A randomized, open-label, active parallel-controlled clinical trial showed that 2 nonconsecutive fasting days (with a daily energy intake of 500 kcal for women and 600 kcal for men) and 5 days of habitual intake per week and meal replacement diet (5:2 MR) achieved better glycemic control compared with metformin and empagliflozin in Chinese adults with early type 2 diabetes (T2D). Between November 2020, and December 2022, 405 T2D patients diagnosed within 1 year (men 65.4%; mean age, 45.5 years; mean body mass index, 29.5; and mean HbA1c level, 7.9%) were randomly allocated in a 1:1:1 ratio to receive either metformin, empagliflozin, or 5:2 MR treatment for 16 weeks, with an 8-week follow-up. There were 332 completed the 16-week treatment. From baseline to week 16, participants in the 5:2 MR group showed the greatest reduction in HbA1c (least-squares mean [LSM], −1.9%), significantly greater than patients receiving metformin (LSM, −1.6%; adjusted LSM difference, −0.3%) and empagliflozin (LSM, −1.5%; adjusted LSM difference, −0.4%). At week 16, the mean weight loss in the 5:2 MR group (LSM, −9.7 kg) was greater than that in the metformin group (LSM, −5.5 kg) and empagliflozin group (LSM, −5.8 kg). The 5:2 MR also reduced blood pressure and triglycerides and increased HDL-C levels, consistent with previous studies indicating improved metabolic parameters with intermittent fasting and MR, indicating potential cardiovascular benefits. The findings suggest that the 5:2 MR approach may serve as an effective initial lifestyle intervention instead of antidiabetic drugs for early-stage T2D patients. Source: https://jamanetwork.com/
