Lifestyle Intervention in Individuals With Low or High Genetic Risk for Type 2 Diabetes (T2D-GENE)

Effect of Lifestyle Intervention on Incident Diabetes in Individuals With Impaired Fasting Glucose and Low or High Genetic Risk for the Development of Type 2 Diabetes

The aim of the study is to compare the effect of lifestyle intervention (diet and physical activity) by applying modern approaches to lifestyle changes on the prevention of incident T2DM and the worsening of hyperglycemia in people with high number of T2DM risk alleles and in people with low number of T2DM risk alleles compared to corresponding control groups.

Study Overview

• Status: Unknown
• Conditions: Type 2 Diabetes
• Intervention / Treatment: Behavioral: Lifestyle intervention

Detailed Description

AIM: The aim of the study is to compare the effect of lifestyle intervention (diet and physical activity) by applying modern approaches to lifestyle changes on the prevention of incident type 2 diabetes (T2DM) and the worsening of hyperglycemia in people with high number of T2DM risk alleles and in people with low number of T2DM risk alleles compared to corresponding control groups.

STUDY GROUPS. A total of 600 participants will be selected from the METabolic Syndrome In Men (METSIM) study. They are divided into two groups: a) high genetic risk for T2DM on the basis of the genetic risk score (N=300), and b) low genetic risk score for T2DM on the basis of the genetic risk score (N=300). For both of these groups a corresponding control group (N=300) will be selected.

PROTOCOL. 1) The first visit at entry (visit 1) for both intervention and control groups: an interview about physical activity at work and leisure time, smoking, alcohol use, education, occupation, diet, history of medication; clinical measurements: blood pressure, body weight, height, bioimpedance; laboratory measurements including an oral glucose tolerance test, fasting measurements (HbA1c, total cholesterol, HDL cholesterol, total triglycerides, ALT, GAD antibodies); 2) Group sessions (about 15 participants in each) 1-7 described below for the intervention group but not for the control group, 3) A 6 month and 24 month visits (identical to visit 1) for the intervention group but not for the control group; 4) A 3-year visit for both intervention and control groups (identical to visit 1).

Detailed protocol for the intervention group: Dietary guidance in the intervention group is based on the Nordic and Finnish nutrition recommendations and they emphasize appropriate energy intake, meal frequency, consumption of fruits vegetables and berriers, quality of dieatry fat and cardohydrates, including sugar and fiber intake. During the intervention the goals for nutrient and food intake (healthy diet) are: Vegetables, fruits and berries >= 500 g/day, carbohydrates 45-60 E%, sucrose < 10 E%, fiber >=35 g/day, fat 25-40 E%, saturated fat < 10 E%, unsaturated fat >= 2/3 of total fat E%, monosaturated fat 10-20 E%, polysaturated fat 5-10 E%, n-3 fatty acids >= 1E%. The goal for physical activity is brisk walking a minimum of 30 min/day at least five days a week. Walking could be replaced by other types of exercise (e.g. cycling, crioss-country skiing, resistance training, and housework such as leaft raking);

The first year of the intervention will be the most active and includes 4-6 group sessions depending on participants' needs. Group sessions for the intervention group:

Session1 (month 1): Motivation and a 4-day food record and personal feedback from food records to participants.

Sessions 2 and 3 (month 1-2): Healthy dietary pattern and physical activity (see above) Sessions 4 and 5 (month 2-3): Dietary advice for weight loss for the participants with BMI > 28 kg/m2.

6 months visit: 4-day food record and personal feedback from food records to participants.

Session 6: month 12: 4-day food record and personal feedback from food records to participants. Advice for healthy diet and physical activity. Adidtionally a measurement of HbA1c; Session 7 (month 24): 4-day food record and personal feedback from food records to participants. Advice for healthy dietary pattern and physical activity and performance of an oral glucose tolerance test and HbA1c.

Final visit at 36 months: An oral glucose toletance test, HbA1c, and food frequency questionnaire for both intervention and control groups.

Thoughout the study the subjects in the intervention groups will be regularly contacted by the researchers via the website in order to ensure that the subjects stay active regarding the intervention. The web portal also enables the distribution of material and makes virtual discussion possible between the participants and clinical nutritionists. Printed material and discussions by phone will be provided to the participants who do not have access to the internet. In order to help the participants recognize their needs for changes in the diet, available tests (e.g. fiber test, sugar test, fat quality test) provided by the Finnish Heart Association and the Finnish Diabetes Association will be used.

• Study Type: Interventional
• Enrollment (Anticipated): 1200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Finland
  • Kuopio, Finland, 70210
    • University of Eastern Finland

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Participant of the METSIM Study
• Impaired fasting glucose (IFG) at entry (fasting plasma glucose 5.6-6.9 mmol/l) and with (2-hour glucose 7.8-11.0 mmol/l) or without impaired glucose tolerance (2-hour glucose <7.8 mmol/l) and HbA1c < 6.5%.
• Age 50-75 years
• Male
• Body mass index ≥ 25 kg/m2

Exclusion Criteria:

• Age < 50 years or > 75 years
• Body mass index < 25 kg/m2
• Type 1 or type 2 diabetes or isolated impaired glucose tolerance (2-hour plasma glucose < 5.6 mmol/l and 2-hour plasma glucose 7.8-11.0 mmol/l) or HbA1c ≥ 6.5%
• Chronic diseases preventing to participate in the trial

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Life-style intervention 1; Life-style intervention in participants with low genetic risk score: The 3-year lifestyle intervention includes 7-9 group sessions (two additional group sessions for participants whose body mass index exceeds 28 kg/m2) on diet (healthy diet according to Nordic and Finnish nutrition recommendations emphasizing appropriate energy intake, meal frequency, consumption of fruits, vegetables and berries, quality of dietary fat and carbohydrates, including sugar and fiber intake) and physical exercise (brisk walking a minimum of 30 minutes per day at least five days a week or other types of exercise, e.g. cycling, cross-country skiing, housework such as leafs raking, resistance training).	Behavioral: Lifestyle intervention; Life-style intervention includes 7-9 group sessions (two additional group sessions for participants whose body mass index exceeds 28 kg/m2) on diet (healthy diet according to Nordic and Finnish nutrition recommendations emphasizing appropriate energy intake, meal frequency, consumption of fruits, vegetables and berries, quality of dietary fat and carbohydrates, including sugar and fiber intake) and physical exercise (brisk walking a minimum of 30 minutes per day at least five days a week or other types of exercise, e.g. cycling, cross-country skiing, housework such as leafs raking, resistance training).
Active Comparator: Life-style intervention 2; Life-style intervention in participants with high genetic risk score: The 3-year lifestyle intervention includes 7-9 group sessions (two additional group sessions for participants whose body mass index exceeds 28 kg/m2) on diet (healthy diet according to Nordic and Finnish nutrition recommendations emphasizing appropriate energy intake, meal frequency, consumption of fruits, vegetables and berries, quality of dietary fat and carbohydrates, including sugar and fiber intake) and physical exercise (brisk walking a minimum of 30 minutes per day at least five days a week or other types of exercise, e.g. cycling, cross-country skiing, housework such as leafs raking, resistance training).	Behavioral: Lifestyle intervention; Life-style intervention includes 7-9 group sessions (two additional group sessions for participants whose body mass index exceeds 28 kg/m2) on diet (healthy diet according to Nordic and Finnish nutrition recommendations emphasizing appropriate energy intake, meal frequency, consumption of fruits, vegetables and berries, quality of dietary fat and carbohydrates, including sugar and fiber intake) and physical exercise (brisk walking a minimum of 30 minutes per day at least five days a week or other types of exercise, e.g. cycling, cross-country skiing, housework such as leafs raking, resistance training).
No Intervention: Control 1; No intervention in participants with low genetic risk score
No Intervention: Control 2; No intervention in participants with high genetic risk score

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incident diabetes	Incident diabetes is defined by fasting plasma glucose ≥ 7.0 mmol/l or 2-hour glucose in an oral glucose tolerance test ≥ 11.1 mmol/l or HbA1c ≥ 6.5% or drug treatment started for diabetes during a 3-year follow-up.	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The change in glucose area under the curve in an oral glucose tolerance test	The glucose area (mmol/l x min) under the curve in an oral glucose tolerance test is calculated on the basis of glucose measurements (mmol/l) at 0, 30 and 120 min. The change in the glucose area under the curve is the difference between the glucose areas under the curve at randomisation and 3-year visits.	3 years
The change in insulin secretion during a 3 year follow-up	Insulin secretion is measured by calculating the glucose area under the curve (mmol/l x min, based on the measurement of glucose in mmol/l at 0 and 30 min) divided by insulin area under the curve (based on the measurement of insulin in pmol/l at 0 and 30 min). The change in insulin secretion is the difference between insulin secretion measured at randomisation and 3-year visits.	3 years
The change in insulin sensitivity during a 3 year follow-up	Insulin sensitivity is measured by the Matsuda index (mg/dl, mU/L) based on insulin and glucose measurements at 0, 30 and 120 min. The change in insulin sensitivity is the difference between the Matsuda index at randomisation and at 3-year follow-up visits.	3 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incident cardiovascular disease	Incident cardiovascular disease is defined as incident fatal or non-fatal myocardial infarction or cardiovascular death or incident non-fatal or fatal stroke	3 years

Collaborators and Investigators

• Sponsor: University of Eastern Finland

Publications and helpful links

General Publications

• Schwab U, Lankinen M, Laakso M. Effect of lifestyle intervention on the risk of incident diabetes in individuals with impaired fasting glucose and low or high genetic risk for the development of type 2 diabetes in men: a T2D-GENE trial. Food Nutr Res. 2021 Sep 23;65. doi: 10.29219/fnr.v65.7721. eCollection 2021.

Study record dates

Study Major Dates

• Study Start: April 1, 2016
• Primary Completion (Anticipated): April 1, 2021
• Study Completion (Anticipated): December 1, 2021

Study Registration Dates

• First Submitted: March 6, 2016
• First Submitted That Met QC Criteria: March 14, 2016
• First Posted (Estimate): March 15, 2016

Study Record Updates

• Last Update Posted (Actual): February 9, 2021
• Last Update Submitted That Met QC Criteria: February 8, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: T2D-GENÈ

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO