Type 2 diabetes is the result of several years of prediabetes and the metabolic syndrome. The goal of treatment is weight loss to reduce insulin resistance and control of blood sugar. Long term data from the Diabetes Control and Complications (DCCT) trial shows that tight correction of HbA1C does not lead to better outcomes in cardiovascular disease, yet tight control does correct microangiopathy, particularly in the retina, in the kidneys and peripheral nerves. Recent reports have shown that insulin therapy does not affect the metabolic syndrome in terms of improving fatty liver and other components of the metabolic syndrome, whereas the oral antiglycemic medications especially metformin, the incretin mimetics (GLP-1 agonists) and the Sodium-glucose co-transporter-2 (SGLT2) inhibitors do indeed correct this. Weight loss correction needs a caloric deficit but this becomes hard with insulin therapy.
We treated patients of type 2 diabetes with a combination of intermittent fasting with low carbohydrate diet and stopping of insulin therapy wherever feasible. A total of 62 patients are reported here with nearly equal gender distribution and average age 61 years with diagnosis of type 2 diabetes and obesity. Average weight loss was 8.9kg with a maximum of 59 kg loss over a variable period of follow-up (three months to three years). Almost all patients came off insulin entirely. Estimated glomerular filtration rate (eGFR) improved by 1.17ml on average. Proteinuria improved by 14.8 units on average, in the albumin creatinine ratio. Mean HbA1C reduction was 0.3%. Clinic blood pressure measurement during the follow-up period was largely unchanged. It seems possible therefore to control blood sugar in type 2 diabetes without resorting to insulin, at least in a subset of patients, by combining newer medications with intermittent fasting with low carbohydrate diets with resultant improvement in renal function (eGFR and proteinuria) along with weight loss.