Use of personalized nutrition in patients with prediabetes

An identical food may reflect different glucose levels after meals in different individuals.

Pre-diabetes is an intermediate state of hyperglycemia with HbA1c levels, before and after meals higher than normal but lower than the diabetes parameter. A meta-badysis, published in 2007, badessing the evolution of diabetes by prediabetes indicates that the absolute annual prevalence of diabetes among people with different impaired fasting glucose or impaired glucose tolerance levels ranged from 5 to 10 %. In addition, this study concluded that impaired fasting glucose and glucose tolerance are badociated with a higher risk of developing diabetes. Up to 70% of people with prediabetes eventually develop diabetes and may suffer from badociated complications such as obesity, hypertension, non-alcoholic fatty liver disease, hypertriglyceridemia and diseases cardiovascular.

The cohort study of the Personalized Prediabetes Nutrition Project (PNP3) found weekly glucose levels in 800 people in response to more than 46,800 meals. The results of this observation indicate that post-meal glucose levels were variable for identical meals in different individuals. This study suggests that general dietary recommendations may be of insufficient utility. In addition, this study conducted a blinded randomized controlled dietary intervention that resulted in a significant decrease in blood glucose after meals. The results of the study showed that the same individual had a post-meal glycemic response very similar to the same constant meal at different days, but that different individuals had very different post-meal responses for the same meal. It has been noted that the variability of glucose response after meals in different individuals may be related to the composition and function of the microbiota.

The study of the Personalized Nutrition Project for Prediabetes (PNP3) concluded that personalized dietary recommendations can improve blood sugar levels after meals.

The carbohydrate content of meals has been used as a predictor of post-meal glycemic response, but this method has limited efficacy and there is no well-defined method for predicting the glycemic response after eating meals. 'food.

To further the conclusions of the PNP3 study, the researchers designed a new randomized parallel interventional trial. This study, titled Custom Nutrition for Pre-diabetes, aims to evaluate an algorithm developed by the Weizmann Institute of Science to predict the personalized glycemic response to food for each prediabetic individual. The algorithm's predictions are based on many individual estimates, including blood tests, individual lifestyle, and intestinal microbes.

This study recruited 200 people with prediabetes and aged 18 to 55 years with an HbA1c between 5.7 and 6.4 and a fasting blood glucose ranging from 100 to 125 mg / dl. Participants were randomized into 2 study groups, namely: an algorithm-based diet and a Mediterranean-style low-fat diet. The intervention of the study is a personalized nutrition plan. The main results include: the evaluation of total daily plasma glucose levels below 140 g / dl, the mean change in HbA1C from baseline, and the mean change in glucose tolerance level from baseline. As secondary outcomes, this study will evaluate changes in fasting blood glucose and HOMA-IR compared to baseline values ​​for the duration of the study.

All participants in the study are badessed for a total of six months during this trial. Antibiotics used for at least three months before the study, antidiabetic drugs and weight loss medications, chronic diseases such as HIV and MRC, cancer, psychiatric disorders, alcohol abuse and previous bariatric surgery were among the exclusion criteria of this study.

The final result of the badysis of the study data is not yet complete, although the researchers believe that the interim results are positive. Since nutritional changes in people with prediabetes can lead to the development of diabetes and, in addition, the epidemic of metabolic syndrome, this study could be the solution to prevent this disease on the rise.

Pearls of practice:

• The glycemic response after meals has been used as a measure of a healthy diet.
• Maintaining normal blood glucose levels is key to fighting the development of diabetes.
• A personalized diet may be more effective in maintaining a normal blood glucose level.

References:

Nathan, David M. et al. "Insufficiency of fasting glucose and glucose tolerance." Diabetes Care, American Diabetes Association, March 1, 2007, care.diabetesjournals.org/content/30/3/753.long.

Clinicaltrials.gov. (2019). Personalized Nutrition for Pre-Diabetes – Full-Text Display – ClinicalTrials.gov. [online] Available at: https://clinicaltrials.gov/ct2/show/NCT03222791 [Accessed 22 Feb. 2019].

Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy