Aims/Hypothesis: Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions like the metabolic syndrome, type 2 diabetes, rheumatic diseases and others. Fasting for people with type 1 diabetes is generally considered too risky. However, the ability and possibility to change from carbohydrate to ketone-based fuel supply might also be relevant for people with type 1 diabetes. The aim of this patient-led research was to investigate the feasibility, bene t and safety of a seven-day multimodal fasting intervention in people with type 1 diabetes. Methods: A non-randomized controlled pilot study, with 20 participants with and 10 without type 1 diabetes. Data acquisition took place prior, post and four months after the intervention and daily during intervention.Results: 29 of 30 participants nished the intervention. Mean ß-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7 while average glucose remained between 4.9 ± 1.5 to 7.5 ± 2.3 mmol/L [89 ± 27 and 136 ± 40 mg/dL]. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes. Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54.0 ± 4.4 to 68.8 ± 15.0 (p = 0.01) after fasting. There was a decrease from before until the follow-up four month later of weight from 77.6 ± 20.4 kg to 76.6 ± 20.9 kg (p = 0.023) and for the BMI from (27.68 ± 7.04) to (26.74 ± 7.15) kg/m 2 (p = 0.008). Diastolic blood pressure increased from 69.75 ± 11.41 mmHg to 75.74 ± 8.42 mmHg (p = 0.028) and stayed in a healthy range on average.Conclusions/Interpretation: This study demonstrates the feasibility, bene ts and safety aspects of a 7-day fast in adults with type 1 diabetes.
Research In ContextWhat is already known about this subject?People with type 1 diabetes have a high risk of developing diabetes-related complications including metabolic syndrome and type 2 diabetes Multimodal 7 day fasting can improve metabolic parameters in people with metabolic syndrome and type 2 diabetes Only recently has the role of ketones in metabolic signaling and downregulation of in ammation become a topic of research, including the prospective roles for ketones in obesity-related and cardiovascular diseases What is the key question? Can multimodal 7 day fasting, including a desired augmentation of ketone bodies, be used as safe intervention to support people with type 1 diabetes What are the new ndings?No ketoacidosis occurred during 7 day fasting in a group of 20 type 1 diabetics Change from carbohydrate-to ketone-based fuel is possible for people with type 1 diabetes under stable blood sugar values By fasting, BMI and other symptoms and risk factors may show long-term improvements in adults with type 1 diabetes How might these results change the focus of research or clinical practice? Multimodal 7 day fasting in type 1 diabetes, as a method preferred by many patients, could se...
