Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2016; 7(20): 627-630
Published online Dec 15, 2016. doi: 10.4239/wjd.v7.i20.627
Intermittent energy restriction in type 2 diabetes: A short discussion of medication management
Sharayah Carter, Peter M Clifton, Jennifer B Keogh
Sharayah Carter, Peter M Clifton, Jennifer B Keogh, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia
Author contributions: The short review was written by Carter S; Clifton PM and Keogh JB edited the paper; all authors have read and approved the paper.
Conflict-of-interest statement: All the authors declare that they have no competing interests. There was no funding.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter M Clifton, Professor of Nutrition, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia. peter.clifton@unisa.edu.au
Telephone: +61-403-197998
Received: July 1, 2016
Peer-review started: July 6, 2016
First decision: September 5, 2016
Revised: September 16, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 15, 2016
Processing time: 160 Days and 18.4 Hours
Abstract
AIM

To discuss type 2 diabetes mellitus (T2DM) medication changes required during the popular 5:2 intermittent energy restriction (IER) diet.

METHODS

A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets (VLCD) in people with T2DM. The search terms used included “VLCD” or “very low energy diet” or “very low energy restriction” or “IER” or “intermittent fasting” or “calorie restriction” or “diabetes mellitus type 2” and “type 2 diabetes”. Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized.

RESULTS

A total of 8 studies were found that investigated the use of VLCD in T2DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only.

CONCLUSION

Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.

Keywords: Diabetes mellitus/therapy; Fasting; Caloric restriction; Diabetes complication; Intermittent energy restriction; Obesity; Very low calorie diet; Medication management; Type 2 diabetes mellitus

Core tip: Use of the popular 5:2 intermittent energy restriction diet in people with type 2 diabetes requires careful manipulation of oral hypoglycemic agents and insulin to prevent poor blood glucose control. This short review fills a very important gap in the literature, reviewing necessary medication changes required in severe energy restriction and outlining how these changes may apply during the 5:2 diet by sharing our experiences from our recent 5:2 pilot trial.