AGMR

Type 2 diabetes (T2D) remission, defined as an A1c level below 6.5% without the use of glucose-lowering medications for at least three months, is now recognized as a viable management strategy for the condition. Despite the growing popularity of intermittent fasting (IF), limited studies investigate whether IF can induce T2D remission, especially in real-world settings. Case presentation: This case study documents a 47-year-old female living with T2D for the past 15 years who achieved T2D remission using IF. In February 2024, the patient was using several glucose-lowering drugs before starting an IF protocol. The protocol involved 13–83 h fasting, 2–3 times/week beginning on March 14th, 2024, with simultaneous discontinuation of medication usage and the use of continuous glucose monitoring (CGM) for guidance. Before starting IF, her 24-h average CGM glucose was 12.7 mmol/L, with 18% time in range and an eA1c of 9.6%. After three months of IF, she lost a total of 13.8 kg and achieved a CGM-derived average glucose of 6.9 mmol/L, spending 98% time in range with an eA1c of 5.97%. Smartwatch data also indicated that the patient maintained an active lifestyle, averaging 280 ± 33 min/week of physical activity. Finally, the patient’s resting heart rate improved after achieving remission (71 ± 2 bpm to 59 ± 3 bpm). Conclusion: This case study underlines the potential of achieving T2D remission with IF and physical activity in real-world settings outside clinical and research environments. It also highlights the utility of using CGM to facilitate self-management.

T2D; nutrition; continuous glucose monitoring; CGM; glycemic variability; reversal