Intermittent Fasting and Prevention of Diabetic Retinopathy: Where Do We Go From Here?

Type 2 diabetes represents one of the most significant global health threats of the 21st century owing to its constantly increasing prevalence and long-term debilitating complications (1). In addition to accelerated macrovascular disease in poorly controlled diabetes that is responsible for increased cardiovascular morbidity and mortality, microvascular complications, such as diabetic nephropathy, neuropathy, and retinopathy, cause a significant burden and may markedly impair not only life expectancy but also quality of life of patients with diabetes (2). Diabetic retinopathy is the most common cause of blindness in developed countries and one of the most feared diabetes complications (3). Significant progress has been made in our understanding of the etiopathogenesis of type 2 diabetes with numerous novel contributing mechanisms identified in the past couple of years (4). Both experimental and clinical studies have demonstrated that gut represents a vital organ with respect to regulation of glucose metabolism and modulation of the risk of type 2 diabetes development (5). Multiple facets of the gut–glucose metabolism interconnection have been uncovered in particular by studying the changes induced by weight loss associated with bariatric surgery or endoscopic methods mimicking bariatric surgery. The possible mechanisms of gut-driven improvements in glucose metabolism after surgical or endoscopic interventions include restriction of food amount, enhanced passage of chymus into distal parts of small …