DEMAND - Multifactorial Study to Reduce Dementia in People With Type 2 Diabetes (DEMAND)

Diet, Physical Exercise and Metabolic Control (DEMAND) Intervention to Reduce the Incidence of Major Neurocognitive Disorders Among Individuals With Type 2 Diabetes Combined With Mild Neurocognitive Impairment - a Pilot Study

In the DEMAND pilot study, we will recruit and randomize 80 participants at two study sites (Umeå and Uppsala) for a one-year intervention. The primary objectives are to study the inclusion rate, the adherence rate, and the acceptability of the intervention. The secondary objectives are to examine the effect of the intervention on intermediate outcomes, including metabolic control (i.e., blood glucose and lipids), body weight, blood pressure, physical fitness, and cognitive function. Third, the investigators will perform focus group interviews to explore the participants views on the intervention to assess the acceptability. The interventions include (a) Mediterranean diet (b) an individualized physical training program and (c) pharmacological treatment for type 2 diabetes (T2D) aimed to achieve individualized optimal goals, according to national guidelines, taking into account the risk of hypoglycaemia. This multi-component intervention is more comprehensive than usual care, and it specifically focuses on vascular domains.

Study Overview

• Status: Active, not recruiting
• Conditions: Type 2 Diabetes Mellitus; Mild Cognitive Impairment
• Intervention / Treatment: Dietary supplement: mediterranean diet; Behavioral: individualized fitness program; Other: recommended modified pharmacological treatment

Detailed Description

To be inserted.

• Study Type: Interventional
• Enrollment (Anticipated): 10
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Västerbotten
    • Umeå, Västerbotten, Sweden, 90185
      • Umea University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• type 2 diabetes diagnosed in the last year
• age >=65 years
• signed consent form
• Mild cognitive impairment

Exclusion Criteria:

• diagnosis type 1 diabetes
• major neurocognitive degeneration
• serious illness with live expectancy less than 3 years
• drug- or alcohol-abuse or other neurological / psychiatric illness which affects the outcome
• depressive syndrome
• predicted inability to conduct the study because of drug abuse, serious illness, language issues
• documented episodes of hypoglycemia where help of a third part was needed
• Allergy to fish or nuts
• Angina pectoris
• Heart failure (NYHA 3-4)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: group of intervention; participants receive; personalized advice of a dietician about mediterranean diet; individualized training program,; recommendation about optimized pharmacological treatment as in high risk groups for cardiovascular diseases	Dietary supplement: mediterranean diet; The recommended Mediterranean diet is based on lean meat, fish, eggs, vegetables, fruits, berries, and nuts. Extra-virgin olive oil is the recommended additional fat source for use in food preparation and dressings. Recommended exclusions or restrictions include dairy products, cereals, added salt, refined fats, and sugar. Participants in the intervention group will receive weekly deliveries of olive oil and mixed nuts, free of cost, and they will receive recipes for Mediterranean meals on a regular basis. During the study, the intervention group will receive written, personalized advice from a project dietician on how to improve their Mediterranean diets. This written personalized advice will be based on the reported food intake, its coherence with a Mediterranean diet, and its adherence to the recommended intakes of energy and nutrients for each participant.; Behavioral: individualized fitness program; The exercise intervention will consist of individualized training programs designed to improve cardiovascular fitness (VO2). A personal trainer will distribute the training program instructions and monitor the training during the entire intervention. Support will be provided via text messages. The training intensity will be based on results from an extensive pre-test of individual physical fitness performance, and we will adjust the intensity over the study period, as fitness improves. The goal is to engage participants in training three times per week, for up to one hour per training session. The individualized training programs will consist of brisk walks, jogging, and cycling, tailored to each participant. To ensure that the training intensity is sufficient to improve cardiovascular fitness, heart rate will be monitored during each session.; Other: recommended modified pharmacological treatment; Hyperglycemia: first metformin till target level of HbA1c 1) 53-58 mmol/mol for patients with ≤2 coexisting chronic illnesses or 2) 59-64 mmol/mol for those with established cardiovascular disease (CVD). We will recommend a second glucose-lowering drug when HbA1c is not achieved and which reduce CVD even when the participant does not have a manifest CVD. Hypertension: will be treated to achieve a target level according to European guidelines. Start with a combination of a renin-angiotensin system (RAS)-blocker and a thiazide in low dose or a combination of a RAS-blocker a calcium channel blocker in low dose. If the target is not reached within 12 weeks additional drugs should be added. Dyslipidemia: Patients with a CVD risk of 2-8% within 5 years should receive treatment with atorvastatin 10mg +ezetimib 10mg; CVD risk 8-20%, atorvastatin 20mg + ezetimib 10mg and CVD risk > 20% atorvastatin 40-80mg +ezetimib 10mg.
NO_INTERVENTION: group of control; participants receive; written information about the advantages of a healthy diet; written information about the advantages of physical activity,; medical treatment according to the latest version of the national guidelines issued by the Swedish Medical Product Agency

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
inclusion rate	How many subjects (n) will be randomized within four months?	4 months
adherence rate	What is the proportion (%) of subjects in the intervention group who will adhere to 90% of the diet, exercise and medical intervention?	1 year
retention rate	What is the proportion of drop-out in the two groups?	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Metabolic change	Is there a significant decrease in HbA1c, blood pressure, and blood lipids in the intervention group compared to the control group?	1 year
Memory function	Is the decline in memory function lower in the intervention froup compared to the control group?	1 year

Collaborators and Investigators

• Sponsor: Umeå University
• Investigators: Principal Investigator: Olov Rolandsson, Professor, Umea University

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 19, 2020
• Primary Completion (ANTICIPATED): March 31, 2022
• Study Completion (ANTICIPATED): June 30, 2023

Study Registration Dates

• First Submitted: February 8, 2019
• First Submitted That Met QC Criteria: March 14, 2019
• First Posted (ACTUAL): March 18, 2019

Study Record Updates

• Last Update Posted (ACTUAL): March 26, 2021
• Last Update Submitted That Met QC Criteria: March 25, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: physical fitness; mediterranean diet
• Additional Relevant MeSH Terms: Mental Disorders; Glucose Metabolism Disorders; Metabolic Diseases; Neurocognitive Disorders; Endocrine System Diseases; Cognition Disorders; Diabetes Mellitus; Diabetes Mellitus, Type 2; Cognitive Dysfunction
• Other Study ID Numbers: DEMAND pilot

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No