Effects of nutrition therapy on HbA1c and cardiovascular disease risk factors in overweight and obese patients with type 2 diabetes

Adham Mottalib, Veronica Salsberg, Barakatun-Nisak Mohd-Yusof, Wael Mohamed, Padraig Carolan, David M Pober, Joanna Mitri, Osama Hamdy, Adham Mottalib, Veronica Salsberg, Barakatun-Nisak Mohd-Yusof, Wael Mohamed, Padraig Carolan, David M Pober, Joanna Mitri, Osama Hamdy

Abstract

Background: Nutrition Therapy (NT) is essential in type 2 diabetes (T2D) management. Standards of care recommend that each patient engages with a nutritionist (RDN) to develop an individualized eating plan. However, it is unclear if it is the most efficient method of NT. This study evaluates the effects of three different methods of NT on HbA1c and cardiovascular disease risk factors in overweight and obese patients with T2D.

Methods: We randomized 108 overweight and obese patients with T2D (46 M/62F; age 60 ± 10 years; HbA1c 8.07 ± 1.05%; weight 101.4 ± 21.1 kg and BMI 35.2 ± 7.7 kg/m2) into three groups. Group A met with RDN to develop an individualized eating plan. Group B met with RDN and followed a structured meal plan. Group C did similar to group B and received weekly phone support by RDN.

Results: After 16 weeks, all three groups had a significant reduction of their energy intake compared to baseline. HbA1c did not change from baseline in group A, but decreased significantly in groups B (- 0.66%, 95% CI -1.03 to - 0.30) and C (- 0.61%, 95% CI -1.0 to - 0.23) (p value for difference among groups over time < 0.001). Groups B and C also had significant reductions in body weight, body fat percentage and waist circumference.

Conclusion: Structured NT alone improves glycemia in comparison to individualized eating plans in overweight and obese patients with T2D. It also reduces other important cardiovascular disease risk factors like body fat percentage and waist circumference.

Trial registration: The trial was retrospectively registered at clinicaltrials.gov( NCT02520050 ).

Keywords: Clinical nutrition; Diabetes management; Lifestyle intervention; Nutrition therapy; Weight management.

Conflict of interest statement

Ethics approval and consent to participate

The Committee on Human Subjects at Joslin Diabetes Center approved the study design (Protocol CHS# 2014–40). The trail was registered at Competing interests

OH is on advisory board of Astra Zeneca, Inc. and is consultant to Merck Inc. He is shareholder of Healthimation, LLC. He receives research grants from Novo-Nordisk, Inc., Intracia, Inc., Abbott, Inc. and the National Dairy Council. JM receives research grants the National Dairy Council. AM, VS, B-NM-Y, WM, PC and DP report no conflicts of interest related to this work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of study enrollment
Fig. 2
Fig. 2
Change in HbA1c (a) and body weight (b) from baseline in response to different methods of nutrition therapy. Values are mean ± SEM. Group A: individualized nutrition therapy, Group B: Structured nutrition therapy, Group C: Structured nutrition therapy + weekly phone support. n = 36 in each group. * p < 0.01 and ** p < 0.001 compared to baseline
Fig. 3
Fig. 3
Change in: mean daily energy intake (a); percentage of energy intake from carbohydrates (CHO), fat and protein (b) in response to different methods of nutrition therapy. Group A: individualized nutrition therapy, Group B: Structured nutrition therapy, Group C: Structured nutrition therapy + weekly phone support. n = 36 in each group. * p < 0.05, ** p < 0.01, compared to baseline

References

    1. Herman WH, Zimmet P. Type 2 diabetes: an epidemic requiring global attention and urgent action. Diabetes Care. 2012;35:943–944. doi: 10.2337/dc12-0298.
    1. Caballero B. The global epidemic of obesity: an overview. Epidemiol Rev. 2007;29:1–5. doi: 10.1093/epirev/mxm012.
    1. Eckel RH, Kahn SE, Ferrannini E, Goldfine AB, Nathan DM, Schwartz MW, Smith RJ, Smith SR. Obesity and type 2 diabetes: what can be unified and what needs to be individualized? J Clin Endocrinol Metab. 2011;96:1654–1663. doi: 10.1210/jc.2011-0585.
    1. Bhupathiraju SN, Hu FB. Epidemiology of obesity and diabetes and their cardiovascular complications. Circ Res. 2016;118:1723–1735. doi: 10.1161/CIRCRESAHA.115.306825.
    1. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS., Jr Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Suppl 1):S120–S143. doi: 10.2337/dc14-S120.
    1. ADA . Standards of medical Care in Diabetes—2017. Diabetes care. 2017. Lifestyle Management. Sec. 4; pp. S33–S43.
    1. Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, Dagogo-Jack S, DeFronzo RA, Einhorn D, Fonseca VA. Consensus statement by the American Association of Clinical Endocrinologists and American College of endocrinology on the comprehensive type 2 diabetes management algorithm–2016 executive summary. Endocr Pract. 2016;22:84–113. doi: 10.4158/EP151126.CS.
    1. Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care. 2002;25:608–613. doi: 10.2337/diacare.25.3.608.
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of diabetes. Diabetes Care. 2015;38:140–149. doi: 10.2337/dc14-2441.
    1. ADA . Standards of medical Care in Diabetes—2016. Diabetes care. 2016. Foundations of care and comprehensive medical evaluation. Sec. 3; pp. S23–S35.
    1. Camelon KM, Hadell K, Jamsen PT, Ketonen KJ, Kohtamaki HM, Makimatilla S, Tormala ML, Valve RH. The plate model: a visual method of teaching meal planning. DAIS project group. Diabetes atherosclerosis intervention study. J Am Diet Assoc. 1998;98:1155–1158. doi: 10.1016/S0002-8223(98)00267-3.
    1. Giusti J, Rizzotto JA. Interpreting the Joslin Diabetes Center and Joslin clinic clinical nutrition guideline for overweight and obese adults with type 2 diabetes. Curr Diab Rep. 2006;6:405–408. doi: 10.1007/s11892-006-0014-y.
    1. Yang YJ, Kim MK, Hwang SH, Ahn Y, Shim JE, Kim DH. Relative validities of 3-day food records and the food frequency questionnaire. Nutr Res Pract. 2010;4:142–148. doi: 10.4162/nrp.2010.4.2.142.
    1. Monzillo LU, Hamdy O. Evaluation of insulin sensitivity in clinical practice and in research settings. Nutr Rev. 2003;61:397–412. doi: 10.1301/nr.2003.dec.397-412.
    1. Karagiannis T, Paschos P, Paletas K, Matthews DR, Tsapas A. Dipeptidyl peptidase-4 inhibitors for treatment of type 2 diabetes mellitus in the clinical setting: systematic review and meta-analysis. BMJ. 2012;344:e1369.
    1. Group LAR Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;2013:145–154.
    1. Pronk NP, Remington PL, on behalf of the Community Preventive Services Task F Combined diet and physical activity promotion programs for prevention of diabetes: community preventive services task force recommendation statement. Ann Intern Med. 2015;163:465–468. doi: 10.7326/M15-1029.
    1. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115:1447–1463. doi: 10.1016/j.jand.2015.02.031.
    1. Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, Williamson D, Berkowitz RI, Kelley DE, Tomchee C, Hill JO, Kumanyika S. The look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006;14:737–752. doi: 10.1038/oby.2006.84.
    1. Raynor HA, Anderson AM, Miller GD, Reeves R, Delahanty LM, Vitolins MZ, Harper P, Mobley C, Konersman K, Mayer-Davis E. Partial meal replacement plan and quality of the diet at 1 year: action for health in diabetes (look AHEAD) trial. J Acad Nutr Diet. 2015;115:731–742. doi: 10.1016/j.jand.2014.11.003.
    1. Mottalib A, Mohd-Yusof B-N, Shehabeldin M, Pober D, Mitri J, Hamdy O. Impact of diabetes-specific nutritional formulas versus oatmeal on postprandial glucose, insulin, GLP-1 and postprandial Lipidemia. Nutrients. 2016;8:443. doi: 10.3390/nu8070443.
    1. Van Loon LJ, Kruijshoop M, Menheere PP, Wagenmakers AJ, Saris WH, Keizer HA. Amino acid ingestion strongly enhances insulin secretion in patients with long-term type 2 diabetes. Diabetes Care. 2003;26:625–630. doi: 10.2337/diacare.26.3.625.
    1. Nuttall FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P. Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care. 1984;7:465–470. doi: 10.2337/diacare.7.5.465.
    1. Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342:1392–1398. doi: 10.1056/NEJM200005113421903.
    1. Hamdy O, Zwiefelhofer D. Weight management using a meal replacement strategy in type 2 diabetes. Curr Diab Rep. 2010;10:159–164. doi: 10.1007/s11892-010-0103-9.
    1. Wadden TA, West DS, Neiberg RH, Wing RR, Ryan DH, Johnson KC, Foreyt JP, Hill JO, Trence DL, Vitolins MZ, Look ARG One-year weight losses in the look AHEAD study: factors associated with success. Obesity (Silver Spring) 2009;17:713–722. doi: 10.1038/oby.2008.637.
    1. Wadden TA, Neiberg RH, Wing RR, Clark JM, Delahanty LM, Hill JO, Krakoff J, Otto A, Ryan DH, Vitolins MZ, Look ARG Four-year weight losses in the look AHEAD study: factors associated with long-term success. Obesity (Silver Spring) 2011;19:1987–1998. doi: 10.1038/oby.2011.230.
    1. Emadian A, Andrews RC, England CY, Wallace V, Thompson JL. The effect of macronutrients on glycaemic control: a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups. Br J Nutr. 2015;114:1656–1666. doi: 10.1017/S0007114515003475.

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