SUN-LB014 Intermittent Complete Fasting for Complicated Severe Obesity in Older Diabetic Subjects: Preliminary Evidence for Massive Fluid and Fat Loss with Improvement in Cardiac and Renal Failure

Background: Diabetic subjects with life-long massive obesity that have reached old age, often develop heart failure, severe hypertension and renal failure. Fluid retention necessitates increasing doses of diuretics, with further decline in renal function. Rationale: In older obese subjects who failed numerous standard dietary attempts and have developed complications which preclude bariatric surgery, prolonged periods of long and repetitive intermittent fasting may lead to a) regular fasting diuresis, such that will lessen the need for diuretics; b) fat loss. Both may ameliorate intractable comorbidities. Goal: To examine whether or not complete intermittent fasting can positively impact fluid overload, functional status and life quality in old obese diabetic subjects with heart and renal failure. Methods: Two 77y/o outpatient men were instructed to avoid any caloric intake, but consume calorie-free fluids ad libitum for 36 hours (last evening meal on the pre-fasting day; first next meal◊ breakfast on the post- fasting day), twice a week (total fasting hours 72/168 weekly hours) over 17 [patient A; A] and 13 months [patient B; B]. Insulin, GLP-1 analogs and oral drugs were individually adjusted for each fasting interval. Results: Extent of Experience: We accrued experience of 30 patient months. Effects: within this time frame, the following effects were observed: 1) Weight (and BMI) declined from 92 to 77kg (37.8->31.6kg/m2) and 108 to 84.6kg (40◊31kg/m2) in A, and B, respectively. 2) Heart failure (diastolic dysfunction with preserved systolic function) and functional capacity: we recorded: I. Improvement from NYHA class IV and III to II in B, A); II. Cessation of pulmonary edema events ( vs. 2 events/ patient in the preceding year); III: decrease >50% in the doses of furosemide; d/c of IV furosemide; IV: disappearance of peripheral edema; 3) Improvement in renal function in B (eGFR 15.7-->36.7cc/min) and stabilization in A (35cc/ml); 4) Improvement in anemia: hemoglobin rose by 2Gr% in B and 0.8gr% in A; 5) HgA1C was unchanged in A (7.8, 7.7%) in A and declined in B (6.7% ->5% in B). 5) Hypertension was not affected. Safety: hypoglycemia was not detected with regular, multiple point home glucose monitoring on the fasting days. Hyperkalemia was present a priori in both patients, required continuous f/u and treatment, but no other electrolyte and mineral abnormalities were seen. Compliance: Several events of partial/complete skipping of fasting resulted in fluid accumulation and leg edema, following which self-reported compliance has been nearly complete. At the present time, these subjects refuse to get off the protocol. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.