Feasibility of Time-Restricted Eating in the Treatment of Type 2 Diabetes (RESET2pilot)

Feasibility of Time-Restricted Eating in the Treatment of Type 2 Diabetes - the RESET2 Pilot Study

The overall aim of this pilot study is to examine feasibility of a 12-week 10-hour time-restricted eating intervention in individuals with overweight or obesity and type 2 diabetes. The results of the pilot study will inform recruitment, design and delivery of a future long-term time-restricted randomized controlled trial.

Study Overview

• Status: Completed
• Conditions: Type 2 Diabetes
• Intervention / Treatment: Other: Time-restricted eating

Detailed Description

In people with type 2 diabetes (T2D), weight loss is associated with improved glycaemic control and markers of cardiometabolic function as well as reduced use of antidiabetic medicine. Beyond pharmacological treatments, current strategies to reduce body weight and improve glycaemia include energy-restricted diets and increased physical activity.

Lifestyle interventions are complex, affecting many aspects of peoples' daily life. Dietary restrictions often result in rapid weight loss, but the weight is gradually regained by many. Barriers to implement and maintain dietary changes include lack of knowledge, support, and insights into the type and amount of foods eaten. Previous lifestyle interventions targeting weight loss in T2D show efficacy for improving markers of metabolic risk, including weight and glycaemia during the intervention, but relapse of behavior and weight regain are often present.

One reason may be that the intervention is not modified according to the needs of the target group. Often, weight loss interventions are shaped by a 'one size fits all' model where both individual capabilities and motivation as well as social and contextual factors are more or less ignored. A user-based design will facilitate enrolment of participants and likely promote uptake and maintenance of the intervention among participants.

Intermittent fasting regimens have been suggested as efficient strategies for improving cardiometabolic health to a greater extent than can be attributed to the reduction in energy intake alone. Time-restricted eating limits the time available for food intake to typically 4-10 hours/day without other dietary restrictions and has been put forward as a novel, acceptable, and safe lifestyle modification and has shown promising effects on body weight, glucose metabolism, appetite, and cardiometabolic health in individuals at high risk of T2D.

The overall aim of this pilot study is to examine feasibility of a 12-week 10-hour time-restricted eating based intervention in individuals with overweight or obesity and T2D. Participants will attend visit 1 (baseline), visit 2 (8 weeks after baseline) and visit 3 (12 weeks after baseline). The study consists of 8 weeks of strict time-restricted eating, followed by 4 weeks of individually adjusted time-restricted eating.

Specific aims are:

1. To assess adherence and participants' experiences, needs and barriers with an 8-week strict time-restricted eating period, followed by a 4-week period with an individually adjusted time-restricted eating based intervention
2. To examine whether intervention components are delivered by health care professionals as intended
3. To explore if intervention support components are acceptable, useful and sufficient for the participants
4. To study recruitment processes and retention, and related barriers and facilitators
5. To evaluate examination days

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Herlev, Denmark, 2730
    • Steno Diabetes Center Copenhagen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age: ≥18 years
• Overweight or obesity (BMI ≥25 kg/m2)
• T2D with HbA1c >53 mmol/mol
• Habitual eating window ≥12 h/day (incl. foods/snacks and energy-containing beverages)
• Associated with the T2D clinic at Steno Diabetes Center Copenhagen (SDCC) or Hvidovre Hospital

Exclusion Criteria:

• Weight loss >5kg last 3 months
• Bariatric surgery or planned bariatric surgery within study duration
• Use of fast acting insulin and combination insulin products
• Unable or unwilling to adhere to time-restricted eating; for instance, due to competing medical conditions.
• A wish to adhere to Ramadan
• For women: current/planned pregnancy or lactation
• Alcohol or drug abuse (judged by investigator) or treatment with disulfiram
• Severe hypoglycaemia within last year (Severe hypoglycaemia, as defined by the American Diabetes Association, denotes severe cognitive impairment requiring external assistance for recovery)
• Inability to understand written and oral information in Danish.
• Diagnosed with an eating disorder in the past 3 years
• Medical condition which, based on investigators assessment, challenges participation including but not limited to severe heart, vascular or lung disease, cancer, chemotherapy, psychiatric gastrointestinal, rheumatic or endocrine diseases etc.
• Concomitant participation in other intervention study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Time-restricted eating; Time-restricted eating for 12 weeks (n=20).

Other: Time-restricted eating; The intervention consists of an 8-week strict time-restricted eating period, where participants follow the same 10-hour eating window (self-selected timing from 6 am to 8 pm) each day with minimal support to obtain lived experiences with challenges associated with time-restricted eating. Followed by an individually adjusted 4-week time-restricted eating period, including supporting components. Staff will help participants select a time-interval that fits into their daily life. Diet is ad libitum and with no further dietary restrictions. The time-restricted eating intervention is an addition to standard care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence (%)	Self-reported adherence to a 10-hour eating window/day during a 8-week strict time-restricted eating period. % compliance = (number of days compliant/total days) * 100%.	Registered 1 day/week on random days per e-mail from baseline to week 8.
Adherence (%)	Self-reported adherence to a 10-hour eating window during a 4-week individually adjusted time-restricted eating period. % compliance = (number of days compliant/total days) * 100%.	Registered 1 day/week on random days per e-mail from week 8 to week 12.
Participants' experiences, needs and barriers	Analysis of conversations at visit 2 to assess participants' experiences, needs and barriers with a 8-week strict time-restricted eating period.	8 weeks after baseline.
Participants' experiences, needs and barriers	Analysis of interviews at visit 3 to assess participants' experiences, needs and barriers with a 4-week individually adjusted time-restricted eating period, including to explore if intervention support components are acceptable, useful and sufficient for the participants.	12 weeks after baseline.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment process and retention	Registered numbers of: people with interest in the project, people attending pre-screening and screening, included participants, drop-outs and completers.	Up to 12 weeks.
Evaluation of examination days	Analysis of interviews to evaluate examination days.	Interviews at baseline and after 8 and 12 weeks.
Fidelity	Assessment of the extent (%) to which the conversations are conducted according to the conversation guidelines. Average score for conversations at baseline and average score for conversations at visit 2 will be calculated.	Conversations at baseline and after 8 weeks.
Body weight (kg)	Measured on a digital scale. Fasted state at baseline and after 12 weeks, non-fasted state after 8 weeks	Measured at baseline and after 8 and 12 weeks
Body mass index (kg/m^2)	Calculated from body weight (kg) and height (m). Fasted state at baseline and after 12 weeks, non-fasted state after 8 weeks.	Measured at baseline and after 8 and 12 weeks.
Fat mass (kg)	Measured by electronical bioimpedance. Fasted state at both visits.	Measured at baseline and after 12 weeks.
Fat free mass (kg)	Measured by electronical bioimpedance. Fasted state at both visits.	Measured at baseline and after 12 weeks.
Fat percentage (%)	Measured by electronical bioimpedance. Fasted state at both visits.	Measured at baseline and after 12 weeks.
Waist circumference (cm)	Measured using tape measure.	Measured at baseline and after 12 weeks.
Hip circumference (cm)	Measured using tape measure.	Measured at baseline and after 12 weeks.
HbA1c (mmol/mol and %)	Assessed from blood samples in fasted state.	Measured at baseline and after 12 weeks.
Systolic blood pressure (mmHg)	Measured under resting and fasting conditions.	Measured at baseline and after 12 weeks.
Diastolic blood pressure (mmHg)	Measured under resting and fasting conditions.	Measured at baseline and after 12 weeks.
Heart rate (bpm)	Measured under resting and fasting conditions during measurements of blood pressure.	Measured at baseline and after 12 weeks.
Metabolites	Fasting concentrations of glucose, cholesterols, triglycerides.	Measured at baseline and after 12 weeks.
Hormone	Fasting concentration of insulin.	Measured at baseline and after 12 weeks.
Marker of kidney function - Sodium	Fasting concentration of sodium.	Measured at baseline and after 12 weeks.
Marker of kidney function - Potassium	Fasting concentration of potassium.	Measured at baseline and after 12 weeks.
Marker of kidney function - Creatinine	Fasting concentration of creatinine.	Measured at baseline and after 12 weeks.
Markers of kidney function - eGFR	Estimated glomerular filtration rate (eGFR).	Measured at baseline and after 12 weeks.
Subjective appetite	Rated using visual analogue scales and includes sensations of: Hunger, fullness, satiety, prospective food consumption, wellbeing, nausea, thirst, desire to eat meat, salty, and sweet. The scale range is 0-100 and each end represent the extremes e.g. hunger rating: "I am not hungry at all" to "I have never been this hungry before".	Measured at baseline and after 12 weeks.
Food choice	Food choice of food items from four combined food categories (high-fat savoury, high-fat sweet, low-fat savoury and low-fat sweet foods) examined from the computerized Leeds Food Preference Questionnaire. Food choice is determined based on frequency of selection made within each food category. The scores range from 0-48 i.e. 0 = foods within a specific food category have not been selected at all to 48 = foods within a specific food category have been selected 48 times.	Measured at baseline and after 12 weeks.
Implicit wanting	Implicit wanting of food items from four combined food categories (high-fat savoury, high-fat sweet, low-fat savoury and low-fat sweet foods) examined from the computerized Leeds Food Preference Questionnaire. Implicit wanting is assessed based on food choice and response time for selected and non-selected food items as well as mean response time.	Measured at baseline and after 12 weeks.
Explicit liking	Explicit liking of 16 food items from four combined food categories (high-fat savoury, high-fat sweet, low-fat savoury and low-fat sweet foods) examined from the computerized Leeds Food Preference Questionnaire. Explicit liking is rated using visual analogue scales and the range is 0-100. Each end represents the extremes e.g. Question: "how pleasant would it be to taste this food right now?" Answer: "not at all" (rated 0 on the 0-100 scale) to "extremely" (rated 100 on the 0-100 scale).	Measured at baseline and after 12 weeks.
Explicit wanting	Explicit wanting of 16 food items from four combined food categories (high-fat savoury, high-fat sweet, low-fat savoury and low-fat sweet foods) examined from the computerized Leeds Food Preference Questionnaire. Explicit wanting is rated using visual analogue scales and the range is 0-100. Each end represents the extremes e.g. Question: "how much do you want some of this food now?" Answer: "not at all" (rated 0 on the 0-100 scale) to "extremely" (rated 100 on the 0-100 scale).	Measured at baseline and after 12 weeks.
Self-reported physical activity	Assessed from questionnaire International Physical Activity Questionnaire, and measures health-related physical activity. To calculate MET minutes a week multiply the MET value given by the minutes the activity was carried out and again by the number of days that that activity was undertaken.	Measured at baseline and after 12 weeks.
Self-reported sleep quality	Assessed from the questionnaire Pittsburgh Sleep Quality Index. The questionnaire consists of 19 items. Each item is weighted on a 0-3 interval scale. The global PSQI score is then calculated by totaling the seven component scores, providing an overall score ranging from 0 to 21, where lower scores denote a healthier sleep quality.	Measured at baseline and after 12 weeks
Self-reported health and wellbeing	Assessed from the questionnaire Self-reported Health (SF-12 health survey). SF-12 consists of 12 items. Scores range from 0 to 100, with higher scores indicating better physical and mental health functioning. A score of 50 or less on the Physical Component Summary has been recommended as a cut-off to determine a physical condition; while a score of 42 or less on the Mental Component Summary may be indicative of 'clinical depression'.	Measured at baseline and after 12 weeks.
Self-reported sleepiness	Assessed from the questionnaire the Epworth Sleepiness Scale. The questionnaire consists of 8 questions, which is weighted on a 0-3 interval scale. A low total score can be interpreted as a normal daytime sleepiness, and a higher score as a mild, moderate and severe excessive daytime sleepiness, respectively.	Measured at baseline and after 12 weeks.
Self-reported chronotype	Assessed from the questionnaire Munich Chronotype Questionnaire (MCTQ). The questionnaire consists of 17 questions to identify type of chronotype. The MCTQ uses the midpoint between sleep on- and offset on free days (mid-sleep on free days) to assess chronotype.	Measured at baseline and after 12 weeks.
Self-reported food intake	Assessed from questionnaire Food Frequency Questionnaire. The questionnaire collects dietary data and uses a context-specific food list to estimate the usual diet. The questionnaire consists of 15 items with sub questions. Output is total energy intake and macronutrient composition.	Measured at baseline and after 12 weeks
Self-reported night eating	Assessed from questionnaire The Night Eating Questionnaire. The questionnaire consists of 14 items, that can be rated from 0 to 4. All items except item 13 are summed to obtain a global score. A total score ≥ 25 has been proposed as a lenient threshold for night eating syndrome.	Measured at baseline and after 12 weeks.
Self-reported eating behavior	Assessed from questionnaire The Dutch Eating Behavior Questionnaire. It consists of 33 items and comprises three scales that measure emotional, external and restrained eating.Items can be rated from 1 (never) to 5 (very often), with higher scores indicating greater endorsement of the eating behavior.	Measured at baseline and after 12 weeks.
Self-reported control over eating	Assessed from the questionnaire Control over Eating Questionnaire. It comprises 21 items designed to assess the intensity and type of food cravings an individual experiences, as well as subjective sensations of appetite and mood. Each item can be rated from 1 to 5 on a continuous scale. a lower scale. A higher score indicate less control over eating.	Measured at baseline and after 12 weeks.
Self-reported fatigue/tiredness	Assessed from questionnaire Fatigue Assessment Scale (FAS). The questionnaire consists of 10 items. Each item can be rated from 1 to 5. The total score ranges from 10 to 50. A total FAS score < 22 indicates no fatigue, a score ≥ 22 indicates fatigue.	Measured at baseline and after 12 weeks.
Self-reported information on social relations and support	Assessed from 8 selected items on social relations and support from The Danish National Health Survey. Item 1-7 provides information on how often a person is in contact with other people (family, husband/wife, partners, friends, neighbors, etc.), and can be rated from 'daily or almost daily', 'once or twice weekly', 'once or twice monthly', 'less than once monthly' to 'never'. Item 8 provides information on whether a person has somebody to talk to if he/she has problems or needs support, and can be rated 'yes, always', 'yes, mostly', 'yes, sometimes', and 'no, never or almost never'.	Measured at baseline and after 12 weeks.
Self-reported diabetes distress	Assessed from the Problem Areas in Diabetes Scale (PAID-5 scale) comprising five of the emotional-distress questions of the full PAID items. Each item can be rated from 0 to 4. A total score of ≥ 8 indicates possible diabetes related emotional distress.	Measured at baseline and after 12 weeks.
Self-reported well-being	Assessed from the WHO (Five) Well-being Index. The WHO-5 consists of five statements, which respondents rate from 0 to five (in relation to the past two weeks).The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being.	Measured at baseline and after 12 weeks
Self-reported diabetes management	Assessed from 9 selected items on diabetes management from the The Danish National Patient Reported Outcome Questionnaire, version 1.05. The items can be rated from 'very sure/confident' to 'not sure/confident at all'.	Measured at baseline and after 12 weeks.
Sexual satisfaction	Assessed from 1 item on sexual satisfaction from the questionnaire The Danish National Health Survey. The item addresses to which degree a persons sexual needs are covered. The item can be rated from 'to a very high degree' to 'not at all'.	Measured at baseline and after 12 weeks.
Sexual functioning	Assessed from 4 items on sexual functioning from the Danish National Patient Reported Outcome Questionnaire, version 1.05. Item 1 can be rated 'yes' or 'no'. 'Yes' represents problems with sexual functioning. Item 2-4 can be rated from 'not at all' to 'extreme', where extreme represents problems with sexual functioning.	Measured at baseline and after 12 weeks.

Collaborators and Investigators

• Sponsor: Kristine Færch
• Collaborators: University of Copenhagen; University of Leeds; Hvidovre University Hospital; Salk Institute for Biological Studies

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2022
• Primary Completion (Actual): November 15, 2022
• Study Completion (Actual): November 15, 2022

Study Registration Dates

• First Submitted: March 27, 2022
• First Submitted That Met QC Criteria: May 10, 2022
• First Posted (Actual): May 17, 2022

Study Record Updates

• Last Update Posted (Actual): November 17, 2022
• Last Update Submitted That Met QC Criteria: November 16, 2022
• Last Verified: November 1, 2022

More Information

Terms related to this study

• Keywords: obesity; overweight; type 2 diabetes; circadian rhythm; fasting; time-restricted eating
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: H-21041830

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

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