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Using Personalized Nutrition in Prediabetes to Reduce Future Complications

Apr 23, 2019
 
Editor: Steve Freed, R.PH., CDE

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

Identical food may reflect different post meal blood glucose levels in different individuals.

Prediabetes is an in-between state of elevated blood glucose level with HbA1c, pre, and post meal levels higher than normal but lower than diabetes parameter. A meta-analysis, published in 2007, assessing the development of diabetes from prediabetes indicates that the absolute annual prevalence of diabetes in individuals with different categories of impaired fasting glucose or impaired glucose tolerance was found to be from 5-10%. Furthermore, this study concluded that impaired fasting glucose and impaired glucose tolerance are associated with higher risk of developing diabetes. As much as 70% of people with prediabetes ultimately develop diabetes and may suffer from related complications such as obesity, hypertension, non-alcoholic fatty liver disease, hypertriglyceridemia and cardiovascular disease.

The Personalized Nutrition Project for Prediabetes (PNP3) cohort study continuously observed week long glucose levels in 800 individuals in response to over 46,800 meals. The results of this observation indicate that post meal blood glucose levels were variable to identical meals in different individuals. This study suggests that general dietary recommendations may have inadequate usefulness. In addition, this study performed a blinded randomized controlled dietary intervention which resulted in significantly lower post meal blood glucose levels. Results of the study showed that the same individual had a very similar post-meal blood glucose response to the same consistent meal across different days, but different individuals have broadly different post-meal responses to the same identical meal. It was noted that variability in post-meal glucose response in different individuals may be linked with microbiota composition and function.

The Personalized Nutrition Project for Prediabetes (PNP3) study concluded that personalized dietary recommendations may result in a better post meal blood glucose level.

The meal carbohydrate content has been used as a predictor of post meal glycemic response, but this method has limited efficacy and there is not a well-defined method which helps in foreseeing the post meal glycemic response of people to food.

To further investigate the PNP3 study’s conclusion, researchers designed a new randomized, parallel interventional trial. This study, called Personalized Nutrition for Pre-Diabetes, is conducted to assess an algorithm that was developed at the Weizmann Institute of Science for predicting the personalized glucose response to food for each prediabetic individual. The algorithm’s forecasts are based on numerous individual estimations, including blood tests, individual lifestyle, and intestine microbes.

This study enrolled 200 individuals with prediabetes who are between the ages of 18-55 with HbA1c of 5.7-6.4 and fasting glucose of 100-125mg/dl. Participants have been randomized into 2 study arms including: algorithm- based diet and Mediterranean-style low- fat diet. The study intervention is a personalized nutrition plan. The primary outcomes include: assessment of the total daily plasma glucose levels less than 140g/dl, average change in HbA1C from the baseline, and average change in glucose tolerance level from the baseline. As secondary outcomes, this study will evaluate the changes in fasting blood glucose and HOMA-IR from the baseline for the duration of study.

All study participants are evaluated for a total of 6 months during this trial.  Antibiotics use for at least three months before study, antidiabetics and weight-loss medication, chronic illnesses such as HIV and CKD, cancer, psychiatric disorders, alcohol abuse, and lastly previous bariatric surgery, were part of the exclusion criteria of this study.

The final data analysis result of the study is not yet completed, although researchers believe that the provisional results are positive. Since nutritional changes in people with prediabetes may lead to development of diabetes and furthermore, the metabolic syndrome epidemic, this study may be the answer in prevention of this rising disease.

Practice Pearls:

  • Post-meal glucose response has been used as a measure of healthy nutrition.
  • Sustaining normal blood glucose levels is the key to fight against developing diabetes.
  • Individualized diet plans may be more successful in maintaining normal blood glucose.

 

References:

Nathan, David M., et al. “Impaired Fasting Glucose and Impaired Glucose Tolerance.” Diabetes Care, American Diabetes Association, 1 Mar. 2007, care.diabetesjournals.org/content/30/3/753.long.

Clinicaltrials.gov. (2019). Personalized Nutrition for Pre-Diabetes – Full Text View – 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