SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1644442
This article is part of the Research TopicWorld Diabetes Day 2024: Exploring Mechanisms, Innovations, and Holistic Approaches in Diabetes CareView all 22 articles
What should the doctor prescribe - formula diet or antidiabetics? Effectiveness of formula diet-based lifestyle intervention vs. pharmacological antiglycemic therapy on weight loss and HbA1c reduction in type-2-diabetes patients – a systematic review
Provisionally accepted
- West-German Centre of Diabetes and Health, Düsseldorf, Germany
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Aim: Lifestyle intervention is the basis in type-2-diabetes therapy and leads, combined with formula diet, to substantial improvements in body weight and glycemic control up to diabetes remission. However, pharmacological therapies have also shown promising results. Aim of this systematical review was to compare the effects of large-sized formula diet-based lifestyle interventions vs. pharmacological interventions with glucagon-like-peptide-1-receptor-agonists (GLP-1 RAs), GLP-1 and glucose-dependent-insulinotropic-polypeptide (GIP) combinations and sodium-glucose-cotransporter-2 (SGLT-2) inhibitors on weight and HbA1c reduction in obese type-2-diabetes patients. Methods: Literature searches were performed using PubMed for articles published until February 5, 2025. Primary and secondary outcomes were changes in weight [kg] and HbA1c [%] determined as estimated treatment difference (ETD) of intention-to-treat analyses (with a treatment policy approach). Results: Of 1409 identified articles, 54 articles describing 3 formula diet-based lifestyle interventions as well as 47 randomized, placebo-controlled pharmacological studies met our inclusion criteria including n=87.871 patients (32.8±1.7kg/m², 60±4 years, 43±7% women). Formula diet-based lifestyle intervention might stronger reduce weight compared to pharmacological interventions with GIP/GLP-1 RAs or SGLT-2 inhibitors after <12 months (studies' mean values: -5.6 vs. -2.6kg) or ≥12 months intervention periods (-7.3 vs. -3.1kg). Despite a trend for treatment superiority of pharmacological therapies in the short-term (-0.9 vs. -0.6%), long-term HbA1c reduction was comparable between lifestyle and pharmacological interventions (-0.7%). Conclusions: There is evidence that formula diet-based lifestyle intervention might improve weight loss to a greater extent than pharmacotherapies with comparable long-term glycaemic control. Thus, formula diet-based lifestyle intervention might be valid therapy option for obese patients with type-2-diabetes.
Keywords: Systematic review, type-2-diabetes, GLP-1 RA, SGLT-2 inhibitor, Weight Loss, Formula diet, meal replacement
Received: 10 Jun 2025; Accepted: 16 Sep 2025.
Copyright: © 2025 Kempf, Röhling and Martin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kerstin Kempf, kerstin.kempf@wdgz.de
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