# 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 PMID: 38638032 Journal: Diabetes care Published: 2024 Jun 1 Authors: Li M, Li J, Xu Y, Gao J, Cao Q, Ding Y, Xin Z, Lu M, Li X, Song H, Shen J, Hou T, He R, Li L, Zhao Z, Xu M, Lu J, Wang T, Wang S, Lin H, Zheng R, Zheng J, Baker CJ, Lai S, Johnson NA, Ning G, Twigg SM, Wang W, Liu Y, Bi Y ## Question Do 5:2 regimens using either 2 days per week energy-restricted diet or 2 days per week low-volume HIIT combined with resistance training improve glycemic control and cardiometabolic health compared with routine lifestyle education in adults with overweight or obesity and type 2 diabetes? ## Summary This two-center randomized controlled trial compared 12 weeks of a 5:2 energy-restricted diet, a twice-weekly low-volume HIIT plus resistance-training program, and routine lifestyle education in adults with overweight or obesity and newly diagnosed type 2 diabetes. The diet intervention improved HbA1c more than control, but the exercise intervention did not significantly improve HbA1c versus control. The exercise program did improve body fat mass, fat-to-lean mass ratio, liver fat, diastolic blood pressure, and preservation of lean body mass versus control, with no serious adverse events reported in the exercise or diet groups. ## Population - Adults aged 40-70 with overweight or obesity and type 2 diabetes diagnosed within the prior 2 years. - Sample size: 326 - Age: Mean 52.65 +/- 8.13 years - Sex: 116 women and 210 men - Fitness level: Excluded if currently doing >75 min high-intensity or 150 min moderate-intensity exercise per week - Health status: BMI 25.0-39.9 kg/m2; HbA1c 7.0-8.9%; early type 2 diabetes ## Methodology - Two-center, open-label, three-arm, parallel-group randomized controlled trial with 12-week intervention and 36-week postintervention follow-up. - 12-week intervention plus 36-week postintervention follow-up - Two clinical/community health care centers in China, with supervised exercise at health care centers and modified supervised home exercise during COVID-19. - Randomized and controlled study design. ## Protocol - 5:2 low-volume HIIT plus resistance training. - Modality: Cycle ergometer HIIT plus machine-based resistance training; home adaptations included treadmill, running in place, and no-equipment strength training. - Work intervals: Single 4-minute HIIT bout. - Sets or repetitions: Four resistance exercises, two sets of 8-12 repetitions, plus one HIIT bout. - Intensity: HIIT at 85-90% age-predicted HRmax; RT at 80% 1RM. - Session duration: 5-minute warm-up + 4-minute HIIT + 5-minute cooldown + resistance training duration not specified. - Frequency: 2 days per week, mostly nonconsecutive. - Program length: 12 weeks. - Progression: RT intensity recorded; detailed progression rules not reported. - Routine lifestyle education control. - Modality: Lifestyle advice on healthy diet and exercise. - Frequency: Weekly telephone or WeChat advice plus monthly face-to-face education. - Program length: 12 weeks. ## Outcomes ### HbA1c Status: mixed Diet improved HbA1c significantly more than control, while exercise did not significantly differ from control. Diet -0.72% vs control -0.37%, between-group -0.34% (95% CI -0.58 to -0.11, p = 0.007); exercise -0.46% vs control -0.37%, between-group -0.09% (95% CI -0.32 to 0.15, p = 0.47). ### Body weight and BMI Status: mixed Diet reduced body weight and BMI more than control; exercise did not significantly reduce body weight or BMI compared with control. Exercise vs control body weight -0.48 kg (95% CI -1.24 to 0.28, p = 0.21); BMI -0.16 kg/m2 (95% CI -0.44 to 0.11, p = 0.25). ### Lean body mass Status: improved Exercise better preserved lean body mass than control. Exercise vs control 1.08 kg (95% CI 0.05 to 2.10, p = 0.039). ### Body fat and liver fat Status: improved Exercise reduced body fat mass, fat-to-lean mass ratio, and liver fat compared with control. Exercise vs control body fat mass -1.62 kg (95% CI -2.57 to -0.66, p = 0.001); fat-to-lean mass ratio -4.17 percentage points (95% CI -6.66 to -1.68, p = 0.001); liver fat -1.27 percentage points (95% CI -2.14 to -0.30, p = 0.012). ### Blood pressure Status: mixed Exercise significantly reduced diastolic blood pressure compared with control but not systolic blood pressure. Exercise vs control diastolic BP -2.48 mmHg (95% CI -4.89 to -0.07, p = 0.043); systolic BP -3.10 mmHg (95% CI -6.92 to 0.72, p = 0.11). ### Safety Status: no clear change No serious adverse events occurred in diet or exercise groups, and adverse events were evenly distributed. One serious adverse event occurred in control group: hospitalization due to nasal polypectomy. ## Practical Insights - For adults with early type 2 diabetes, low-volume HIIT plus resistance training can improve body composition outcomes even when HbA1c does not improve beyond lifestyle education. - A twice-weekly HIIT dose may need resistance training and clinical monitoring to reproduce this study's outcomes. - HIIT content for diabetes should distinguish between body composition benefits and glycemic control benefits. - Consumer translation should include medical-screening cautions for diabetes, glucose monitoring, and medication-management boundaries. ## Limitations - Participants only had type 2 diabetes diagnosed within the prior 2 years and HbA1c 7.0-8.9% - Excluded insulin-treated and higher-risk patients - Body composition was measured with bioelectrical impedance rather than DEXA - Finger-prick glucose monitoring may underestimate hyperglycemic and hypoglycemic episodes - No data were collected on whether participants maintained the diet or exercise regimen after intervention - Exercise required supervision and equipment for the standard center-based protocol ## Safety And Adherence - No serious adverse events occurred in diet or exercise intervention groups. - One serious event occurred in the control group: hospitalization due to nasal polypectomy. - Serious adverse events or adverse events were evenly distributed across groups. - Medication and glucose-monitoring safety rules were used during the intervention. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/38638032/) (pubmed) - [DOI](https://doi.org/10.2337/dc24-0241) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116924/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.