The Effect of 3 Different Models of MNT on DM Control in Overweight Patients With T2DM

February 28, 2019 updated by: Joslin Diabetes Center

The Effect of Three Different Models of Medical Nutrition Therapy (MNT) on Diabetes Control in Overweight and Obese Patients With Type 2 Diabetes: A Randomized Comparative Study. (Nutrition Path Study)

The American Diabetes Association (ADA), among other medical societies, is strongly recommending medical nutrition therapy (MNT) for prevention and management of type 2 diabetes. However, the ADA recognized that there is no "one size fits all" diet and thus recommends that MNT should be conducted through a consultation with registered dietitians (RD). Previous studies have shown that using diabetes-specific nutritional formulas, as an integral part of the MNT, lowers postprandial blood glucose levels. Through our experience from the Joslin's Weight Achievement and Intensive Treatment (Why WAIT™) program, applying MNT within a structured dietary intervention protocol has the best impact on blood glucose values and body weight. Meanwhile, the frequent use of health coaching during dietary intervention proved to be effective in managing diabetes and inducing weight loss. However, no study compared those three intervention methods in a randomized clinical study.

The aim of this study is to evaluate the effect of different models of conducting medical nutrition therapy on the glycemic control in patients with type 2 diabetes.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

108

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Massachusetts
      • Boston, Massachusetts, United States, 02215
        • Joslin Diabetes Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Subject has voluntarily signed and dated an informed consent form, approved by an Institutional Review Board/Independent Ethics Committee, and provided Health Insurance Portability and Accountability Act authorization (HIPAA) or other privacy authorization prior to any participation in study.
  2. Subject states that he/she had type 2 diabetes, as evidenced by use of anti-hyperglycemic medication or managed on lifestyle intervention only with A1C >7%
  3. Subject is between 30 and 80 years of age.
  4. Subject on stable dose of antihyperglycemic medications for the past 3 months or lifestyle intervention
  5. Subject is a male or a non-pregnant, non-lactating female, at least 6 weeks postpartum prior to screening visit. A urine pregnancy test is required for all female subjects unless she is not of childbearing potential, defined as postmenopausal for at least one year prior to screening visit or surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy).

  6. If a female is of childbearing potential, she is practicing one of the following methods of birth control (and continued through the duration of the study):

    • Condoms, sponge, diaphragm or intrauterine device;
    • Oral or parenteral contraceptives for 3 months prior to screening visit;
    • Vasectomized partner;
    • Total abstinence from sexual intercourse.
  7. Subject's BMI is > 25 kg/m2.
  8. Subject has A1C between 7-10%
  9. If on a chronic medication such as anti-hypertensive, lipid-lowering, thyroid medication or hormone therapy, subject has been on stable dose for at least three months prior to screening visit. These medications will not be changed during intervention unless it is mandatory.

Exclusion Criteria:

  1. Subjects using exogenous insulin since insulin titration may impact the primary endpoint.
  2. Subject states that he/she had a history of diabetic ketoacidosis.
  3. Subject is pregnant or lactating.
  4. Subject uses corticosteroid treatment with the exception of inhaled or topical steroids in the last 3 months; or antibiotics within the last 3 weeks prior to the screening visit.
  5. Subject states that he/she had an active malignancy (excluding the following dermal malignancies: basal cell carcinoma, squamous cell carcinoma, carcinoma in-situ of the cervix).
  6. Subject states that he/she has had a recent cardiovascular event (e.g., myocardial infarction, stroke) ≤ six months prior to screening visit; or stated history of congestive heart failure.
  7. Subject states that he/she has had end stage organ failure (such as end stage renal disease) or had status post organ transplant.
  8. Subject states that he/she has had a history of renal disease (Creatinine >1.5mg/dL or GFR <60 mL/min/1.73 m2).
  9. Subject states that he/she has had current hepatic disease.
  10. Subject has history of gastroparesis.
  11. Subject states that he/she has had a chronic, contagious, infectious disease
  12. Subject states that he/she has had clotting or bleeding disorders.
  13. Subject is known to be allergic or intolerant to any ingredient found in the study products.
  14. Subject is known to have a history of special nutritional need requiring special diet.
  15. Subject is currently participating in any weight loss program.
  16. Subject has used meal replacements during the 3 months prior to the start of the study.

  17. Subject has history of bariatric surgery.

    -

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Traditional MNT
Will be instructed to follow a MNT plan as recommended by the ADA through consultation with a RD.
Behavioral: Traditional MNT
Will follow the nutritional recommendations set by the American Diabetes Association in 2013.
Active Comparator: Structured MNT
Will be instructed to follow a MNT plan as applied in the Why WAIT™ program, which includes structured dietary plan, dietary modification and use of diabetes-specific meal replacement (Ultra Glucose Control®; Metagenics Inc.) three times per day.
Behavioral: Structured MNT
Will follow a meal plan developed at Joslin plus use of use of diabetes-specific nutritional formula.
Other Names:
  • Medical Nutritional Therapy Plan
Active Comparator: Structured MNT plus Weekly Support
Will be instructed to follow a MNT plan as applied in the Why WAIT™ program, which includes structured dietary plan, dietary modification and use of diabetes-specific meal-replacement (Ultra Glucose Control®; Metagenics Inc.) three times per day plus weekly coaching.
Behavioral: Structured MNT plus Weekly Support
Will follow a meal plan developed at Joslin plus use of use of diabetes-specific nutritional formula; in addition to receiving weekly coaching from a registered dietitian

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Absolute and relative change in HbA1c
Time Frame: 16 weeks
16 weeks

Secondary Outcome Measures

Outcome Measure
Time Frame
Absolute and relative change in body weight
Time Frame: 16 weeks
16 weeks
Absolute and relative change in fasting blood glucose
Time Frame: 16 weeks
16 weeks
Absolute and relative change in lipid profile (cholesterol, HDL, LDL, triglycerides)
Time Frame: 16 weeks
16 weeks
Absolute and relative change in blood pressure
Time Frame: 16 weeks
16 weeks
Absolute and relative change in High-sensitivity C - reactive protein (hsCRP)
Time Frame: 16 weeks
16 weeks
Absolute and relative change in HOMA insulin resistance (IR) index
Time Frame: 16 weeks
16 weeks
Absolute and relative change in c-peptide level
Time Frame: 16 weeks
16 weeks
Absolute and relative change in microalbumin/creatinine ratio
Time Frame: 16 weeks
16 weeks
Absolute and relative change in fat mass
Time Frame: 16 weeks
16 weeks
Absolute and relative change in body fat percentage
Time Frame: 16 weeks
16 weeks
Absolute and relative change in waist/hip ratio
Time Frame: 16 weeks
16 weeks
Absolute and relative change in visceral fat content
Time Frame: 16 weeks
16 weeks
Absolute and relative change in dietary protein
Time Frame: 16 weeks
16 weeks
Absolute and relative change in energy intake
Time Frame: 16 weeks
16 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Joslin Diabetes Center

Collaborators

Metagenics, Inc.

Investigators

  • Principal Investigator: Osama Hamdy, MD, PhD, Joslin Diabetes Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

April 1, 2015

Primary Completion (Actual)

July 1, 2018

Study Completion (Actual)

July 1, 2018

Study Registration Dates

First Submitted

August 4, 2015

First Submitted That Met QC Criteria

August 6, 2015

First Posted (Estimate)

August 11, 2015

Study Record Updates

Last Update Posted (Actual)

March 4, 2019

Last Update Submitted That Met QC Criteria

February 28, 2019

Last Verified

February 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CHS#: 2014-40

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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