LoBAG30 Diet in Patients on Metformin (LoBAG Diet)

US Department of Veterans Affairs (VA)

Status: Terminated

Conditions: Diabetes Mellitus; Diet

Treatments: Other: LoBAG30 diet; Other: Control Diet

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT00607867

CLIN-010-07F

Details and patient eligibility

About

We will determine the metabolic response to a Low Biologically Available Glucose Diet (LoBAG30) in subjects currently receiving the maximum dose of metformin as monotherapy in whom the glycohemoglobin is not at an acceptable level (>8.0%). Our hypothesis is that introduction of a LoBAG30 diet to subjects currently treated with a full therapeutic dose of metformin will improve blood glucose control in people who have not achieved an acceptable total glycohemoglobin on metformin alone.

Full description

Subjects will ingest a control diet (55% carbohydrate (CHO), 15% protein, 30% fat) or a LoBAG30 diet (30% CHO, 30% protein, 40% fat) in a parallel design with block randomization in pairs of two. Subjects will return to the study center twice each week while on the diets to have blood glucose, glycohemoglobin, lactate, weight and blood pressure measured, and to have urine assayed for urea and creatinine. At the beginning and end of the 5 week study period, the subjects will be admitted to the study center for 28 hours during which time blood will be drawn for 24 hour profiles of glucose, insulin, other hormones and several metabolites. For those subjects randomized to the LoBAG30 arm of the study, the control diet will be given during the first 24 hour study period; the assigned diet will be given at the end of the 5 week period.

Enrollment: 20 patients

Sex: All

Ages: 50 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• People with type 2 diabetes mellitus who currently are receiving the maximal dose of metformin monotherapy (2500 mg/day).
• These subjects will have had a stable glycohemoglobin (tGHb) in an unacceptably high range (8-11%) for at least 4 months prior to beginning the study.
• Subjects with tGHB > 11% (HbA1c > 10%) will not be recruited into the study.

Exclusion criteria

• Hematological abnormalities

• liver disease

• kidney disease

• macroalbuminuria (>300 mg albumin/24 hours)

• untreated thyroid disease

• congestive heart failure

• angina

• life-threatening malignancies

• proliferative retinopathy

• severe diabetic neuropathy

• peripheral vascular disease

• serious psychological disorders

• a body mass index > 35

• and a fasting triglyceride of >400 mg/dl.

  • Subjects taking slow-release metformin will not be studied.
  • Subjects taking medications other than metformin, known to affect fuel metabolism such as:

• insulin

• the sulfonylureas

• glucagon-like peptide 1 (GLP-1) analogs and metabolic inhibitors

• pramlintide

• prednisone and similar steroids

• thyroid hormone

• antipsychotic medications

• thiazide diuretics

• medroxyprogesterone

• high dose aspirin, also will be excluded.

  • If concentrations of serum folate, B12 or iron are low, the subject will be excluded from the study until corrected, i.e. until normal concentrations are recorded.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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20 participants in 2 patient groups, including a placebo group

Arm 1

Active Comparator group

Description:

A LoBAG30, weight maintenance diet will be given to subjects on metformin. All food will be provided for 5 weeks.

Treatment:

Other: LoBAG30 diet

Arm 2

Placebo Comparator group

Description:

A weight maintenance, control diet consisting of 55% carbohydrate, 15% protein, 30% fat will be given to subjects on metformin. All food will be provided for 5 weeks.

Treatment:

Other: Control Diet