Monday’s Oral Presentations session The Wide-Ranging Field of Clinical Nutrition Research—From the Role of Nutrients to How We Eat will highlight results from eight recent studies examining dietary and nutritional interventions in diabetes patients. The two-hour session will begin at 4:30 p.m. in S-10 (South, Exhibition Level). ADAMeetingNews.org asked three of the presenting authors to preview their study presentations.
Prediabetes Conversion to Normoglycemia Is Superior Adding a Low-Carbohydrate Formula Diet to Lifestyle Intervention—A 12-Month Subanalysis of the ACCORH Study
Stephan Martin, MD, Heinrich Heine University and West-German Centre of Diabetes and Health, Dusseldorf Catholic Hospital Group, Dusseldorf, Germany
Dr. Martin: Lifestyle interventions can reverse hyperglycemia to normoglycemia. However, most of the studies so far required high intensive care. In our trial, we used a low intensive care approach using a low-carb formula diet. As formula diets have been shown to be effective in improving glycemic control, we hypothesized that adding a low-carbohydrate formula diet to a low-intensity lifestyle intervention is superior in reversing prediabetes than lifestyle intervention alone.
Dr. Martin: We performed an international, multicenter trial with overweight persons and randomized them into either a control group with lifestyle intervention or a lifestyle intervention group on a formula diet. Both groups were equipped with telemonitoring devices, received information on healthy diet, and were instructed to increase physical activity. The formula group received a low-carbohydrate, soy-protein-rich formula substitute for three meals/day within the first week. During weeks two to four, participants replaced two meals/day, and during weeks five to 26 only one meal/day was substituted. Follow-up was performed after 52 weeks.
Shared Medical Appointments (SMA) with Weight Management vs. SMA Alone for Overweight or Obese Patients with Type 2 Diabetes
William S. Yancy Jr., MD, MHS, Duke University Diet and Fitness Center
Dr. Yancy: Shared medical appointments have been shown to be effective for managing blood glucose control and blood pressure and are increasingly being used in various settings because they are an efficient and effective way to manage diabetes. One issue with SMAs, however, is that typically the emphasis has been to intensify medications in order to manage blood glucose, and they haven’t emphasized weight management as much.
Dr. Yancy: In this study, we combined SMAs with an intensive weight management strategy, which in this case was a low-carbohydrate diet, and compared that to a traditional SMA for diabetes. Our hypothesis was that the weight management strategy would be as effective as the standard SMAs for blood glucose control and might allow patients to be on less diabetes medicine, have fewer hypoglycemic events, and lose weight better than the standard SMA group.
We recruited patients whose diabetes was out of control and who needed to lose weight, and randomized them either to SMA, which we considered the control condition, or the intensive weight management combined with the SMA. Participants met periodically for their group visits, during which they received counseling and medication management, and we monitored their blood glucose control. The group that received intensive weight management was counseled to follow a very low-carbohydrate diet; their diabetes medications were actually reduced initially, in order to prevent hypoglycemia that can occur when carbohydrate intake is reduced.
Glycemic Index and Postprandial Blood Glucose Excursions, Insulin Requirements, and Hunger in T1D
Belinda S. Lennerz, MD, PhD, Boston Children’s Hospital
Dr. Lennerz: High glycemic index foods elicit larger blood glucose excursions and insulin secretion and are associated with lower satiety in people without diabetes compared to low glycemic index foods. In individuals with insulin-dependent diabetes, however, standard treatment paradigms consider all carbohydrate equivalent and insulin is used at doses proportional to the amount of carbohydrate consumed. Postprandial mismatches in insulin action and carbohydrate absorption are common and lead to alternating hyperglycemia and hypoglycemia.
Dr. Lennerz: Fifteen young, otherwise healthy men with well-controlled type 1 diabetes underwent three experimental conditions in a randomized cross-over design: (1) a high glycemic index meal (milkshake) and intravenous insulin to maintain normal blood glucose; (2) a low glycemic index milkshake and intravenous insulin to maintain normal blood glucose; (3) a high glycemic index milkshake and intravenous insulin matched to the dose needed to cover the high glycemic index meal.