Intermittent Fasting: A User-Friendly Method for Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus (T2DM) is an alarmingly rising disorder characterized mainly by insulin resistance and hyperglycemia. Due to the impairment of glucose homeostasis, most subjects present with elevated serum glucose levels, which can lead to several complications, including hospitalizations and even death. Diet quality and quantity are at the heart of its pathogenesis; hence, for the management of this condition, a technique known as intermittent fasting (IF) has been an area of interest for researchers. Different fasting regimens, including alternate-day fasting, religious fasting, and time-restricted fasting, have proven to be of strategic importance for glycemic control due to their physiologic effects. According to case studies and randomized trials, therapeutic fasting has been shown to reverse insulin resistance, resulting in the discontinuance of insulin therapy while maintaining blood sugar levels. Studies on IF have demonstrated their efficacy in glycemic control and other metabolic parameters, including reducing visceral fat and controlling inflammatory mediators and markers such as C-reactive protein (CRP) and interleukin-6 (IL-6), but control in obesity is its most significant effect as it acts as a risk factor for T2DM. Several case studies have shown a reduction in elevated hemoglobin A1c (HbA1c) levels in subjects after fasting, which some believe is due to sirtuin-6 (SIRT6) proteins. SIRT6 proteins are believed to be responsible for blood glucose homeostasis and insulin resistance reversal by increasing its sensitivity. This family of proteins is increased after fasting; hence, further research in this area will help researchers better understand its mechanism of action and potential therapeutic effects on T2DM. With an alarming increase in the incidence of T2DM around the world, a cost-effective strategy is required to control the disease with easy patient compliance, and IF might prove to be the solution.

Therapeutic Fasting and Vitamin D Levels: A New Dimension in Type 2 Diabetes Mellitus Prevention and Management—A Brief Report

“…27 Our findings also support previous findings that fasting can reduce anthropometric measurements and prevent cardiovascular complications. 10,27 No adverse events or hypoglycemic events were reported by the study participants during the entire duration of the fasting program. This may be due to the monitoring support provided by the lifestyle physicians who were involved in the fasting delivery.…”

“…A recent review suggests therapeutic fasting is a safe and useful regimen in T2DM that not only improves glycemic control but also reduces the need for antidiabetic medication. 10 Another systematic review and meta-analysis on fasting and T2DM found that fasting lowers BMI, insulin resistance, glycated hemoglobin levels (HbA1C), blood glucose levels, leptin, and increases adipokine concentration. 14,15 These evidences indicate a positive role of therapeutic fasting in T2DM.…”

“…9 Recent evidence suggests therapeutic fasting is a safe and beneficial modality among T2DM patients. 10 Insulin resistance which is linked to diabetes is characterized by heightened inflammation in the body, elevated C-reactive protein, and decreased adiponectin. 6 One of the many advantages of calorie restriction is the stimulation of the activated protein kinase (AMPK) pathway, which helps with glucose regulation and increases insulin sensitivity.…”

The effects of different intermittent fasting regimens in people with type 2 diabetes: a network meta-analysis

“…Previous clinical trials have been devoted to improving insulin sensitivity to ameliorate the reduced response to insulin in patients with T2DM due to defective insulin secretion from their own pancreatic β-cells or insulin sensitivity. There is now increasing evidence confirming the beneficial effects of IF in animals ( 39 ) and T2DM patients ( 40 ). The present results show that TWF has a better overall effect on improving insulin sensitivity and therefore can be a preferred option for dietary intervention in patients with T2DM.…”

Fasting intervention and its clinical effects on the human host and microbiome

“…The relevance of processes potentially impacted through restricted feeding is major, as the examples mentioned in the literature—immune system, metabolism, breakdown and repair, nervous system signaling, proliferation, compensatory processes—together comprise most core actors in maintaining homeostasis, which, when lost, results in broad and diverse (yet substantially comorbid) gradual progression of chronic (with acute escalation following various breakpoints) diseases. This underlies indications for the utility of restricted feeding under diverse indications including hypertension [1–7], dyslipidemia [1, 4–8], glycemic dysregulation and diabetes [1, 9–16], cardiovascular diseases [1, 8, 17–20], liver disease [7, 21–25], as well as autoimmune and inflammatory diseases [11, 26, 27] including rheumatoid arthritis (RA) [28], endocrine disorders [29], even mood and pain conditions [30], neurological diseases [31–33], and possibly cancer [34–36] (Fig. 1).…”