Can DNA-based diets improve blood sugar levels in people at high risk of type 2? New study needs participants to find out the answer

Diabetes UK | August 2021 | Can DNA-based diets improve blood sugar levels in people at high risk of type 2?

Adult over 18 with prediabetes could help contribute to research to test a new type of diet that might improve blood sugar levels and potentially prevent the development of type 2 diabetes in this population. The new diet is tailored to a person’s particular genetic makeup- a DNA-based diet.

Researchers at Imperial College are looking for participants who will be randomised to three different groups: one group will receive special dietary guidelines via an app and wearable wristband or via a dietitian, or usual care which is standard dietary advice for people at risk of developing type 2 diabetes the study will run for 26 weeks.

Further information is available from Diabetes UK

Risk of Progression to Diabetes Among Older Adults With Prediabetes

Rooney MR, Rawlings AM, Pankow JS, et al. | 2021| Risk of Progression to Diabetes Among Older Adults With Prediabetes. JAMA Intern Med. doi:10.1001/jamainternmed.2020.8774

This study explores the question: What is the risk of progression to diabetes among older adults with prediabetes (based on glycated hemoglobin level of 5.7 per cent-6.4 per cent, fasting glucose levels of 100-125 mg/dL, either, or both) in a community-based population?

It sought to compare the prevalence of prediabetes—based on glycated hemoglobin (HbA1c) levels, fasting glucose (FG) levels, either, or both—and examine progression from normoglycemia to prediabetes or diabetes and progression from prediabetes to diabetes in a community-based cohort of older adults from the Atherosclerosis Risk in Communities (ARIC) Study.

The cohort study followed more than 3 000 adults the prevalence of prediabetes (mean [SD] age, 75.6 [5.2] years) was high and differed substantially depending on the definition used, with estimates ranging from 29 per cent for glycated hemoglobin levels of 5.7 per cent to 6.4 per cent to 73 per cent for either glycated hemoglobin levels of 5.7 per cent to 6.4 per cent or fasting glucose levels of 100 to 125 mg/dL. During the 6 years of follow-up, death or regression to normoglycemia from prediabetes was more frequent than progression to diabetes.

They find that prediabetes may not be a robust diagnostic entity in older age. As although prediabetes was common, during the 6.5-year follow-up period, fewer than 12 per cent of older adults progressed from prediabetes to diabetes, regardless of the definition of prediabetes. In addition, a substantial proportion of individuals with prediabetes at baseline regressed to normoglycemia at the follow-up visit (1 among those with fasting glucose levels of 100-125 mg/dL). Indeed, in older adults with prediabetes, regression to normoglycemia or death was more common than progression to diabetes during the study period.

Paper available from JAMA Internal Medicine

Metformin Should Not Be Used to Treat Prediabetes

Davidson, M.B. (2020)| Metformin Should Not Be Used to Treat Prediabetes | Diabetes Care| DOI: 10.2337/dc19-2221


Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110-125 vs. 100-109 mg/dL (6.1-6.9 vs. 5.6-6.0 mmol/L) and A1C levels 6.0-6.4% (42-46 mmol/mol) vs. less than 6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes-i.e., those with FPG concentrations of 110-125 mg/dL (6.1-6.9 mmol/L) or A1C levels of 6.0-6.4% (42-46 mmol/mol) or women with a history of gestational diabetes mellitus-should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.

Rotherham NHS staff can request a copy of this article from the Library