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Cellular and Physiological Nutrition/Metabolism

Clinical and Translational Nutrition

Session: 2024 George Bray Outstanding Scientific Achievements Award in Obesity Research Lecture and Student Awards: The Discovery of GLP-1 as a Satiety Hormone and Implications for Management of Obesity

(AL02-01-24) Adaptive Dietary and Exercise Strategies for Adults With Prediabetes Trial (ADAPT): A Sequential Multiple Assignment Randomized Trial

Sunday, June 30, 2024
11:00 AM – 11:15 AM CT
Location:  W375E
George Bray ELPC
Objectives: Dietary carbohydrate restriction, time restricted eating (TRE), and exercise (Ex) are commonly used strategies for weight loss and improving glycemic control. However, the optimal combination and sequence of these strategies is unclear.

Methods: ADAPT was a 16-week group-based weight loss Sequential Multiple Assignment Randomized Trial (SMART). Ninety adults with BMI ≥27 kg/m2 and prediabetes were initially randomized to either a reduced carbohydrate (RC) or high carbohydrate (HC) diet. Participants achieving < 2.5% weight loss at week 4 (non-responders) were re-randomized to augment their dietary prescriptions with either TRE or Ex counseling. Linear mixed models were used to compare 1st (RC vs. HC) and 2nd (TRE vs. Ex) stage interventions and the resulting 4 embedded adaptive interventions (EAI) were rank ordered for changes in weight, fasting glucose and glycated hemoglobin (A1c).

Results: Among the 82 participants (53.8 ± 11.7 years, 84.3% female, BMI 38.3 ± 7.2 kg/m2) who completed week 4, 55.4% (n=46) were re-randomized to TRE (n=22) or Ex (n=24). There was no difference in weight loss between HC and RC (-0.18 kg, 95%CI: -2.21, -1.86, P=0.87). Fasting glucose improved more with HC compared to RC (-13.10 mg/dL, 95%CI: -19.90, -6.630, P=0.0002), but changes in A1c were not different (-0.02%, 95%CI: -0.15, 0.11, P=0.73). Among non-responders, augmenting with TRE or Ex did not significantly affect changes in weight (-0.21 kg, 95%CI: -2.32, 1.90, P=0.85), fasting glucose (-8.39 mg/dL, 95%CI: -17.9, 1.11, P=0.084), or A1c (-0.13%, 95%CI: -0.31, 0.04, P=0.14). The EAI initiating with a HC diet and adding Ex counseling for non-responders produced the quantitatively largest reductions in weight (-4.77 kg, 95%CI: -6.16, -3.39), fasting glucose (-18.6 mg/dL, 95%CI: -29.2, -8.0), and A1c (-0.21%, 95%CI: -0.35, -0.07).

Conclusions: Initiating behavioral weight loss with a HC diet prescription was more effective for reducing fasting glucose in people with prediabetes compared to a RC diet despite similar weight loss. The lack of a meaningful impact of TRE or Ex counseling suggests that more intensive strategies (e.g., food provision and supervised exercise) may be needed for early non-responders to counseling-based dietary weight loss programs.

Funding Sources: Funded by General Mills, Inc. Additional support from UAB NORC (P30DK056336).