Weight management is a cornerstone of type 2 diabetes care, with intermittent fasting emerging as a promising intervention for improving metabolic health and body composition. These findings were presented at EASD 2025, highlighting the potential of meal replacement strategies in early type 2 diabetes.

In the EARLY trial, 85 overweight or obese adults with early type 2 diabetes were randomized to receive metformin, empagliflozin, or a 5:2 intermittent fasting meal replacement for 16 weeks. The 5:2 MR group demonstrated the most pronounced improvements compared with the other groups. Reductions were observed in body mass index (−3.41 kg/m²), waist circumference (−8.83 cm), waist-to-hip ratio (−0.04), waist-to-height ratio (−0.05), and body fat percentage (−4.84%). Abdominal fat distribution also improved, with decreases in abdominal cross-sectional area (−66.05 cm²), subcutaneous fat area (−58.27 cm²), and improved liver-to-spleen ratio (0.43). 

Changes in body mass index showed strong positive correlations with improvements in waist-to-hip ratio, waist-to-height ratio, body fat percentage, and abdominal fat measures. These results suggest that 5:2 intermittent fasting meal replacement may offer a potent strategy to optimize weight, fat distribution, and metabolic health in adults with early type 2 diabetes.