ADA 81st Symposium: Treatment for Prediabetes and Diabetes Can Be Found at a Grocery Store, Part 1 

A prescription for vegetables can significantly lower weight, blood pressure, and A1C.  

Researchers from the Sansum Diabetes Research Institute discussed food insecurity, a barrier to following a recommended diet in about 17% of individuals with T2D. In addition, researchers wanted to know if improving access to fresh vegetables improved cardio-metabolic risk factors in adults at risk or who had T2D. Four hundred participants of the Farming for Life initiative received a weekly prescription for 21 servings of fresh produce for ten weeks at no cost. There was no nutritional or diabetes education supplement provided. Weight, waist circumference, blood pressure, A1C, food security, self-reported sleep, mood, and pain were measured at baseline and three months post-intervention. Researchers also recorded vegetable, tortilla, and soda consumption during this time. The first 235 adults who participated in the trial were approximately 54 years old (+/- 12.7 years), primarily female (75%), and mostly Hispanic/Latino (81%). In addition, 35% were uninsured, 33% had T2D for 11.4 years (+/- 8.2), and 66% were at risk or had pre-T2D.  

Results found a significant reduction in systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), waist circumference (p < 0.001) and HbA1C (p= 0.032). Participants reported improved sleep (p < 0.001), better mood (p=0.005) and pain reduction (p=0.009). Food insecurity was reduced from 32% to 17%. Daily tortilla consumption (p < 0.001), weekly sugary drink intake (p < 0.001), and weekly meals out (p=0.011) were also reduced. In conclusion, new vegetable prescriptions were associated with lowering cardiometabolic risk factors. A current study incorporates the use of a continuous glucose monitor to record participant A1C.  

The University of Colorado School of Medicine and Eastern Colorado VA Health Care System looked at the recent D2d trial, which found that vitamin D supplementation did not significantly lower the risk of developing diabetes compared to placebo. A secondary analysis of this study looked at the effects of vitamin D supplementation on insulin sensitivity and beta-cell function. Researchers included data from all individuals who had glucose, C-peptide, and insulin labs at baseline. At least one follow-up visit at 12 months or 24 months was also required. After evaluating exclusion criteria, they selected 888/1211 individuals who were given 4,000 units of daily vitamin D and 886/1212 in the placebo group. The average baseline HbA1c was 5.9%, fasting plasma glucose 108 mg/dL, and serum 25(OH)D was 28 ng/mL. A general linear mixed model was used to compare insulin sensitivity and beta-cell function over time. Mean baseline vitamin D levels increased from 27.9 ng/mL to 54.9 ng/ml in the vitamin D group post-follow-up. There was no significant difference in insulin sensitivity index (95%CI [HOMA2%Scpep -1.4 to 1.5], [HOMAS2%Sins -3.8 to 2.6]) or early beta-cell response (95% CI [C peptide index -2.4 to 0.8], [insulinogenic index [-2.7 to 0.9] between the vitamin D group and placebo group over time.   

Researchers from Pennington Biomedical Research Center discussed previous studies in which patients who receive short sleep (categorized as <7 hours) had an increased risk of obesity. They investigated this effect to determine if short sleepers reacted differently to calorie restriction than good sleepers. The findings were based on a secondary analysis of the CALERIE trial, which assessed young and middle-aged individuals with a BMI between 22-27.9. Participants had a 25% energy restriction and took fasting blood levels at baseline, 12 months, and 24 months. With adequate sleepers (N=65), the mean sleep duration (7.8 hours), body weight (72.4 kg), BMI (25.2), body fat (31.1%), glucose (81.7%), insulin (4.9), and HOMA-IR (1.0) was recorded. In short sleepers (N=45), the mean sleep duration (6.4 hours), body weight (72.5 kg), BMI (25.3), body fat (30.1%), glucose (83.5), insulin (5.7), and HOMA-IR (1.2) was also noted. Researchers found no significant difference in glucose, insulin, weight, and body fat over time. Glycemic variations occurred at baseline and weight maintenance but disappeared during active weight loss.  

Practice Pearls: 

• Supplementing vitamin D3 to individuals with prediabetes for two years did not improve insulin sensitivity or beta-cell function. 
• Individuals with/at-risk of T2D received a prescription for vegetables. Data found a significant decrease in weight, waist circumference, blood pressure, and A1C in 3 months. 
• Short sleepers (<7 hours) and adequate sleepers (>7 hours) reacted similarly to calorie restriction. There was no significant difference with glucose, insulin, weight, and body fat over time.  

Chen, G. et al.  (2021, June). Food Is Medicine for People with Diabetes and At-Risk of Diabetes. American Diabetes Association. Copenhagen; Denmark. (Requires ADA Symposium login.) 

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions