Innowacyjne podejście do leczenia cukrzycy typu 2: Czy post przerywany zrewolucjonizuje terapię metaboliczną?

Dawid Kolanko; Marek Kurowicz; Sara Wardenga; Zofia Zawadzka-Dyrkacz; Wiktoria Wójcik; Ola Wybraniec

Innowacyjne podejście do leczenia cukrzycy typu 2: Czy post przerywany zrewolucjonizuje terapię metaboliczną?

Authors

Dawid Kolanko, ; Marek Kurowicz, ; Sara Wardenga, ; Zofia Zawadzka-Dyrkacz, ; Wiktoria Wójcik, ; Ola Wybraniec,

Keywords:

post przerywany, cukrzyca typu 2, odżywianie, zapobieganie cukrzycy

Synopsis

Abstrakt:

Cukrzyca typu 2 (ang. type 2 diabetes, T2D) stanowi jeden z najpowszechniejszych problemów medycznych XXI wieku. Ze względu na wysoką zależność choroby od stylu życia, badania nad niefarmakologicznymi sposobami leczenia zajmują znaczną część uwagi badaczy. W ostatnich latach, popularną formą diety jest post przerywany (ang. intermittent fasting, IF). Opisano kilka różnych modyfikacji IF, jednak wspólnym dla nich mianownikiem są dwa okresy: okna żywieniowego oraz faza postu, czyli czas ograniczonego lub całkowitego wstrzymania się od spożywania kalorii. W literaturze obserwuje się rosnącą liczbę badań poświęconych wpływowi IF na skuteczność w leczeniu T2D. Szereg badań klinicznych dotyczących najczęściej stosowanych schematów IF wskazuje na korzystny wpływ tej strategii żywieniowej na parametry metaboliczne, takie jak glikemia na czczo, masa ciała, poziom HbA1C czy wskaźnik HOMA-IR. Ciągłe ograniczenie energii (ang. continuous calorie restriction, CR) od wielu lat stanowi standardową metodę żywienia w leczeniu T2D, lecz dane sugerują, że IF może prowadzić do większej utraty masy ciała i porównywalnej poprawy parametrów metabolicznych. Zastosowanie postu przerywanego może umożliwić redukcję dawek, a nawet odstawienie leków przeciwcukrzycowych, jednak należy pamiętać o ryzyku wystąpienia hipoglikemii, szczególnie u osób stosujących insulinę i pochodne sulfonylomocznika. W związku z tym konieczne jest indywidualne dostosowanie dawek wybranych leków przyjmowanych w T2D oraz ścisły nadzór lekarski. IF może powodować również inne działania niepożądane, zwłaszcza u osób z chorobami współistniejącymi. Przed jego wdrożeniem przeprowadza się ocenę przeciwwskazań.

Zastosowanie takich technologii jak system ciągłego monitorowania glikemii (continuous glucose monitoring, CGM) umożliwia skuteczne monitorowanie glikemii, a co za tym idzie – zwiększa bezpieczeństwo IF. Obecnie nie ma oficjalnych wytycznych rekomendujących tę formę leczenia T2D. Post przerywany jest stosowany jako forma uzupełnienia leczenia farmakologicznego, stanowiąc skuteczną alternatywę wobec innych modeli żywienia. IF posiada duży potencjał w leczeniu T2D, dlatego aby został uwzględniony w oficjalnych wytycznych, zaleca się dalsze prowadzenie badań spełniających wysokie standardy metodologiczne.

Słowa kluczowe: post przerywany, cukrzyca typu 2, odżywianie, zapobieganie cukrzycy

Abstract:

Type 2 Diabetes (T2D) represents one of the most common medical problems of the 21st century. Due to the high dependence of the disease on lifestyle, research into non-pharmacological treatments occupies a large part of researchers’ attention. A popular form of a diet in recent years is intermittent fasting (IF). Several different modifications of IF have been described, but the common denominator is the presence of two periods: a feeding window and a fasting period, which is a period of either limited or total abstinence from food intake.

There is a growing number of studies in the literature dedicated to the impact of IF on the efficiency in T2D treatment. A series of clinical studies on the most commonly used IF regimens indicate a beneficial effect of this dietary strategy on metabolic parameters such as fasting glycaemia, body weight, HbA1C level or HOMA-IR index. Continuous energy restriction (CR) has been the standard dietary method for T2D treatment for many years, however data suggest that IF can lead to greater weight loss and comparable improvement of metabolic parameters. The use of intermittent fasting may allow for the reduction of a dose or even discontinuation of antidiabetic drugs. The risk of hypoglycaemia should be taken into consideration, especially among those who use insulin and sulphonylurea derivatives. Therefore, it is necessary to adjust individually the doses of selected medications taken in T2D and remain under the strict doctor’s supervision. IF may also cause other side effects, especially in people with comorbidities. An assessment of contraindications is carried out before its implementation. The use of technologies such as continuous glucose monitoring (CGM) system allows for effective glycaemic monitoring and therefore increases the safety of IF. There are currently no official guidelines recommending this form of T2D treatment. Intermittent fasting is used as a form of complementary treatment to pharmacological treatment, providing an effective alternative to other dietary models. IF embraces a great potential in T2D treatment and, in order for it to be included in official guidelines, further research that meets high methodological standards is recommended to be continued.

Keywords: intermittent fasting, type 2 diabetes, nutrition, diabetes prevention

References

Referencje

‘Diagnosis and Classification of Diabetes Mellitus’, Diabetes Care, vol. 36, no. Suppl 1, pp. S67–S74, Jan. 2013, doi: 10.2337/dc13-S067.

Pandarek, ‘Zalecenia kliniczne dotyczące postępowania u osób z cukrzycą 2024 Stanowisko Polskiego Towarzystwa Diabetologicznego’. Accessed: Apr. 07, 2025. [Online]. Available: https://ptdiab.pl/zalecenia-ptd/zalecania-aktywni-czlonkowie-2024

Szczeklik A, ed. Interna Szczeklika 2023. Medycyna Praktyczna; 2023.

S. C. Palmer et al., ‘Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials’, BMJ, p. m4573, Jan. 2021, doi: 10.1136/bmj.m4573.

X. Lu et al., ‘Type 2 diabetes mellitus in adults: pathogenesis, prevention and therapy’, Signal Transduct. Target. Ther., vol. 9, no. 1, p. 262, Oct. 2024, doi: 10.1038/s41392-024-01951-9.

U. Galicia-Garcia et al., ‘Pathophysiology of Type 2 Diabetes Mellitus’, Int. J. Mol. Sci., vol. 21, no. 17, p. 6275, Aug. 2020, doi: 10.3390/ijms21176275.

P. Farmaki, C. Damaskos, N. Garmpis, A. Garmpi, S. Savvanis, and E. Diamantis, ‘Complications of the Type 2 Diabetes Mellitus’, Curr. Cardiol. Rev., vol. 16, no. 4, pp. 249–251, Nov. 2020, doi: 10.2174/1573403X1604201229115531.

D. Herz et al., ‘Efficacy of Fasting in Type 1 and Type 2 Diabetes Mellitus: A Narrative Review’, Nutrients, vol. 15, no. 16, p. 3525, Aug. 2023, doi: 10.3390/nu15163525.

A. Langa, ‘Alternatywne modele żywienia w cukrzycy typu 2’, Kosmos, vol. 71, no. 4, Art. no. 4, 2022, doi: 10.36921/kos.2022_2871.

I. Vasim, C. N. Majeed, and M. D. DeBoer, ‘Intermittent Fasting and Metabolic Health’, Nutrients, vol. 14, no. 3, p. 631, Jan. 2022, doi: 10.3390/nu14030631.

M. M. Grajower and B. D. Horne, ‘Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus’, Nutrients, vol. 11, no. 4, Art. no. 4, Apr. 2019, doi: 10.3390/nu11040873.

T. K. Ojo, O. O. Joshua, O. J. Ogedegbe, O. Oluwole, A. Ademidun, and D. Jesuyajolu, ‘Role of Intermittent Fasting in the Management of Prediabetes and Type 2 Diabetes Mellitus’, Cureus, vol. 14, no. 9, p. e28800, Sep. 2022, doi: 10.7759/cureus.28800.

S. H. Min et al., ‘Degree of ketonaemia and its association with insulin resistance after dapagliflozin treatment in type 2 diabetes’, Diabetes Metab., vol. 44, no. 1, pp. 73–76, Feb. 2018, doi: 10.1016/j.diabet.2017.09.006.

S. Cienfuegos, M. McStay, K. Gabel, and K. A. Varady, ‘Time restricted eating for the prevention of type 2 diabetes’, J. Physiol., vol. 600, no. 5, pp. 1253–1264, Mar. 2022, doi: 10.1113/JP281101.

T. G. Arnason, M. W. Bowen, and K. D. Mansell, ‘Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study’, World J. Diabetes, vol. 8, no. 4, pp. 154–164, Apr. 2017, doi: 10.4239/wjd.v8.i4.154.

B. Liu, A. J. Page, A. T. Hutchison, G. A. Wittert, and L. K. Heilbronn, ‘Intermittent fasting increases energy expenditure and promotes adipose tissue browning in mice’, Nutrition, vol. 66, pp. 38–43, Oct. 2019, doi: 10.1016/j.nut.2019.03.015.

N. R. Ekberg, A. Hellberg, M. L. Sundqvist, A. L. Hirschberg, S.-B. Catrina, and K. Brismar, ‘The 5:2 Diet Affects Markers of Insulin Secretion and Sensitivity in Subjects with and without Type 2 Diabetes-A Non-Randomized Controlled Trial’, Int. J. Mol. Sci., vol. 25, no. 17, p. 9731, Sep. 2024, doi: 10.3390/ijms25179731.

X. T. Teong et al., ‘Intermittent fasting plus early time-restricted eating versus calorie restriction and standard care in adults at risk of type 2 diabetes: a randomized controlled trial’, Nat. Med., vol. 29, no. 4, pp. 963–972, Apr. 2023, doi: 10.1038/s41591-023-02287-7.

A. Obermayer et al., ‘Efficacy and Safety of Intermittent Fasting in People With Insulin-Treated Type 2 Diabetes (INTERFAST-2)-A Randomized Controlled Trial’, Diabetes Care, vol. 46, no. 2, pp. 463–468, Feb. 2023, doi: 10.2337/dc22-1622.

N. Sukkriang and S. Buranapin, ‘Effect of intermittent fasting 16:8 and 14:10 compared with control-group on weight reduction and metabolic outcomes in obesity with type 2 diabetes patients: A randomized controlled trial’, J. Diabetes Investig., vol. 15, no. 9, pp. 1297–1305, Sep. 2024, doi: 10.1111/jdi.14186.

T. Che, C. Yan, D. Tian, X. Zhang, X. Liu, and Z. Wu, ‘Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial’, Nutr. Metab., vol. 18, no. 1, p. 88, Oct. 2021, doi: 10.1186/s12986-021-00613-9.

B. Schuppelius, B. Peters, A. Ottawa, and O. Pivovarova-Ramich, ‘Time Restricted Eating: A Dietary Strategy to Prevent and Treat Metabolic Disturbances’, Front. Endocrinol., vol. 12, p. 683140, 2021, doi: 10.3389/fendo.2021.683140.

L. Joaquim, A. Faria, H. Loureiro, and P. Matafome, ‘Benefits, mechanisms, and risks of intermittent fasting in metabolic syndrome and type 2 diabetes’, J. Physiol. Biochem., vol. 78, no. 2, pp. 295–305, May 2022, doi: 10.1007/s13105-021-00839-4.

M. Albosta and J. Bakke, ‘Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians’, Clin. Diabetes Endocrinol., vol. 7, no. 1, p. 3, Feb. 2021, doi: 10.1186/s40842-020-00116-1.

S. K. Sharma, S. K. Mudgal, S. Kalra, R. Gaur, K. Thakur, and R. Agarwal, ‘Effect of Intermittent Fasting on Glycaemic Control in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials’, TouchREVIEWS Endocrinol., vol. 19, no. 1, pp. 25–32, May 2023, doi: 10.17925/EE.2023.19.1.25.

Y. Fujitani, R. Kawamori, and H. Watada, ‘The role of autophagy in pancreatic β-cell and diabetes’, Autophagy, Feb. 2009, doi: 10.4161/auto.5.2.7656.

J. Liu, Y. Zhong, X. M. Luo, Y. Ma, J. Liu, and H. Wang, ‘Intermittent Fasting Reshapes the Gut Microbiota and Metabolome and Reduces Weight Gain More Effectively Than Melatonin in Mice’, Front. Nutr., vol. 8, Nov. 2021, doi: 10.3389/fnut.2021.784681.

‘Remodeling of the gut microbiome during Ramadan-associated intermittent fasting - PubMed’. Accessed: Mar. 29, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/33842951/

C. A. Thaiss et al., ‘Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection’, Science, vol. 359, no. 6382, pp. 1376–1383, Mar. 2018, doi: 10.1126/science.aar3318.

F. Fava and S. Danese, ‘Intestinal microbiota in inflammatory bowel disease: Friend of foe?’, World J. Gastroenterol. WJG, vol. 17, no. 5, pp. 557–566, Feb. 2011, doi: 10.3748/wjg.v17.i5.557.

A. Zaky, S. J. Glastras, M. Y. W. Wong, C. A. Pollock, and S. Saad, ‘The Role of the Gut Microbiome in Diabetes and Obesity-Related Kidney Disease’, Int. J. Mol. Sci., vol. 22, no. 17, p. 9641, Sep. 2021, doi: 10.3390/ijms22179641.

N. Eguchi, N. D. Vaziri, D. C. Dafoe, and H. Ichii, ‘The Role of Oxidative Stress in Pancreatic β Cell Dysfunction in Diabetes’, Int. J. Mol. Sci., vol. 22, no. 4, p. 1509, Feb. 2021, doi: 10.3390/ijms22041509.

E. F. Sutton, R. Beyl, K. S. Early, W. T. Cefalu, E. Ravussin, and C. M. Peterson, ‘Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes’, Cell Metab., vol. 27, no. 6, pp. 1212-1221.e3, Jun. 2018, doi: 10.1016/j.cmet.2018.04.010.

‘Effects of four-hour and six-hour time-restricted feeding on weight and cardiometabolic health: a randomized controlled trial in adults with obesity - PMC’. Accessed: Mar. 29, 2025. [Online]. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC9407646/

R. E. Patterson et al., ‘INTERMITTENT FASTING AND HUMAN METABOLIC HEALTH’, J. Acad. Nutr. Diet., vol. 115, no. 8, pp. 1203–1212, Aug. 2015, doi: 10.1016/j.jand.2015.02.018.

F. A. J. L. Scheer, M. F. Hilton, C. S. Mantzoros, and S. A. Shea, ‘Adverse metabolic and cardiovascular consequences of circadian misalignment’, Proc. Natl. Acad. Sci. U. S. A., vol. 106, no. 11, pp. 4453–4458, Mar. 2009, doi: 10.1073/pnas.0808180106.

E. B. Parr et al., ‘Comparing the effects of time-restricted eating on glycaemic control in people with type 2 diabetes with standard dietetic practice: A randomised controlled trial’, Diabetes Res. Clin. Pract., vol. 217, p. 111893, Nov. 2024, doi: 10.1016/j.diabres.2024.111893.

C. Andriessen et al., ‘Three weeks of time-restricted eating improves glucose homeostasis in adults with type 2 diabetes but does not improve insulin sensitivity: a randomised crossover trial’, Diabetologia, vol. 65, no. 10, pp. 1710–1720, Oct. 2022, doi: 10.1007/s00125-022-05752-z.

A. T. Hutchison et al., ‘Time-Restricted Feeding Improves Glucose Tolerance in Men at Risk for Type 2 Diabetes: A Randomized Crossover Trial’, Obes. Silver Spring Md, vol. 27, no. 5, pp. 724–732, May 2019, doi: 10.1002/oby.22449.

K. C. Allison and N. Goel, ‘Timing of Eating in Adults Across the Weight Spectrum: Metabolic Factors and Potential Circadian Mechanisms’, Physiol. Behav., vol. 192, pp. 158–166, Aug. 2018, doi: 10.1016/j.physbeh.2018.02.047.

J. Lopez-Minguez, P. Gómez-Abellán, and M. Garaulet, ‘Timing of Breakfast, Lunch, and Dinner. Effects on Obesity and Metabolic Risk’, Nutrients, vol. 11, no. 11, p. 2624, Nov. 2019, doi: 10.3390/nu11112624.

S. Lynch, J. D. Johnston, and M. D. Robertson, ‘Early versus late time-restricted feeding in adults at increased risk of developing type 2 diabetes: Is there an optimal time to eat for metabolic health?’, Nutr. Bull., vol. 46, no. 1, pp. 69–76, Mar. 2021, doi: 10.1111/nbu.12479.

A.-D. Termannsen et al., ‘Feasibility of time-restricted eating in individuals with overweight, obesity, prediabetes, or type 2 diabetes: A systematic scoping review’, Obes. Silver Spring Md, vol. 31, no. 6, pp. 1463–1485, Jun. 2023, doi: 10.1002/oby.23743.

L. Muñoz-Hernández, Z. Márquez-López, R. Mehta, and C. A. Aguilar-Salinas, ‘Intermittent Fasting as Part of the Management for T2DM: from Animal Models to Human Clinical Studies’, Curr. Diab. Rep., vol. 20, no. 4, p. 13, Mar. 2020, doi: 10.1007/s11892-020-1295-2.

S. Carter, P. M. Clifton, and J. B. Keogh, ‘Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial’, JAMA Netw. Open, vol. 1, no. 3, p. e180756, Jul. 2018, doi: 10.1001/jamanetworkopen.2018.0756.

S. Carter, P. M. Clifton, and J. B. Keogh, ‘The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial’, Diabetes Res. Clin. Pract., vol. 122, pp. 106–112, Dec. 2016, doi: 10.1016/j.diabres.2016.10.010.

L. Guo et al., ‘A 5:2 Intermittent Fasting Meal Replacement Diet and Glycemic Control for Adults With Diabetes: The EARLY Randomized Clinical Trial’, JAMA Netw. Open, vol. 7, no. 6, p. e2416786, Jun. 2024, doi: 10.1001/jamanetworkopen.2024.16786.

T. M. Sundfør, M. Svendsen, and S. Tonstad, ‘Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial’, Nutr. Metab. Cardiovasc. Dis. NMCD, vol. 28, no. 7, pp. 698–706, Jul. 2018, doi: 10.1016/j.numecd.2018.03.009.

B. T. Corley, R. W. Carroll, R. M. Hall, M. Weatherall, A. Parry-Strong, and J. D. Krebs, ‘Intermittent fasting in Type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial’, Diabet. Med. J. Br. Diabet. Assoc., vol. 35, no. 5, pp. 588–594, May 2018, doi: 10.1111/dme.13595.

F. Cook, J. Langdon-Daly, and L. Serpell, ‘Compliance of participants undergoing a “5-2” intermittent fasting diet and impact on body weight’, Clin. Nutr. ESPEN, vol. 52, pp. 257–261, Dec. 2022, doi: 10.1016/j.clnesp.2022.08.012.

V. A. Catenacci et al., ‘A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity’, Obes. Silver Spring Md, vol. 24, no. 9, pp. 1874–1883, Sep. 2016, doi: 10.1002/oby.21581.

S. Y. Chair, H. Cai, X. Cao, Y. Qin, H. Y. Cheng, and M. T. Ng, ‘Intermittent Fasting in Weight Loss and Cardiometabolic Risk Reduction: A Randomized Controlled Trial’, J. Nurs. Res., vol. 30, no. 1, p. e185, Feb. 2022, doi: 10.1097/jnr.0000000000000469.

A. R. Barnosky, K. K. Hoddy, T. G. Unterman, and K. A. Varady, ‘Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings’, Transl. Res., vol. 164, no. 4, pp. 302–311, Oct. 2014, doi: 10.1016/j.trsl.2014.05.013.

K. Gabel et al., ‘Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance’, Obes. Silver Spring Md, vol. 27, no. 9, pp. 1443–1450, Sep. 2019, doi: 10.1002/oby.22564.

V. Pavlou et al., ‘Effect of Time-Restricted Eating on Weight Loss in Adults With Type 2 Diabetes: A Randomized Clinical Trial’, JAMA Netw. Open, vol. 6, no. 10, p. e2339337, Oct. 2023, doi: 10.1001/jamanetworkopen.2023.39337.

X. Wang, Q. Li, Y. Liu, H. Jiang, and W. Chen, ‘Intermittent fasting versus continuous energy-restricted diet for patients with type 2 diabetes mellitus and metabolic syndrome for glycemic control: A systematic review and meta-analysis of randomized controlled trials’, Diabetes Res. Clin. Pract., vol. 179, p. 109003, Sep. 2021, doi: 10.1016/j.diabres.2021.109003.

S. Furmli, R. Elmasry, M. Ramos, and J. Fung, ‘Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin’, BMJ Case Rep., vol. 2018, p. bcr2017221854, Oct. 2018, doi: 10.1136/bcr-2017-221854.

L. Olansky, ‘Strategies for management of intermittent fasting in patients with diabetes’, Cleve. Clin. J. Med., vol. 84, no. 5, pp. 357–358, May 2017, doi: 10.3949/ccjm.84a.16118.

S. Uldal, K. K. B. Clemmensen, F. Persson, K. Færch, and J. S. Quist, ‘Is Time-Restricted Eating Safe in the Treatment of Type 2 Diabetes?-A Review of Intervention Studies’, Nutrients, vol. 14, no. 11, p. 2299, May 2022, doi: 10.3390/nu14112299.

P. E. Bendheim, B. Poeggeler, E. Neria, V. Ziv, M. A. Pappolla, and D. G. Chain, ‘Development of indole-3-propionic acid (OXIGON) for Alzheimer’s disease’, J. Mol. Neurosci. MN, vol. 19, no. 1–2, pp. 213–217, 2002, doi: 10.1007/s12031-002-0036-0.

‘Intermittent fasting inhibits platelet activation and thrombosis through the intestinal metabolite indole-3-propionate’, ResearchGate, Apr. 2025, doi: 10.1093/lifemeta/loaf002.

M. Altay, ‘Evidence-based information about intermittent fasting in diabetes patients: useful or harmful?’, Turk. J. Med. Sci., vol. 52, no. 4, pp. 873–879, Aug. 2022, doi: 10.55730/1300-0144.5386.

M. N. Harvie et al., ‘The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women’, Int. J. Obes. 2005, vol. 35, no. 5, pp. 714–727, May 2011, doi: 10.1038/ijo.2010.171.

G. A. Soliman, ‘Intermittent fasting and time-restricted eating role in dietary interventions and precision nutrition’, Front. Public Health, vol. 10, p. 1017254, Oct. 2022, doi: 10.3389/fpubh.2022.1017254.

E. Borgundvaag, J. Mak, and C. K. Kramer, ‘Metabolic Impact of Intermittent Fasting in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Interventional Studies’, J. Clin. Endocrinol. Metab., vol. 106, no. 3, pp. 902–911, Mar. 2021, doi: 10.1210/clinem/dgaa926.

J. H. Choi et al., ‘Effect of carbohydrate-restricted diets and intermittent fasting on obesity, type 2 diabetes mellitus, and hypertension management: consensus statement of the Korean Society for the Study of obesity, Korean Diabetes Association, and Korean Society of Hypertension’, Clin. Hypertens., vol. 28, no. 1, p. 26, Jun. 2022, doi: 10.1186/s40885-022-00207-4.

E. Pavlidou et al., ‘Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management’, Nutrients, vol. 16, no. 1, p. 34, Dec. 2023, doi: 10.3390/nu16010034.