Microbiome-based diet may improve metabolic markers in early type 2 diabetes
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An algorithm-based, personalized diet based on gut microbiome features and clinical data may improve glycemic response and other metabolic parameters for adults with newly diagnosed type 2 diabetes, data show.
“Our dietary approach was not intended for weight loss and did not include caloric restriction, regardless of the participants’ BMI,” Michal S. Rein, a doctoral student and researcher with the Eran Segal Lab at the Weizmann Institute of Science, and the School of Public Health at Haifa University, Israel, told Healio. “We were enthusiastic to find that there was significant weight loss during the 6-month intervention part of the study. Notably, although weight management has an important role in glycemic control, half of the participants who did not lose weight still exhibited improvements in HbA1c and other glycemic measures.”
Dietary modifications are crucial for the management of newly diagnosed type 2 diabetes and prevention of its health complications, but many people reach clinical goals with diet alone, Orly Ben-Yacov, RD, PhD, a registered dietitian and researcher with the Eran Segal Lab at the Weizmann Institute of Science, said during a presentation at the virtual American Diabetes Association Scientific Sessions. The researchers previously developed a machine learning algorithm for predicting personalized postprandial glucose responses to meals using clinical and gut microbiome features, and showed that dietary interventions based on this algorithm successfully lowered postprandial glucose responses in adults with prediabetes.
“Here, we sought to evaluate the clinical efficacy of our algorithm-based diet in people with newly diagnosed type 2 diabetes,” Ben-Yacov said during the presentation.
In a short-term, randomized controlled, crossover trial, researchers compared the effect of an algorithm-based personalized postprandial-targeting (PPT) diet with a commonly used Mediterranean diet on glucose levels in 23 participants with newly diagnosed type 2 diabetes who were naive to glucose-lowering medications. Participants went through a profiling phase, providing stool samples for microbiome analysis and food logs via a mobile app. The intervention included limited meals from a meal bank generated for the study, with scores based on diet principles for each treatment.
“For the PPT diet, meals were scored based on the algorithm predictions, and in the Mediterranean diet, they were scored based on the Mediterranean principles,” Ben-Yacov said.
Participants in both arms wore continuous glucose monitors throughout the study.
Compared with the Mediterranean diet, average postprandial glucose response, glucose fluctuations, daily time spent with a glucose level above 140 mg/dL and fructosamine levels all decreased significantly more during the PPT intervention, Ben-Yacov said.
In a long-term analysis of clinical effects of the PPT diet among 16 participants with an additional 6-month PPT intervention, researchers observed improvements in multiple clinical parameters, including HbA1c (mean decrease, –0.39%; P < .001), fasting glucose (mean decrease, –16.4 mg/dL; P = .02), fasting insulin (mean decrease, –2.3 µIU/mL; P = .04), triglycerides (mean decrease, –49 mg/dL; P < .001), body weight (mean decrease, –3 kg; P = .005), body fat percentage (mean decrease, –2.5%; P = .005) and waist circumference (mean decrease, –4.7 cm; P = .001).
“Importantly, 61% of the participants exhibited diabetes remission at the end of the intervention, as measured by HbA1c,” the researchers wrote in an abstract.
Ben-Yacov said some of the improvements in clinical outcomes were accompanied by significant alterations to the gut microbiome composition.
“In a short-term intervention, the PPT intervention improved CGM-based glycemic measures more than a Mediterranean diet, and also improved blood fructosamine levels more than the Mediterranean diet,” Ben-Yacov said.
Nastya Godneva, MSc, a data analyst in the Segal lab, said the intervention improved other metabolic outcomes, which suggests the treatment is safe, and that researchers found that that greater adherence to the intervention resulted in greater glycemic improvements.
"When it comes to managing health with the help of big data, we are only at the beginning of this journey, but it is promising and exciting,” Godneva told Healio.
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Rein MS, et al. 9-OR. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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