American Diabetes Association
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Effect of “5:2 regimens”: energy-restricted diet or low-volume high-intensity interval training combined with resistance exercise on glycemic control and cardiometabolic health in adults with overweight/obesity and type 2 diabetes: A three-arm, randomized controlled trial

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posted on 2024-04-18, 18:12 authored by Mian Li, Jie Li, Yu Xu, Jinli Gao, Qiuyu Cao, Yi Ding, Zhuojun Xin, Ming Lu, Xiaoting Li, Haihong Song, Jue Shen, Tianzhichao Hou, Ruixin He, Ling Li, Zhiyun Zhao, Min Xu, Jieli Lu, Tiange Wang, Shuangyuan Wang, Hong Lin, Ruizhi Zheng, Jie Zheng, Callum John Baker, Shenghan Lai, Nathan Anthony Johnson, Guang Ning, Stephen Morris Twigg, Weiqing Wang, Yan Liu, Yufang Bi


We aimed to examine the effects of “5:2 regimens” diet (2-day/week of energy restriction by formula diet) or exercise (2-day/week of high-intensity interval training and resistance training) intervention compared with routine lifestyle education (control) on glycemic control and cardiometabolic health among adults with overweight/obesity and type 2 diabetes.

Research Design and Methods

This two-center, open-label, three-arm, parallel-group, randomized controlled trial recruited 326 participants with overweight/obesity and type 2 diabetes, and randomized them into a 12-week of diet intervention (N=109), exercise intervention (N=108), or lifestyle education (control) (N=109). The primary outcome was the change of glycemic control measured as glycated hemoglobin (HbA1c) between the diet or exercise intervention groups and the control group after a 12-week intervention.


The diet intervention significantly reduced HbA1c level (%) after the 12-week intervention (−0.72, 95% confidence interval (CI) −0.95 to −0.48), compared with the control group (−0.37, 95% CI −0.60 to −0.15) (diet vs. control: −0.34, 95% CI −0.58 to −0.11, p=0.007). The reduction in HbA1c level in the exercise intervention group (−0.46, 95% CI −0.70 to −0.23) did not significantly differ from the control group (exercise vs. control: −0.09, 95% CI −0.32 to 0.15, p=0.47). The exercise intervention group was superior in maintaining lean body mass. Both diet and exercise interventions induced improvements in adiposity and hepatic steatosis.


These findings suggested that the medically supervised 5:2 energy-restricted diet could provide an alternative strategy for improving glycemic control, and the exercise regimen improved body composition, although inadequate to improve glycemic control.


Funding for this research was obtained from the National Natural Science Foundation of China (grant numbers 81561128019, 82088102, 91857205, 82022011, 81970728, 81930021), the National Key R&D Program of China (grant number 2022ZD0162102, 2023YFC2506700), the Shanghai Rising-Star Program (grant number 21QA1408100), the Innovative Research Team of High-Level Local Universities in Shanghai, the Shanghai Clinical Research Center for Metabolic Diseases (grant number 19MC1910100), and the Shanghai Municipal Government grant (grant number 22Y31900300). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no competing interests.


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