Clinical Assessment of Intermittent Fasting With Ketogenic Diet in Glycemic Control and Weight Reduction in Patients With Type II Diabetes Mellitus: A Systematic Review and Meta-Analysis
Abstract:Diabetes mellitus (DM) is a global epidemic causing significant morbidity and mortality. The most occurring DM is type 2 diabetes mellitus (T2DM) which has similar symptoms as type 1 diabetes mellitus (T1DM). However, it is less marked, making it difficult to diagnose during the early stages. The management of T2DM is usually based on weight and glycemic control, which can be achieved through dietary interventions such as intermittent fasting (IF) and the ketogenic diet (KD). Therefore, this systematic review … Show more
“…The final selection yielded 23 meta-analyses to be included for the main analysis. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 50 , 52 , 53 , 61 , 62 , 63 Fig. 1 Flow diagram of the study selection process .…”
Section: Resultsmentioning
confidence: 99%
“… 16 , 38 , 62 Ten associations conducted on participants with obesity or overweight, T2DM and at least 1 risk marker for metabolic syndrome, premenopausal women, compared IF (TWF, MADF, and TRE) with usual diet, ad libitum, unrestricted, or CER diets, reporting no significant effects on HbA1c (three moderate, six low, and one very low). 14 , 19 , 20 , 31 , 37 , 53 , 62 …”
Section: Resultsmentioning
confidence: 99%
“…Additionally, there have been several high-quality meta-analyses published after the retrieval deadline (January 12, 2021) that could provide updated evidence. 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 For instance, Gu et al. (2022) conducted a comprehensive review of 43 RCTs and found no significant results on fasting glucose after IF intervention compared to non-intervention diets, 16 which contradicts the findings of the UR.…”
Section: Introductionmentioning
confidence: 99%
“… 27 It is worth noting that several high-quality studies with more health-related outcomes investigating this topic have been published in recent years. 14 , 16 , 17 , 20 …”
“…The final selection yielded 23 meta-analyses to be included for the main analysis. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 50 , 52 , 53 , 61 , 62 , 63 Fig. 1 Flow diagram of the study selection process .…”
Section: Resultsmentioning
confidence: 99%
“… 16 , 38 , 62 Ten associations conducted on participants with obesity or overweight, T2DM and at least 1 risk marker for metabolic syndrome, premenopausal women, compared IF (TWF, MADF, and TRE) with usual diet, ad libitum, unrestricted, or CER diets, reporting no significant effects on HbA1c (three moderate, six low, and one very low). 14 , 19 , 20 , 31 , 37 , 53 , 62 …”
Section: Resultsmentioning
confidence: 99%
“…Additionally, there have been several high-quality meta-analyses published after the retrieval deadline (January 12, 2021) that could provide updated evidence. 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 For instance, Gu et al. (2022) conducted a comprehensive review of 43 RCTs and found no significant results on fasting glucose after IF intervention compared to non-intervention diets, 16 which contradicts the findings of the UR.…”
Section: Introductionmentioning
confidence: 99%
“… 27 It is worth noting that several high-quality studies with more health-related outcomes investigating this topic have been published in recent years. 14 , 16 , 17 , 20 …”
“…It is also important to note that among patients with T2DM, dietary therapies may be considered to improve glycemic control. Our most recent meta-analyses established that ketogenic diets significantly improve glycemic control in T2DM patients [34,35].…”
Type II diabetes mellitus (T2DM) is a global epidemic affecting people of all ages in developed and developing countries. The disease is usually characterized by insulin resistance and glucose intolerance; therefore, oral antidiabetic drugs such as thiazolidinediones (TZDs) and biguanide metformin are used to counter these defects. Due to the varied action mechanisms of TZDs and Metformin, their effects on insulin sensitivity and glucose tolerance may differ. Therefore, the current study was carried out to compare the effects of Metformin and TZDs on insulin sensitivity and glucose tolerance among patients with T2DM.Two methods, including using a well-outlined search strategy in 5 electronic databases including ScienceDirect, Google Scholar, PubMed, Scopus, and Embase, and a manual search which involved going through the reference lists of studies from the electronic databases were used to retrieve studies published between 2000 and 2022. Additionally, data analysis of outcomes retrieved from the studies eligible for inclusion and the methodological quality was carried out using the Review Manager software (RevMan 5.4.1) and STATA.The meta-analysis has shown that TZDs have a significantly better overall effect on fasting plasma glucose (FPG) (SMD:0.61; 95% CI:0.06, 1.16: p = 0.03) and insulin sensitivity than Metformin (Mean QUICKI: 0.306 ± 0.019 vs. 0.316 ± 0.019, respectively; p=0.0003). However, the TZDs and Metformin offer the same effect on glycemic control as assessed using HBA1c levels (MD: 0.10; 95% CI: -0.20, 0.40; p = 0.52).TZDs offer better insulin sensitivity and glucose tolerance improvements compared to Metformin. This evidence contradicts the current guidelines by the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), which recommend the use of Metformin as the first-line drug monotherapy for patients with T2DM.
The combination of ketogenic diet (KD) with intermittent fasting (IF) has, for years, aroused a great interest in the scientific world and among healthy lifestyle enthusiasts. Its importance is even greater when the study subjects are physically active individuals. The aim of the study was a determination of the effect of strict calculated ketogenic menu combined with IF and with caloric deficit on the selected biochemical markers and body composition in a 23-year-old man performing strength training. At the same time, we decided to conduct the first so-deeply investigated and controlled case study in this respect. The study protocol included a 13-week-long ketogenic diet with intermittent fasting (of delayed time-restricted eating 16:8 type) and caloric deficit. A detailed menu was designed and was used by the man throughout the whole study duration. A number of blood tests were performed before and after the implemented dietary intervention. Additionally, body composition was determined weekly and the concentrations of glucose and ketone bodies, as well as pulse rate and arterial pressure, were measured daily. The most important changes noted included a significant increase in testosterone and vitamin D concentrations and significant reduction in the HOMA-IR index and concentrations of hepatic enzymes, insulin, glucose, iron, urea, and free triiodothyronine (FT3). Moreover, a significant improvement of body composition occurred (the ratio of total body mass to the adipose and muscular tissue and water mass improved). Favourable changes were also noted in heart rate and arterial pressure values. In view of that, the KD with IF and caloric deficit exerted favourable effects on most biochemical parameters and on body composition and caused an almost twofold increase in serum testosterone concentration.
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