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- Sperimentazione clinica NCT03258918
A Low-Carbohydrate Diabetes Prevention Program
A Mixed Methods Pilot Study of a Low-Carbohydrate Diabetes Prevention Program Among Individuals With Prediabetes
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
An estimated 86 million US adults are have prediabetes, and, without intervention, many will develop T2DM over time. Fortunately, T2DM can be prevented or delayed through modest lifestyle changes. The landmark Diabetes Prevention Program (DPP) Trial demonstrated a 58 percent reduction in the 3-year incidence of T2DM among individuals with prediabetes who achieved 7 percent body weight loss and engaged in routine physical activity. Accordingly, the DPP lifestyle intervention has been translated to communities across the United States, and, on average, participant weight change is 4 percent at 12 months. Thus, while group-based DPPs and can effectively promote weight loss among some participants, many DPP participants do not achieve the program goal of 5 to 7 percent body weight loss.
Novel strategies to help participants achieve DPP weight-loss goals are important for two key reasons. First, weight loss is the primary driver of T2DM risk reduction, and the potential population health impact of the intervention is diminished when participants do not lose weight. Second, a growing number of health plans including Medicare offer coverage for the DPP and proposed reimbursement is largely tied to weight loss of at least 5 percent at 6 months and 12 months. The DPP costs approximately $400-$500 per participant per year. Unfortunately, organizations that offer the DPP may be reimbursed for much less than this if participants do not meet weight loss goals, which could significantly compromise the program's long-term financial sustainability.
One promising approach to help DPP participants lose more weight may be through a low-carbohydrate (LC) dietary intervention. Consistent with United States Dietary Guidelines (USDG), the original DPP Trial and translational group-based curricula recommend a low-fat (LF), calorie-restricted diet. However, there is growing controversy regarding the scientific merit of the Dietary Guidelines as well as growing recognition that LC diets may be more effective than LF diets for short-term weight loss and long-term weight maintenance. Notably, weight loss occurs without calorie restriction and LC diets improve blood glucose levels among individuals with T2DM and insulin resistance. Thus, a LC dietary intervention for prediabetes may augment individual weight loss and T2DM risk reduction while also maximizing third-party reimbursement.
The aim of this mixed methods pilot study is to test whether a LC-DPP may lead to greater weight loss than the original DPP. In addition to objective measures of this program's preliminary efficacy (e.g. weight, HbA1c) the study team will also obtain qualitative participant feedback on the intervention. Taken together, these data will be used to improve the curriculum and inform a larger-scale intervention.
Tipo di studio
Iscrizione (Effettivo)
Fase
- Non applicabile
Contatti e Sedi
Luoghi di studio
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Michigan
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Ann Arbor, Michigan, Stati Uniti, 48109
- Michigan Medicine
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion criteria:
- Overweight, defined as BMI≥25 kg/m2 [31]
- HbA1c between 5.7-6.4% drawn within 6 months of the study start date
- Willingness to participate in group-based classes
- Able to engage in at least light physical activities such as walking.
Exclusion criteria:
- History of type 1 diabetes or type 2 diabetes
- Current participation in another lifestyle or behavior change program or research study
- Vegetarian or vegan lifestyle
- History of bariatric surgery
- Inability to read, write, or speak English
- Inability to provide informed consent
- Women who are pregnant or intend to become pregnant during the intervention period.
- Insured by Premier Care or Grad Care; these individuals have the opportunity to participate in a standard DPP, which is offered as a covered benefit through their health plan.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Prevenzione
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
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Sperimentale: Low-Carbohydrate Diabetes Prevention Program
At least 20 individuals with prediabetes will participate in a year-long , group-based program.
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LC-DPP participants will be instructed to follow ad-libitum very low-carbohydrate, ketogenic diet, which restricts carbohydrate intake (not including fiber) to 20-35 grams per day with the goal of achieving nutritional ketosis.
Participants will be encouraged to eat a normal amount of protein (roughly 80-120 grams per day) and to derive the remaining calories from fat.
Allowable foods include: meats, fish, poultry, eggs, cheese, seeds, nuts, leafy greens, non-starchy vegetables, and some fruits.
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
Change in body weight per participant over the study period
Lasso di tempo: Baseline, 12 months
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Measured as percent body weight loss per participant
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Baseline, 12 months
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Percentage of participants who achieve weight loss goal
Lasso di tempo: Baseline,12 months
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Measured as percentange of participants who achieve 5% total body weight loss
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Baseline,12 months
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
Change in self-reported weekly physical activity minutes
Lasso di tempo: Baseline, 12 months
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Participants will maintain a log of weekly physical activity minutes
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Baseline, 12 months
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Change in physical activity measured using the International Physical Activity Questionnaire
Lasso di tempo: Baseline, 12 months
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Participants will complete this validated survey
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Baseline, 12 months
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Change in food cravings measured using the Control of Eating Questionnaire
Lasso di tempo: Baseline, 12 months
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Participants will complete this validated survey
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Baseline, 12 months
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Change in stress eating measured using the Palatable Eating Motives Scale
Lasso di tempo: Baseline, 12 months
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Participants will complete this validated survey
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Baseline, 12 months
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Change in self-reported health measured using the Global Health PROMIS Questionnaire
Lasso di tempo: Baseline, 12 months
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Participants will complete this validated survey
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Baseline, 12 months
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Change in autonomous motivation measured using the Treatment Self-Regulation Questionnaire
Lasso di tempo: Baseline, 12 months
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Participants will complete this validated survey
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Baseline, 12 months
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Change in hemoglobin A1c
Lasso di tempo: Baseline, 12 months
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Measured using a laboratory blood draw
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Baseline, 12 months
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Session attendance
Lasso di tempo: Baseline, 12 months
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Measured as the number of sessions attended per participant
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Baseline, 12 months
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Study attrition
Lasso di tempo: Baseline, 12 months
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Number of participants lost to follow-up
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Baseline, 12 months
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Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
Change in diet as assessed by qualitative review of foods logs
Lasso di tempo: Baseline, 12 months
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Participants will maintain weekly food logs
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Baseline, 12 months
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Change in diet as assessed by response to survey questions
Lasso di tempo: Baseline, 12 months
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Participants will respond to exploratory survey questions about diet created by the study team.
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Baseline, 12 months
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Change in physical symptoms
Lasso di tempo: Baseline, 12 months
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Participants will respond to exploratory survey questions about physical symptoms created by the study team.
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Baseline, 12 months
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Collaboratori e investigatori
Sponsor
Collaboratori
Pubblicazioni e link utili
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Inizio studio (Effettivo)
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- F046400
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Prove cliniche su Low-Carbohydrate Diabetes Prevention Program
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University of Southern CaliforniaThe Leona M. and Harry B. Helmsley Charitable TrustCompletatoDiabete mellito di tipo 1Stati Uniti