues, conducted a review of literature titled “Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians” published in BMC Clinical Diabetes and Endocrinology Journal. A summary of the review of the literature is mentioned below.

Objective:

To discuss whether intermittent fasting should be considered as an alternative, non-medicinal treatment option for patients with this disorder.

Methods:

PubMed, Google Scholar, and Ovid MEDLINE were referred to search for published articles, including randomized controlled trials, clinical trials, case reports, and case series between the years 1990 and 2020. Online referencing from ADA and EASD for guidelines and recommendations was carried out.

Findings:

Investigators report the beneficial effects of IF in improving body composition, metabolic risk factors, insulin resistance, and weight loss in obese individuals. Additionally, IF was found to cause an increased level of AMP-activated protein kinase (AMPK) that promotes reduction in chronic disease, healthier aging, improvements in insulin sensitivity, and glucose homeostasis. As far as T2DM is concerned, IF is reported to be a tolerable non-medicinal treatment option by several studies.
Recommendation for prescribing IF in practice:
 Immediate elimination of regular snacking and meals from day to day schedule can cause irritability, hunger, and can decrease compliance.
 It is recommended to introduce intermittent fasting gradually, starting with 12h restricted period to 20h with a decrease in the number of hours for feeding per day.
 For patients who have successfully adjusted to time-restricted feeding, can be suggested to switch to alternate day or periodic fasting under the supervision and guidance of a registered dietician.
Important points to consider while prescribing IF in practice:
 Discuss potential safety risks associated with fasting.
 In order to prevent hypoglycemia, patients administered insulin or sulfonylurea medications should be monitored closely by their healthcare provider.
 Appropriate adjustments to their medications should be considered by physicians, especially on days of fasting
 The patient should be instructed to record blood glucose levels and weight daily.
 Patient education on nutrient-rich meals, and adequate protein intake during the feeding period is necessary.
 Patient should be educated on adequate hydration during the fasting period
 Fasting is not recommended in some populations such as adults in an advanced stage, pregnant/lactating women, individuals with hypoglycemic events, individuals with immunodeficiencies, and those who suffer from eating disorders.

Limitations:

Authors recommend a systematic review for further evidence-based statistical evaluation and significance.

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