Intermittent fasting has short-term effects on albuminuria, AGE formation and acylcarnitines in patients with type 2 diabetes mellitus

Aim This study aims to assess whether intermittent fasting (IF) can induce substantial changes in endogenous defense mechanisms in patients with type 2 diabetes (T2D) and diabetic nephropathy (DN). Design&Methods: Patients with T2D and increased albumin-to-creatinine ratio (ACR) are randomized to receive for 5 days once a month either a fasting-mimicking diet (intervention) or a Mediterranean diet (control) for a total of 6 diet cycles. Primary endpoint is the difference of the change in ACR from baseline to after 3 and after 6 diet cycles. Secondary endpoints are the difference of the change in MG-H1 and acylcarnitines (AC). Statistical analysis is done by ANCOVA adjusted for respective baseline values, age, sex, and BMI. Results: Interim analysis after 3 diet cycles shows in the intervention group a decrease of ACR in patients with microalbuminuria levels at baseline (absolute change in ACR -32.2 mg/g [95 % CI -61.4, -2.9], n = 18) compared to the control group (absolute change in ACR -3.1 mg/g [95 % CI -26.4, 19.9], n = 17) (p < 0.05) and a decrease of MG-H1 by 49.8 % (95 % CI -68.6 %, -30.6 %) corrected to respective baseline values and to the control group (p < 0.01). No change is observed in the glyoxalase detoxification system as well as in yH2Ax as marker of DNA-damage. AC analysis shows a significant increase of acetylcarnitine in patients of the intervention group that respond with better ACR improvement. Conclusion: Intermittent fasting temporarily changes ACR, MG-H1 and AC levels in T2D patients with DN, probably due to fasting-induced altered energy consumption.

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Publication History

Article published online:
19 August 2021