Personalised Nutritional Recommendations Based on Individual Post-Prandial Glycaemic Responses Improve Glycaemic Metrics and PROMs in Patients with Type 2 Diabetes: A Real-World Assessment

Ungersboeck, Madlen; Tang, Xiaowen; Neeff, Vanessa; Steele, Dominic; Grimm, P.; Fenech, Matthew

doi:10.3390/nu14102123

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…An example of a more refined precision nutrition strategy could be the utilization of continuous glucose monitoring (CGM) as a behavioral tool for instant feedback on the impact of dietary modifications on glycaemic control. While the available evidence to support this approach is currently limited, it warrants additional investigation for its potential efficacy [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of basic carbohydrate counting versus standard dietary care for glycaemic control in type 2 diabetes (The BCC Study): a randomised, controlled trial

Ewers,

Blond,

Bruun

et al. 2024

Nutr. Diabetes

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Background Clinical guidelines recommend basic carbohydrate counting (BCC), or similar methods to improve carbohydrate estimation skills and to strive for higher consistency in carbohydrate intake potentially improving glycaemic control. However, evidence for this approach in type 2 diabetes (T2D) is limited. Objective To examine the efficacy of a structured education program in BCC as add-on to standard dietary care on glycaemic control in individuals with T2D. Methods The BCC Study was a randomized, controlled, open-label, parallel-group trial. Individuals with T2D aged 18-75 years with glycated haemoglobin A1c (HbA1c) 53–97 mmol/mol (7.0–11.0%) were randomly assigned (1:1) to BCC or standard dietary care. The primary outcomes were differences in changes in HbA1c or glycaemic variability (calculated as mean amplitude of glycaemic excursions [MAGE]) between groups after six months of intervention. Results Between September 2018 and July 2021, 48 participants were randomly assigned, 23 to BCC and 25 to standard dietary care. Seven participants did not receive the allocated intervention. From a baseline-adjusted mean of 65 mmol/mol (95% CI 62-68 [8.1%, 7.8-8.4]), HbA1c changed by −5 mmol/mol (−8 to −1 [−0.5%, −0.7 to −0.1]) in BCC and -3 mmol/mol (−7 to 1 [−0.3%, −0.6 to 0.1]) in standard care with an estimated treatment effect of −2 mmol/mol (−7 to 4 [−0.2%, −0.6 to 0.4]); p = 0.554. From a baseline-adjusted mean of 4.2 mmol/l (3.7 to 4.8), MAGE changed by −16% (−33 to 5) in BCC and by −3% (−21 to 20) in standard care with an estimated treatment effect of −14% (−36 to 16); p = 0.319. Only median carbohydrate estimation error in favour of BCC (estimated treatment difference −55% (−70 to −32); p < 0.001) remained significant after multiple testing adjustment. Conclusions No glycaemic effects were found but incorporating BCC as a supplementary component to standard dietary care led to improved skills in estimating carbohydrate intake among individuals with T2D.

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Section: Discussionmentioning

confidence: 99%

Effects of basic carbohydrate counting versus standard dietary care for glycaemic control in type 2 diabetes (The BCC Study): a randomised, controlled trial

Ewers,

Blond,

Bruun

et al. 2024

Nutr. Diabetes

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“…The iAUC is a simple and robust metric that allows characterization of relative changes in the concentration of metabolites of interest in the acute response to food intake. 36,37 To investigate age and product effects, the previously selected features with significant postprandial response were tested by f1.ld.f1 using the iAUCs (nparLD, p < 0.05). If a feature showed significant differences in the acute response between the YA and OA groups (age effect) or after milk or yogurt intake (product effect), a Wilcoxon signed-rank test was applied to identify which of the groups responded significantly: a feature with a significant product effect was confirmed by the test in the separate age group (YA-M vs YA-Y and OA-M vs OA-Y, paired, p < 0.05), and those with a significant age effect was confirmed by the test in the separate product group (YA-M vs OA-M and YA-Y vs OA-Y, non-paired, p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…The incremental area under the curve (iAUC) (MESS package v0.3.2) of the features selected by the nparLD test was further tested by the Wilcoxon signed-rank test ( p < 0.05) to determine if each was significantly different from zero in at least one of the four groups (young adults after milk intake: YA-M; young adults after yogurt intake: YA-Y; older adults after milk intake: OA-M; older adults after yogurt intake: OA-Y). The iAUC is a simple and robust metric that allows characterization of relative changes in the concentration of metabolites of interest in the acute response to food intake. , …”

Section: Methodsmentioning

confidence: 99%

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Age-Dependent Serum Volatilomics of Milk and Yogurt Intake: A Randomized Crossover Study in Healthy Young and Older Men

et al. 2023

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Nutritional biomarkers of dairy intake can be affected by both food transformation and the metabolic status of the consumer. To assess these effects, this study investigated the serum volatilome of 14 young (YA) and 14 older (OA) adult men undergoing a 3 week restriction of dairy and fermented foods followed by a randomized crossover acute intake of milk and yogurt. 3,5-Dimethyl-octan-2-one was identified as a potential marker of dairy product intake as its response after both milk and yogurt intake was significantly increased during the postprandial phase but significantly decreased in fasting serum samples of the OA group after the restriction phase. The postprandial response of two metabolites was significantly different for the two dairy products while 19 metabolites were modulated by age. Remarkably, the response of all age-dependent metabolites was higher in the OA than in the YA group after milk or yogurt intake, whereas at the end of the restriction phase, their fasting concentrations were lower in the OA than in the YA group. Among these, p-cresol, a specific marker of colonic protein fermentation, had a significant response in the OA but not the YA group, which may suggest impaired intestinal processing of dietary proteins in the OA group.

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“…The limited success of current interventions might be explained by several reasons. First, increasing studies have shown that differences in individual post-prandial glycemic responses occur even when consuming the same food ( 17 – 19 ), but current lifestyle or dietary interventions are mainly based on one-size-fits-all advice and do not consider such differences between individuals. Moreover, if participants are unable to get immediate feedback on whether dietary approaches are effective in improving post-prandial glucose levels, it is hard for them to comply with recommended advice ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention

Gao

Luo

et al. 2023

Front. Nutr.

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BackgroundIncreased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control.MethodsWe have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point.DiscussionThis trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention.Trial registration numberChinese clinical trial registry, ChiCTR2200060923.

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Personalised Nutritional Recommendations Based on Individual Post-Prandial Glycaemic Responses Improve Glycaemic Metrics and PROMs in Patients with Type 2 Diabetes: A Real-World Assessment

Cited by 7 publications

References 39 publications

Effects of basic carbohydrate counting versus standard dietary care for glycaemic control in type 2 diabetes (The BCC Study): a randomised, controlled trial

Effects of basic carbohydrate counting versus standard dietary care for glycaemic control in type 2 diabetes (The BCC Study): a randomised, controlled trial

Age-Dependent Serum Volatilomics of Milk and Yogurt Intake: A Randomized Crossover Study in Healthy Young and Older Men

Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention

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