Can intermittent fasting and weight loss lead to diabetes remission?

Over 44 per cent of the people put on an intermittent fasting diet for three months achieved Type-2 diabetes remission, discontinued their medication or insulin and maintained it as such for the follow-up period of one year, according to a recent study published in the Journal of Clinical Endocrinology and Metabolism.

In fact, the intake of diabetes medicines went down in nearly 90 per cent of the participants – the medication cost was 77.2 per cent lower than in the control group.

Diabetes medications are costly and a barrier for many patients who are trying to effectively manage their disease. Our study saw medication costs decrease by 77 per cent in people with diabetes after intermittent fasting,” said Dongbo Liu, one of the authors of the study from Hunan Agricultural University in China, in a release.

Liu added, “Type 2 diabetes is not necessarily a permanent, lifelong disease. Diabetes remission is possible if patients lose weight by changing their diet and exercise habits.”

At the three-month follow-up, 47.2 per cent of those on the intermittent fasting diet had achieved remission in comparison to 2.8 per cent among the control group. The weight-loss among those on the intermittent fasting diet was 5.93 kg as compared to 0.27 kgs among the control group, according to the study.

“Weight-loss is the key when it comes to diabetes remission – whether it is achieved by a calorie-restricted diet, intermittent fasting, or with the help of medicines. A community-based study from UK was the first to establish diabetes remission in 2018; it showed that nearly 80 per cent people went into remission with drastic weight loss,” said Dr Anoop Misra, Chairman, Fortis CDOC Hospital for Diabetes and Allied Sciences. “We see remission of 100 per cent with bariatric surgery,” he added.

Dr Misra said that the only problem with the current study was the limited number of participants and short duration of follow-up. The randomised control trial was done with 36 participants between the ages of 38 and 72 years, with a history of Type-2 diabetes for one to 11 years. The participants were followed up for a period of one year after a three-month intervention.

While it is well and good for obese persons to lose weight and achieve diabetes remission, it is not so for lean people who contract the disease, said Misra, describing them as “an enigma.”

“We still do not fully understand why someone who is lean gets the disease but we hesitate to recommend weight loss in them as they might become under-nourished,” he said.

How many of such lean patients does he see? “It can vary depending on geographical location or socio-economic conditions. Say, in Delhi around 10 per cent of the new diabetics would be lean. In an under-privileged or rural setting, it can go up to 30 per cent. A higher proportion of lean patients would be seen in Odisha or Bangladesh. And, as yet there is no study to show remission in such patients,” said Dr Misra.

How long does the remission last? Remission is defined as controlled sugar levels – the average blood glucose (HbA1C) level of less than 6.5 per cent — for three months after discontinuing the medicines. “It is not clear how many or who becomes diabetic again after remission but in a study following such patients for two years, nearly 20 to 30 per cent became diabetic again. Following a very good exercise and diet plan to keep the weight off can help in reducing the risk of becoming a diabetic again,” said Dr Misra, adding that those who are obese must attempt remission. “Complications of diabetes are likely to be less in those who go into remission for whatever period.”