Intermittent Fasting to Improve Insulin Secretion

NCT ID: NCT04607096

Last Updated: 2024-05-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-08

Study Completion Date

2025-03-01

Brief Summary

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Type 2 diabetes (T2D) mellitus is a challenge for health care systems as the numbers increases constantly. In 2014, 422 million people had been living with diabetes worldwide. The absolute numbers of people with prediabetes have also grown substantially over 25 years worldwide. In Germany, about 10% of the population has T2D and another 21 % of the population has prediabetes.Overall, 16% of all deaths in Germany are attributable to type 2 diabetes. Macro- and microvascular complications of diabetes imply a significant threat for the patients and are already present in the prediabetic state. Short term and long term complications, the burden of treatment, and reduced quality of life are major burdens of the disease. Accumulating data indicate that currently recommended therapeutic diet regimens in patients with obesity and diabetes are not sustainable on the long term. Novel concepts are therefore urgently needed.

T2D occurs when insulin secretion from pancreatic beta-cells cannot sufficiently be increased to compensate for insulin resistance. Causes of beta-cell dysfunction are heterogeneous. In addition, the most important determinants of diabetes remission are the extend of weight loss and restoration of beta-cell function. In the course of diabetes progression, the inability to recover insulin secretion might identify the state of no return to normal glucose tolerance. It is therefore crucial to improve insulin secretion in treatment and prevention of diabetes. Up to now lifestyle intervention trials in prediabetes or pharmacological intervention trials in diabetes did not show improvement of insulin secretion after intervention. However, one recent small human trial shows that intermittent fasting (early time restricted fasting) is able to improve insulin secretion.Currently, there are no trials that examine the effect of intermittent fasting in individuals with a broad range of impaired glucose metabolism (from prediabetes to diabetes). Recently novel subtypes of diabetes and prediabetes with high risk for the early manifestation of diabetes complications have been identified. Currently, prevention strategies for this high risk individuals have not been examined yet. We will study for the first time the effectiveness of 4 weeks intermittent fasting on changes in insulin secretion capacity in subphenotypes of diabetes and in prediabetes.

Detailed Description

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Conditions

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PreDiabetes Diabetes type2 Intermittent Fasting Insulin Secretion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants wil either receive a control diet or join the intermittent fasting group stratified by glycemia (prediabetes/diabetes) as well as by subphenotype.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Prediabetic subjects - cluster 3

Presence of a cluster 3 phenotype will be examined according to the parameters described by Wagner et al.(Nat. Med. 2020).

Group Type ACTIVE_COMPARATOR

Intermittent fasting

Intervention Type BEHAVIORAL

The intermittent fasting intervention consists of a decreased daily caloric intake of 400 kcal below individual requirements (Harris Benedict Formula) combined with early time restricted fasting according to the schema 16:8. fasting will be performed over 4 weeks.

Control diet

Intervention Type BEHAVIORAL

Control group will be advised to reduce daily caloric intake of 400 kcal below individual requirements (Harris Benedict formula)

Prediabetic subjects - cluster 5

Presence of a cluster 5 phenotype will be examined according to the parameters described by Wagner et al.(Nat. Med. 2020).

Group Type ACTIVE_COMPARATOR

Intermittent fasting

Intervention Type BEHAVIORAL

The intermittent fasting intervention consists of a decreased daily caloric intake of 400 kcal below individual requirements (Harris Benedict Formula) combined with early time restricted fasting according to the schema 16:8. fasting will be performed over 4 weeks.

Control diet

Intervention Type BEHAVIORAL

Control group will be advised to reduce daily caloric intake of 400 kcal below individual requirements (Harris Benedict formula)

Patients with type 2 diabetes - subphenotype: Severe insulin-deficient diabetes (SIDD)

Presence of a SIDD phenotype will be examined according to the parameters de-scribed Ahlqvist et al. (Lancet Diabetes Endocrinol. 2018 May;6(5):361-369).

Group Type ACTIVE_COMPARATOR

Intermittent fasting

Intervention Type BEHAVIORAL

The intermittent fasting intervention consists of a decreased daily caloric intake of 400 kcal below individual requirements (Harris Benedict Formula) combined with early time restricted fasting according to the schema 16:8. fasting will be performed over 4 weeks.

Control diet

Intervention Type BEHAVIORAL

Control group will be advised to reduce daily caloric intake of 400 kcal below individual requirements (Harris Benedict formula)

Patients with type 2 diabetes - subphenotype: Severe insulin-resistant diabetes (SIRD)

Presence of a SIRD phenotype will be examined according to the parameters de-scribed Ahlqvist et al (Lancet Diabetes Endocrinol. 2018 May;6(5):361-369).

Group Type ACTIVE_COMPARATOR

Intermittent fasting

Intervention Type BEHAVIORAL

The intermittent fasting intervention consists of a decreased daily caloric intake of 400 kcal below individual requirements (Harris Benedict Formula) combined with early time restricted fasting according to the schema 16:8. fasting will be performed over 4 weeks.

Control diet

Intervention Type BEHAVIORAL

Control group will be advised to reduce daily caloric intake of 400 kcal below individual requirements (Harris Benedict formula)

Interventions

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Intermittent fasting

The intermittent fasting intervention consists of a decreased daily caloric intake of 400 kcal below individual requirements (Harris Benedict Formula) combined with early time restricted fasting according to the schema 16:8. fasting will be performed over 4 weeks.

Intervention Type BEHAVIORAL

Control diet

Control group will be advised to reduce daily caloric intake of 400 kcal below individual requirements (Harris Benedict formula)

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Body mass index (BMI) between 25 - 40 kg/m²
* Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures.
* Subjects with prediabetes (IFG and/or IGT, HbA1c 5,4 % - 6,4 %, subphenotype cluster 3 or 5) or
* Subjects with diabetes mellitus type 2 (diagnosis \< 1 year, HbA1c = 6,5 - 9 %, no medical treatment, subphenotype SIDD or SIRD)

Exclusion Criteria

* Subjects with diabetes mellitus type 1 (GAD-, IA2-AB positive)
* Women during pregnancy and lactation
* Treamtent with any medication effecting on glucose metabolism like anti-diabetic drugs or steroids
* Subjects with a haemoglobin (Hb) ≤ 11.5 g/dl (for males) and Hb ≤ 10.5 g/dl (for females) at screening
* Any pancreatic disease
* Medical history of cancer and/or treatment for cancer within the last 5 years.
* Known current presence or history of severe neurological or psychiatric diseases, schizophrenia, bipolar disorder
* Known history of bariatric surgery
* Severe liver or kidney diseases (Alanine Aminotransferase (ALT \[SGPT\]), Aspartate Aminotransferase (AST \[SGOT\]) above 3 x upper limit of normal (ULN) or Glomerular Filtration Rate (eGFR) ≤ 60 ml/min (MDRD formula)
* Systemic infection (CRP \> 1 mg/dl)
* Severe diabetic complications like chronic kidney disease (CKD), proliferating retinopathy or symptomatic cardiovascular disease
* Presence of any contraindication for the conduct of an MRI investigation, such as cardiac pacemakers, ferromagnetic haemostatic clips in the central nervous system, metallic splinters in the eye, ferromagnetic or electronically operated active devices like automatic cardioverter defibrillators, cochlear implants, insulin pumps and nerve stimulators, prosthetic heart valves etc.
* Persons with limited temperature sensation and / or elevated sensitivity to warming of the body
* Persons with a hearing disorder or a increased sensitivity for loud noises
* Claustrophobia
* Participation in other clinical trials or observation period of competing trials up to 30 days prior to this study
* Refusal to get informed of unexpected detected pathological findings
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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German Institute of Human Nutrition

OTHER

Sponsor Role collaborator

Charite University, Berlin, Germany

OTHER

Sponsor Role collaborator

University Hospital Carl Gustav Carus

OTHER

Sponsor Role collaborator

University of Leipzig

OTHER

Sponsor Role collaborator

Ludwig-Maximilians - University of Munich

OTHER

Sponsor Role collaborator

University Hospital Heidelberg

OTHER

Sponsor Role collaborator

University of Luebeck

OTHER

Sponsor Role collaborator

German Diabetes-Center, Leibniz-Institut in Düsseldorf

OTHER

Sponsor Role collaborator

German Center for Diabetes Research

OTHER

Sponsor Role collaborator

University Hospital Tuebingen

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Charité Berlin - Department of Endocrinology and Metabolic Diseases

Berlin, , Germany

Site Status NOT_YET_RECRUITING

Universtiy Hospital Carl Gustav Carus

Dresden, , Germany

Site Status NOT_YET_RECRUITING

German Diabetes Center

Düsseldorf, , Germany

Site Status NOT_YET_RECRUITING

Heidelberg University Hospital - Department of Endocrinology and Metabolism

Heidelberg, , Germany

Site Status NOT_YET_RECRUITING

University Hospital Leipzig - Clinic for Endocrinology and Nephrology

Leipzig, , Germany

Site Status NOT_YET_RECRUITING

University of Luebeck - Institute of Endocrinology and Diabetes

Lübeck, , Germany

Site Status NOT_YET_RECRUITING

Technical University of Munich - Else Kroener-Fresenius-Center for Nutritional Medicine

Munich, , Germany

Site Status NOT_YET_RECRUITING

University Hospital Tuebingen - Institute for Diabetes Research and Metabolic Diseases (IDM)

Tübingen, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Andreas Fritsche, MD

Role: CONTACT

+49 7071 29 80590

Michael Roden, MD

Role: CONTACT

+49 211 3382 201

Facility Contacts

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Joachim Spranger, MD

Role: primary

+49 30 450 514 252

Peter Schwarz, MD

Role: primary

+49 (0) 351 458271

Michael Roden, MD

Role: primary

+49 211 3382 201

Julia Szendrödi, MD

Role: primary

+49 (0) 6221 56-8601

Matthias Blüher, MD

Role: primary

+49 (0)341 - 97 13320

Sebastian Schmid, MD

Role: primary

Hans Hauner, MD

Role: primary

+49 (0) 8928924911

Andreas Fritsche, MD

Role: primary

+49 7071 29 80590

References

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Heilmann G, Trenkamp S, Moser C, Bombrich M, Schon M, Yurchenko I, Strassburger K, Rodriguez MM, Zaharia OP, Burkart V, Wagner R, Roden M. Precise glucose measurement in sodium fluoride-citrate plasma affects estimates of prevalence in diabetes and prediabetes. Clin Chem Lab Med. 2023 Oct 24;62(4):762-769. doi: 10.1515/cclm-2023-0770. Print 2024 Mar 25.

Reference Type DERIVED
PMID: 37870928 (View on PubMed)

Other Identifiers

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596/2020BO1

Identifier Type: -

Identifier Source: org_study_id

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