Diabetes Nutrition Algorithm - Prediabetes (Dietary Strategies in the Prevention of Diabetes Mellitus Type 2 in a High-risk Cohort)
Trial Snapshot
- Phase
- Not Applicable
- Enrollment
- 250
- Locations
- 2
- Primary Endpoint
- change in hepatic fat content confirmed by proton magnetic resonance spectroscopy by 3 T MR imaging
Study Overview
Brief Summary
Prediabetes, defined by either impaired fasting glucose and/or impaired glucose tolerance, is a known high-risk condition predisposing to future diabetes mellitus type 2. Strategies to prevent progression from prediabetes to diabetes have been widely studied, however, without striking long-term effects of any kind of intervention (pharmacological, behavioral...). The investigators therefore investigate certain nutritional approaches concerning nutrient content and favorable food components, targeting metabolic improvement.
Detailed Description
Prediabetes, defined by either impaired fasting glucose and/or impaired glucose tolerance, is a known high-risk condition predisposing to future diabetes mellitus type 2. Strategies to prevent progression from prediabetes to diabetes have been widely studied, however, without striking long-term effects of any kind of intervention (pharmacological, behavioral...). The investigators therefore investigate certain nutritional approaches concerning nutrient content and favorable food components, targeting metabolic improvement.
The main comparison will assess differences in metabolic outcome due to low-carb or low-fat dietary intervention in short- and long-term design.
Additionally, the role of PUFA will be assessed during long-term intervention to achieve better maintenance of metabolic improvements from the first study phase.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 75 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •impaired fasting glucose (IFG) fasting blood glucose 100-126 mg/dl
- •impaired glucose tolerance (IGT) 75 g OGTT 120 minutes: 140-200 mg/dl
Exclusion Criteria
- •current pregnancy or breastfeeding
- •BMI > 45 kg/m²
- •Diabetes mellitus Typ 1 or 2
- •serious disease e.g symptomatic coronary heart disease
- •serious symptomatic malignant disease (weight loss > 10% within the last 6 month)
- •severe liver or kidney disease ( an increase in transaminases > 3 times than the upper limit of the standardized range, GFR < 50 ml/min/1,73m²)
- •systemic infection (CRP > 1 mg/dl)
- •severe mental illness
- •drug abuse
- •treatment with steroids
- •potentially incompliant subjects
- •exclusion criteria for magnetic resonance tomography
- •any kind of metal in or on the body: cardiac pacemakers prosthetic heart valves metal prosthesis magnetic implanted metallic parts contraceptive coil metal fragments/ grenade shrapnel fixed braces acupuncture needles insulin pump intraport etc. Field strength > 3 Tesla further tattoos, permanent make-up
- •persons with limited thermosensory or heightened sensitivity to heating
- •persons where cardiovascular disease cannot be ruled out by examination
- •persons with heightened sensitivity to loud noise or diseases of the ear
- •used closed whole body scanner: claustrophobia
Arms & Interventions
intensive consulting, conventional diet
subjects receive 16 units of nutritional consulting, first 3 weeks of intervention phase are designed as a conventional hypocaloric low-fat diet referring to DGE guidelines (below 30 % fat), followed by 11 months of isocaloric-to-moderate-hypocaloric low-fat diet (below 30 kcal% fat ) - dietary intervention without supplement
Intervention: dietary consulting (Behavioral)
conventional consulting, low-carb diet
subjects receive 8 units of nutritional consulting, first 3 weeks of intervention phase are designed as a very-low calory ketogenic (low-carb) diet (< 40 g CH / day), following 11 months are restricted to not more than 40 % energy intake by carbohydrates under isocaloric-to-moderate-hypocaloric conditions - dietary intervention without supplement
Intervention: dietary consulting (Behavioral)
conventional consulting, conventional diet
subjects receive 8 units of nutritional consulting, first 3 weeks of intervention phase are designed as a conventional hypocaloric low-fat diet referring to DGE guidelines (below 30 % fat), followed by 11 months of isocaloric-to-moderate-hypocaloric low-fat diet (below 30 kcal% fat) - dietary intervention without supplement
Intervention: dietary consulting (Behavioral)
intensive consulting, low-carb diet
subjects receive 16 units of nutritional consulting, first 3 weeks of intervention phase are designed as a very-low calory ketogenic (low-carb) diet (< 40 g CH / day), following 11 months are restricted to not more than 40 % energy intake by carbohydrates under isocaloric-to-moderate-hypocaloric conditions - dietary intervention without supplement
Intervention: dietary consulting (Behavioral)
Outcomes
Primary Outcomes
change in hepatic fat content confirmed by proton magnetic resonance spectroscopy by 3 T MR imaging
Time Frame: 3 weeks, 6 months, 1 year, 3 years
change in postprandial glycaemia (2h plasma glucose level of the 75 g oral glucose tolerance test (OGTT))
Time Frame: 3 weeks, 6 months, 1 year, 3 years
Secondary Outcomes
- change in insulin secretion confirmed by 75 g oral glucose tolerance test (OGTT)(3 weeks, 6 months, 1 year, 3 years)
- change in distribution of body fat confirmed by MR-Imaging by 3 T whole body imager(3 weeks, 6 months, 1 year, 3 years)
- change in insulin sensitivity confirmed by 75 g oral glucose tolerance test (OGTT)(3 weeks, 6 months, 1 year, 3 years)
Investigators
Prof. Dr. med. Andreas F. H. Pfeiffer
Director / Department for Clinical Nutrition
German Institute of Human Nutrition