Prediabetes is a leading risk factor for the development of type 2 diabetes mellitus (T2DM) and its metabolic complications. Current practice for prevention of diabetes includes weight loss-targeting dietary and lifestyle modifications but has had limited success. Alternative approaches, such as dietary interventions that directly target blood glucose levels for prevention of T2DM, are not well established and have been much less studied. In particular, postprandial (post-meal) glucose responses (PPGR) are a major determinant of glycemic control, but dietary methods for controlling PPGRs are rare and show limited efficacy. We previously recruited a population-based cohort of 900 people in which we continuously tracked blood glucose and obtained clinical and gut microbiota measurements. Our data of ∼50,000 PPGRs revealed that different people have vastly different responses to the same meal. We devised a machine learning algorithm based on clinical and microbiome features that accurately predicted personalized PPGRs to any food combination. Here, we sought to evaluate the long-term clinical efficacy of a dietary intervention based on our algorithm in prediabetes, and test the hypothesis that a dietary treatment that targets meal PPGR can lead to long-term improvements in glycemic control and other metabolic outcomes, as compared to a standard Mediterranean-style diet. To this end, we conducted a 6-month randomized controlled diet intervention trial (RCT) followed by a 6-month post-intervention follow-up program, and randomly assigned 225 adults with prediabetes to receive a Mediterranean-style (Med) diet or a Personalized Postprandial-targeting (PPT) diet. At 6 months, mean daily time of glucose levels above 140 mg/dl changed by -29% and -65% in the Med diet and PPT diet, respectively (p=3.4x10-10). Mean HbA1c% levels changed by -0.08% and -0.16% in the Med diet and PPT diet, respectively (p=6.9x10-3). The favorable effects of the ’PPT diet’ on glycemic control persisted also at one year follow up.


O. Ben-Yacov: None. A. Godneva: None. E. Segal: Consultant; Self; DayTwo.

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