Mian Li, Jie Li, Yu Xu, Jinli Gao, Qiuyu Cao, Yi Ding, Zhuojun Xin, Ming Lu, Xiaoting Li, Haihong Song, Jue Shen, Tianzhichao Hou, Ruixin He, Ling Li, Zhiyun Zhao, Min Xu, Jieli Lu, Tiange Wang, Shuangyuan Wang, Hong Lin, Ruizhi Zheng, Jie Zheng, Callum John Baker, Shenghan Lai, Nathan Anthony Johnson, Guang Ning, Stephen Morris Twigg, Weiqing Wang, Yan Liu, Yufang Bi
Journal: Diabetes care 2024;47(6):1074-1083
PMID: 38638032
Diet and physical activity are important lifestyle factors for the management of type 2 diabetes (T2DM). The aim of this 12-week randomised controlled trial, including 326 patients with T2DM and overweight/obesity, was to evaluate the effect of a 5:2 diet regime versus exercise versus standard education (control) on cardiometabolic parameters and glycaemic control. Participants in the 5:2 diet group received a formula containing 790 kcal on 2 days per week whilst eating their normal diet on the other 5 days; the participants in the exercise group engaged in a supervised high-intensity interval training combined with resistance training on 2 days per week. Participants were followed for a further 36 weeks following the 12-week intervention. Compared to control, the 5:2 diet group but not the exercise group had a significant improvement in HbA1c (glycaemic control). Other parameters of glycaemic control also improved in the diet but not the exercise group, relative to control. The diabetes went into remission in significantly more participants in the diet group (19.4%), compared to the control group (10.5%), whilst this was not significantly different between the exercise (11.8%) and the control group. Both the diet and the exercise group had significantly greater reductions in fat mass, fat-to-lean mass ratio and liver fat, compared to controls. Body mass and body mass index went down more in the diet than control group, whilst lean body mass only improved in the exercise group. 36 weeks after the interventions, there was no longer a difference between the groups in body weight or HbA1c. The authors conclude that a medically supervised 5:2 diet may be an alternative strategy for improving glycaemic control.
OBJECTIVE
We aimed to examine the effects of a 5:2 diet (2 days per week of energy restriction by formula diet) or an exercise (2 days per week of high-intensity interval training and resistance training) intervention compared with routine lifestyle education (control) on glycemic control and cardiometabolic health among adults with overweight/obesity and type 2 diabetes.
RESEARCH DESIGN AND METHODS
This two-center, open-label, three-arm, parallel-group, randomized controlled trial recruited 326 participants with overweight/obesity and type 2 diabetes and randomized them into 12 weeks of diet intervention (n = 109), exercise intervention (n = 108), or lifestyle education (control) (n = 109). The primary outcome was the change of glycemic control measured as glycated hemoglobin (HbA1c) between the diet or exercise intervention groups and the control group after the 12-week intervention.
RESULTS
The diet intervention significantly reduced HbA1c level (%) after the 12-week intervention (-0.72, 95% CI -0.95 to -0.48) compared with the control group (-0.37, 95% CI -0.60 to -0.15) (diet vs. control -0.34, 95% CI -0.58 to -0.11, P = 0.007). The reduction in HbA1c level in the exercise intervention group (-0.46, 95% CI -0.70 to -0.23) did not significantly differ from the control group (exercise vs. control -0.09, 95% CI -0.32 to 0.15, P = 0.47). The exercise intervention group was superior in maintaining lean body mass. Both diet and exercise interventions induced improvements in adiposity and hepatic steatosis.
CONCLUSIONS
These findings suggest that the medically supervised 5:2 energy-restricted diet could provide an alternative strategy for improving glycemic control and that the exercise regimen could improve body composition, although it inadequately improved glycemic control.
© 2024 by the American Diabetes Association.
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