PPT outshines Mediterranean diet for improving glucose control in prediabetes

Following a personalized postprandial-targeting (PPT) diet appears to result in better glycaemic control among individuals with prediabetes as compared with Mediterranean (MED) diet, a study reports.

A total of 225 adults with prediabetes were randomized to adhere to a MED diet or a PPT diet during a 6-month dietary intervention, with an additional 6-month follow-up. The PPT diet predicted individual postprandial glucose responses with the help of a machine learning algorithm that integrated clinical and microbiome features of the participant.

All participants were instructed to connect to continuous glucose monitoring (CGM) for the entire duration of the intervention. In addition, they reported dietary intake using a smartphone application.

The mean age of the cohort was 50 years, and 58.7 percent were women. At baseline, the mean body mass index was 31.3 kg/m², mean HbA1c was 5.9 percent (41 mmol/mol), and the mean fasting plasma glucose was 114 mg/dL (6.33 mmol/L).

Of the patients, 200 (89 percent) completed the 6-month intervention and 177 had complete 12-month follow-up data. Both dietary interventions reduced the daily time with glucose levels >140 mg/dL (7.8 mmol/L) and HbA1c levels. However, the changes were substantially greater with PPT than with MED.

Specifically, the mean 6-month change in “time above 140” was −0.3 h/day with MED and −1.3 h/day with PPT (p<0.001). The corresponding mean 6-month change in HbA1c was −0.08 percent (−0.9 mmol/mol) and −0.16 percent (−1.7 mmol/mol; p=0.007).

The observed between-group differences remained significant at the 12-month follow-up. Results for a CGM-measured oral glucose tolerance test showed no significant difference between MED and PPT.

The present data may inform dietary advice in clinical practice.