Objective: This study evaluated the effects of intensive lifestyle modification (ILM) incorporating calorie-carbohydrate restriction (CCR) with or without time-restricted feeding (IFCCR) on psychological health in adults with type 2 diabetes (T2D).
Research design and methods: In a 24-week randomized controlled trial, 120 adults with T2D were allocated to CCR (n = 40), IFCCR (n = 40), or a control group (n = 40). Both intervention arms followed an energy-restricted diet (1000-1200 kcal/day), received behavioral support, and performed ≥ 150 min/week of physical activity. The IFCCR group additionally restricted eating to an 8-hour daily window. Primary and secondary outcomes were eating disorder psychopathology (EDE-Q scale) and diabetes-related distress (PAID scale), respectively.
Results: Both CCR and IFCCR significantly reduced diabetes-related distress compared to the control (CCR: β = -1.80, p = 0.007; IFCCR: β = -1.78, p = 0.01). EDE-Q scores also improved significantly. Improvements were observed across EDE-Q subscales, particularly in weight and shape concern. After adjustment for changes in weight and HbA1c, reductions in PAID became non-significant, while improvements in several EDE-Q domains, particularly in the IFCCR group, remained significant. IFCCR showed numerically greater reductions than CCR, though differences were not statistically significant. The control group demonstrated minimal changes.
Conclusions: Intensive lifestyle modification incorporating CCR or IFCCR improved eating disorder psychopathology, whereas reductions in diabetes-related distress appear largely related to metabolic changes. These findings support the integration of structured dietary and behavioral interventions into diabetes care.
Trial registration: This trial was registered in Iranian Registry of Clinical Trials (IRCT), IRCT20230917059447N1 (https//irct.behdasht.gov.ir/trial/72666).
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