Effects of intermittent fasting on HbA1c and weight in insulin versus oral hypoglycemic therapy-treated patients with type 2 diabetes mellitus: a systematic review and meta-analysis
Abstract
Aim: Intermittent fasting (IF) has emerged as a beneficial dietary strategy for managing type 2 diabetes mellitus (T2DM), with improvements in certain indicators of body composition and cardiometabolic health. However, limited research compares the different effects of IF in oral hypoglycemic agents (OHAs) versus insulin-treated patients.
Methods: A comprehensive search was performed across PubMed, Scopus, and Cochrane Library (January 2010-January 2025). Randomized controlled trials (RCTs) involving adults (>18-years) with T2DM undergoing IF, time-restricted feeding (TRF), alternate-day fasting (ARF), fasting-mimicking diets (FMD), and Ramadan fasting were included.
Results: In total, 12 studies (n = 1,441 participants) met the inclusion criteria. IF improved glycemic control in both groups, with HbA1c reductions of 0.54% in OHA-users and 2.8% in insulin-users. In the meta-analysis of four eligible trials (n = 280), IF produced a significant pooled reduction in HbA1c (-1.85, 95% CI: -2.86 to -0.84), despite substantial heterogeneity (I2 = 98.1%). In contrast, IF did not produce a significant change in body weight (-1.45 kg, 95% CI: -5.51 to 2.61; I2 = 96.7%). Most studies reported weight loss, with an average body mass index (BMI) reduction of 1.53 kg/m2 in OHA users. Among insulin-users, one study reported a significant reduction in weight for the IF group (-4.77 ± 4.99 kg, p < 0.001).
Conclusion: IF represents an effective adjuvant therapeutic strategy in T2DM and could…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,441 participants or records.
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