Abstract Body

Dietary modifications are crucial for managing newly-diagnosed type-2 diabetes mellitus (T2DM) and preventing its health complications, but many patients fail to achieve clinical goals with diet alone.

We previously developed a machine-learning algorithm for predicting personalized postprandial glucose responses (PPGR) to meals using clinical and gut microbiome features, and showed that dietary interventions based on this algorithm successfully lowered PPGRs in adults with prediabetes. Here, we sought to evaluate the clinical effects of a personalized postprandial-targeting (PPT) diet on glycemic control and metabolic health in individuals with newly-diagnosed T2DM.

We preformed a short-term randomized controlled crossover trial and compared the effects of an algorithm-based personalized postprandial-targeting (‘PPT’) diet, to those of a commonly used Mediterranean-style (MED) diet on glucose levels in 23 newly diagnosed T2DM subjects. The PPT diet lead to significant decrease in glycemic parameters as compared to the MED diet, for example, average PPGR (mean difference between diets, -19.8±16.3 mg/dl×h, p<0.001), mean glucose (mean difference between diets, -7.8±5.5mg/dl, p<0.001), daily time of glucose levels >140mg/dl (mean difference between diets, -2.42±1.7 hour/day, p<0.001) and blood fructosamine (mean change difference between diets, -16.4±37μmol/dl, p<0.0001). We further evaluated the long-term clinical effects of the PPT diet in 16 of the participants by an additional 6-month PPT intervention program, and found significant improvements in multiple metabolic health parameters, including HbA1c (mean±SD, -0.39±0.48%, p<0.001), fasting plasma glucose (FPG) (-16.4±24.2mg/dl, p=0.02) , fasting insulin (-2.3±4.0MCU/ml, p=0.04), triglycerides (-49±46mg/dl, p<0.001) and body composition measurements including body fat% (-2.5±3%, p=0.005) and waist circumference (-4.7±3.7cm, p=0.001). Importantly, 61% of the participants exhibited diabetes remission at the end of the intervention, as measured by HbA1c. Finally, we show that some of the improvements in clinical outcomes were accompanied by significant alterations to the gut microbiome composition per person.

Our findings suggest that a personalized postprandial-targeting diet may be an effective alternative treatment compared to standard dietary approaches for improving glycemic control in newly diagnosed T2DM.