Effects of a 13-Week Personalized Lifestyle Intervention Based on the Diabetes Subtype for People with Newly Diagnosed Type 2 Diabetes

Abstract

A type 2 diabetes mellitus (T2DM) subtyping method that determines the T2DM phenotype based on an extended oral glucose tolerance test is proposed. It assigns participants to one of seven subtypes according to their β-cell function and the presence of hepatic and/or muscle insulin resistance. The effectiveness of this subtyping approach and subsequent personalized lifestyle treatment in ameliorating T2DM was assessed in a primary care setting. Sixty participants, newly diagnosed with (pre)diabetes type 2 and not taking diabetes medication, completed the intervention. Retrospectively collected data of 60 people with T2DM from usual care were used as controls. Bodyweight (p < 0.01) and HbA1c (p < 0.01) were significantly reduced after 13 weeks in the intervention group, but not in the usual care group. The intervention group achieved 75.0% diabetes remission after 13 weeks (fasting glucose ≤ 6.9 mmol/L and HbA1c < 6.5% (48 mmol/mol)); for the usual care group, this was 22.0%. Lasting (two years) remission was especially achieved in subgroups with isolated hepatic insulin resistance. Our study shows that a personalized diagnosis and lifestyle intervention for T2DM in a primary care setting may be more effective in improving T2DM-related parameters than usual care, with long-term effects seen especially in subgroups with hepatic insulin resistance.

Personalized Versus Non-personalized Nutritional Recommendations/Interventions for Type 2 Diabetes Mellitus Remission: A Narrative Review

“…For instance, one study delivered a precision nutrition intervention [ 19 ] based on participants’ postprandial glucose responses measured through continuous glucose monitoring (a personalized postprandial-targeting [PPT] diet). Another study personalized the diet on the basis of diabetes subtypes [ 20 ], while another developed individual dietary plan including calorie restriction and specific exercise prescriptions intending to achieve a BMI ≤ 25 [ 21 ]. Yet another study reported using a personalized dietary intervention, but did not describe how it was personalized nor the participants’ characteristics.…”

“…In a study by de Hoogh et al, 75% of the participants in the personalized intervention group experienced remission at 13 weeks, compared to only 22% of their usual care group peers [ 20 ]. In this study, seven subtypes of diabetes were identified on the basis of their beta cell function and the presence of hepatic and/or muscle insulin resistance: (1) reduced beta cell function (PB), (2) hepatic insulin resistance (HIR), (3) muscle insulin resistance (MIR), (4) a combination of muscle and liver IR (CIR), (5) PB and HIR, (6) PB and MIR, and (7) PB and CIR [ 20 ].…”

“…In a study by de Hoogh et al, 75% of the participants in the personalized intervention group experienced remission at 13 weeks, compared to only 22% of their usual care group peers [ 20 ]. In this study, seven subtypes of diabetes were identified on the basis of their beta cell function and the presence of hepatic and/or muscle insulin resistance: (1) reduced beta cell function (PB), (2) hepatic insulin resistance (HIR), (3) muscle insulin resistance (MIR), (4) a combination of muscle and liver IR (CIR), (5) PB and HIR, (6) PB and MIR, and (7) PB and CIR [ 20 ]. The classification of subgroups was based on clinical and biochemical data, utilizing glucose and insulin responses to the oral glucose test (OGTT) to calculate indices such as disposition index, Matsuda index, hepatic insulin resistance index, and muscle insulin sensitivity index.…”

Digital Biomarkers for Personalized Nutrition: Predicting Meal Moments and Interstitial Glucose with Non-Invasive, Wearable Technologies

“…Full remission into a healthy glucose metabolism through lifestyle medicine is well achievable, especially in the early phase preceding the disease. Multiple studies, indeed, have shown that lifestyle medicine is only successful in achieving T2D remission in a pre- or less advanced stage of the disease, but often fails in persons who have a more advanced, irreversible stage of T2D, especially those with β-cell dysfunction or combined tissue insulin resistance [ 19 , 20 , 21 ]. Therefore, early diagnosis and intervention are essential for reducing the societal burden of T2D.…”

Diabetes: A Multifaceted Disorder

“…The second one is an intervention study, which evaluated a 13-week personalized lifestyle intervention in newly diagnosed type 2 diabetes mellitus. The results showed an improvement in type 2 diabetes mellitus parameters compared with patients who received usual care [ 10 ]. The final two studies are narrative reviews devoted to the treatment of diabetes mellitus.…”