Supplementary Online Content

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1 Supplementary Online Content Carter S, Clifton PM, Keogh JB. Effect of intermittent compare with continuous energy restricte iet on glycemic control in patients with type 2 iabetes: a ranomize noninferiority trial. JAMA Netw Open. 2018;1(3):e oi: /jamanetworkopen etable 1. Intermittent Energy Restriction Example Meal Plan etable 2. Meication etable 3. Meication s Using First etable 4. Meication s Using Secon etable 5. Primary, Seconary, an Exploratory Outcomes From Baseline to 12 Months for Intermittent vs Continuous Groups, Completers Analysis This supplementary material has been provie by the authors to give reaers aitional information about their work.

2 etable 1. Intermittent Energy Restriction Example Meal Plan 500kcals 600kcals 1 serve of fruit (150g) Breakfast + Lunch Dinner 1 tub of iet yoghurt Small tin of tuna in spring water + 1 cup of sala 100g of cooke chicken breast (1 teaspoon of oil for cooking) cups cooke low carbohyrate vegetables A: 1 serve of breas/cereals e.g. thin style wrap te: 2 litres of flui was recommene. Diet proucts were allowe e.g. iet jelly.

3 etable 2. Meication HbA1c Sulphonylureas : Reuce by ~10 units/ay <8% Discontinue at baseline for both groups : Halve insulin ose on intermittent ays *If insulin ose be was consiere to be too high in preparation for an intermittent iet ay, be ose was also ecrease. >8% N/A : Reuce by ~10 units on ays only Abbreviations:, continuous energy restriction;, intermittent energy restriction; ~, approximately.

4 etable 3. Meication s Using First a Grp. uring s ) s s mg 6.7 (non- on on 7.3 Restarte (pt MP) () on on 7.5 (both Ae back half ose () (both ( + ) u, 12u, 12u, 6u, (x3) 16u, 7u (pt MP) 22u, 11u (pt MP), 27u, 8u (pt MP) 27u, 8u (MIX) /45u ne (x3) 20/30u 20/25u, 20/20u 15/25u, 15/30u (levels inc.) 15/30u (MIX) 9 88/58u ne W/D /22u ne (x1) 25/17u 20/15u, 17/10u, 20/10u (levels inc.) 20/5u 20/5u

5 Grp. uring s ) s s ( + ) u, 15/15u 20u, 7/7u on (x2) (both 20u on an 30u, 7/7u on non- 30u only on non- (both 15u on an 20u on non-, 10u on an 20u non- 10u on, 20u non- (MIX) /75u 40/38u on (x3) ( 20/20u on () 20/10u on W/D 8.8 6/41u 6/20u an on, > (x1) ( 0/10u on W/D /50u 10/30u on an 25u, > () 10/30u non-, 10/10u an 10/30u non-, 10/10u an ( + ) /15/28u, 28/15/28u ne W/D a Recommenations mae by the stuy s enocrinologist unless otherwise specifie. First protocol, etable 2. Abbreviations: Grp, group; Me, meication;, glycate hemoglobin; Wt, weight; wks, weeks; mths, months;, continuous energy restriction;, intermittent energy restriction;, oral hypoglycemic agent (gliclazie unless otherwise state; Discont, iscontinue; hypers, hyperglycemia; hypo, hypoglycemia; low, mg/L; inc. increasing; W/D, withrew;, ay/s; pt, participant; MP, meical practitioner;, long-acting insulin (insulin glargine); ; long-acting insulin (insulin glargine); MIX, vamix;, varapi; u, units

6 etable 4. Meication s Using Secon a Grp. uring s ) s s 6.1, pt MP ecrease to. At pt MP avice, < mg 80mg ne W/D ne W/D ne ne W/D 9 ne W/D mg ne W/D 6 1mg 6.2 (x2) (non- 7 on s (non- 30mg on non- W/D 7 2mg on

7 Grp. uring s ) s s 7.3 on (x2) (both Restart W/D 7.6 on s (x2) (non- an (x5) (non- Decrease to on non- on non- 7.8 on W/D 7.9 on (both Restart 9.2 on completely 9.5 on on ( + ) u, 12/12u 30u, iscont., < 28u 22u 22u u ne u 10u, <, all pt woul agree too, < 9u 8u

8 Grp. uring s ) s s (MIX) /30u, 15/20u,, > Hyper 15/25u 17/27u 17/27u u, 4mg ne, < 20u, 18u, 16u 14u, 12u, 10u 10u u ne W/D /34u ne (x5) (pt MP avice) (pt MP avice) (pt MP avice) (pt MP avice) u ne (x4) 35u, 38u, 40u 40u /75u ne 70/70u 70/70u u, 4mg ne Low 20u W/D (MIX) /45u, 10/10u, no on, 25/25u on non-, < Hyper 25/30 non- 10/15u on, 15/30u on non- 10/15u on, 15/30u non u, insulin the or on, no on (x4) (non- 18u non- 16u non- 16u non-

9 Grp. uring s ) s s /70u, 10/10u, no on an 10u the on, all pt woul agree too, < s (x6) (both, (x2) (non- 50/50u non- s (both 40/40u non- an no insulin or on s (non- 30/30u on non- an no insulin or on, 20/20u 20/20u non u 30u on. Pts MP, < 30u (MIX) /40u insulin on (non- 65/65u on non-, 30/30u on non- 30/30u (MIX + ) /24u MIX, 6u as req. MIX or on (x14) (both 10u of on as req u insulin or on (x1) (non- 25u on non- (non- 20u on non- W/D u, 4mg 5u an none on, < (x12) (both 10u () Decrease to 5u (both 10u, 20u on non- 20u non-, 10u an none on u, 4mg 22u on, < 17u on 15u on 12u on 12u a Recommenations mae by the stuy s enocrinologist unless otherwise specifie. Secon protocol etaile in manuscript.

10 Abbreviations: Grp, group; Me, meication;, glycate hemoglobin; Wt, weight; wks, weeks; mths, months;, continuous energy restriction;, intermittent energy restriction;, oral hypoglycemic agent (gliclazie unless otherwise state; GP, glimepirie; Discont, iscontinue; hypers, hyperglycemia; hypo, hypoglycemia; low, mg/L;, ay/s; W/D, withrew; pt, participant; MP, meical practitioner;, long-acting insulin (insulin glargine); ; long-acting insulin (insulin glargine); MIX, vamix;, varapi; u, units

11 etable 5. Primary, Seconary an Exploratory Outcomes From Baseline to 12 Months for Intermittent vs Continuous Groups (Completers Analysis) a Mean (SEM) [95% CI] Variable All Participants (n = 97) P Value for Time Continuous Intermittent P Value for Diet by Time Primary Outcome HbA1c, % -0.4 (0.09) [-0.6 to -0.1] -0.4 (0.2) [-0.8 to -0.05] -0.3 (0.1) [-0.6 to -0.01].62 Seconary Outcomes -6.1 (0.7) Weight, kg b [-7.8 to -4.3] -5.0 (0.8) [-7.0 to -3.0] -7.1 (1.1) [-9.9 to -4.4] (0.2) BMI, kg/m 2 [-2.7 to -1.5] -1.8 (0.3) [-2.5 to -1.1] -2.5 (0.4) [-3.4 to -1.6] (0.4) Total Boy Fat, % c [-3.3 to -1.1] -1.7 (0.4) [-2.7 to -0.6] -2.8 (0.8) [-4.7 to -0.9] (0.6) Total Fat Mass, kg c [-5.9 to -3.0] -3.7 (0.7) [-5.4 to -1.9] -5.2 (0.9) [-7.5 to -2.9].22 Total FF Mass, kg c -1.8 (0.2) [-2.3 to -1.3] -1.3 (0.3) [-2.1 to -0.5] -2.2 (0.3) [-2.9 to -1.5] (0.7) Anroi Fat, % c [-5.0 to -1.6] -2.1 (0.5) [-3.4 to -0.8] -4.5 (1.2) [-7.6 to -1.4] (0.1) Anroi Fat Mass, kg c [-0.9 to -0.5] -0.6 (0.1) [-0.9 to -0.3] -0.9 (0.1) [-1.2 to -0.5] (0.04) Anroi FF Mass, kg c [-0.3 to -0.1] -0.3 (0.05) [-0.2 to 0.1] -0.2 (0.06) [-0.2 to 0.1] (0.07) VAT, kg c [-0.4 to -0.1] -0.2 (0.09) [-0.4 to -0.05] -0.3 (0.1) [-0.5 to -0.05].38 Abbreviations:, glycate hemoglobin; BMI, boy mass inex; FF, fat free; VAT, visceral aipose tissue. a Data were inclue for 97 participants ( group: n=46; group: n=51) unless otherwise state: mean (SEM) an [95% CI] were estimate with repeate-measures ANOVA. b Total analyse: n=94 ( group: n=44; group: n=50) 3 participants i not atten final appointment, GP sent HbA1c results. c Total analyse: n=81 ( group: n=39; group: n=42) weight >130kg or ecline DEXA scan.