Intermittent Fasting May Control Blood Sugar Better Than Diabetes Drugs

Scientists found that people with newly diagnosed type 2 diabetes who followed a specific intermittent fasting plan experienced greater glycemic control than those taking metformin or empagliflozin.

Health experts project that more than 1 billion people will be diagnosed with type 2 diabetes by 2050, more than double the current numbers. Primarily, type 2 diabetes is associated with obesity, low physical activity, and eating a poor diet.

Although scientists have made great strides towards effectively managing diabetes, such as developing drugs like insulin, metformin, and Ozempic, lifestyle interventions, including dietary changes, can also help treat the condition.


For example, reports suggest that time-restricted eating may help people with type 2 diabetes lose weight, and following the Mediterranean diet may prevent the condition altogether.

Now, the results of a new study published on June 21 in JAMA Network Open suggests that a specific intermittent fasting diet plan may be a better option for managing blood sugar levels than drugs like metformin, with fewer side effects.

The 5:2 meal replacement plan and glycemic control

The trial involved 405 adults with newly diagnosed type 2 diabetes from the Exploration of Treatment of Newly Diagnosed Overweight/Obese Type 2 Diabetes Mellitus (EARLY) study in China.

At the start of the study, the team gathered baseline measurements of the participants' hemoglobin A1c (HbA1c) level — a measurement of average blood sugar levels over a two-to-three-month period. They also recorded the participant's blood pressure and several metabolic markers.

The research team divided the participants into three groups. One group followed the 5:2 meal replacement (5:2 MR) diet, and the other two groups received either 0.5 grams (g) to 2 g of metformin twice a day or 10 mg of empagliflozin once a day.

The 5:2 MR diet plan involves replacing meals with a low-calorie prepackaged food or beverage product on two consecutive "fasting" days. During the study period, on these fasting days, the participants consumed one serving of the meal replacement instead of all three regular meals for a total daily energy intake of 600 kcal for men and 500 kcal for women.

Of the 405 participants, 332 completed the 16-week treatment plus an 8-week follow-up.


The scientists found that at week 16, participants in the 5:2 meal replacement group showed the most significant reduction in HbA1c, much greater than those receiving metformin and empagliflozin.

Alarm clock on plate
Image by LadyRhino via Shutterstock

For example, nearly 89% of people in the 5:2 MR group achieved an HbA1c level of less than 7%. In comparison, just over 73% of people taking metformin and around 70% receiving empagliflozin experienced similar HbA1c levels.

According to the American Diabetes Association, individuals with diabetes who achieve an HbA1c of less than 6.5% for at least three months after stopping treatment or starting an intervention are considered to be in diabetes remission.

The study's authors say that 80% of participants in the 5:2 meal replacement group reached this level within 16 weeks, and 76.6% maintained an HbA1c level of less than 6.5% at the end of the 8-week follow-up period.

Participants following the 5:2 MR also lost more weight than those in the medication groups. By week 16, the intermittent fasting group lost an average of 21 pounds, while people taking metformin or empagliflozin lost around 12 pounds.

Moreover, the 5:2 MR group experienced a significant reduction in waist and hip circumference, blood pressure, and cholesterol levels. However, the researchers found no differences in other metabolic markers among the three groups.

Still, the study authors are unsure whether the glycemic improvement in individuals with type 2 diabetes is due to weight loss or the 5:2 MR diet approach itself.

Safety of intermittent fasting vs. diabetes medications

The research team also monitored the participants for side effects and found that metformin led to 36 adverse events, 11 occurred with empagliflozin, and the 5:2 intermittent fasting group experienced nine.


The significant events among people following the 5:2 meal replacement diet included eight cases of hypoglycemia or low blood sugar. In contrast, 26 individuals had mild gastrointestinal symptoms, and eight individuals had hypoglycemia in the metformin group.

In the empagliflozin group, five people had hypoglycemia, and two serious adverse events occurred, namely hospitalization due to a severe rash and elevated ketones in the blood.

The scientists say that this diet strategy could be a safe and effective lifestyle intervention for people with type 2 diabetes and offer an alternative to medications like metformin and empagliflozin.

Long-term follow-up studies are currently underway to confirm their findings.

Of note, while the researchers claim no conflicts of interest, Beijing Metabolic Control Technology Co Ltd, the company that produces the low-calorie meal replacement product used in the study, funded the research.


Leave a reply

Your email will not be published. All fields are required.