Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Obermayer, A.
Nonpharmacological interventions for weight reduction in people with type 2 diabetes
PhD-Studium (Doctor of Philosophy); Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2023. pp. 96
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Sourij Harald
- Stadlbauer-Köllner Vanessa
- Altmetrics:
- Abstract:
- With the steady increase in people with obesity and type 2 diabetes mellitus, simple and cost-effective therapies are needed to support people with their blood glucose control and weight management. Reducing body weight is a key strategy to reduce the risk of diabetes. In obese and pre-diabetic individuals, weight loss of 5-7% improves typical diabetes risk parameters, including fasting glucose and insulin sensitivity. Although this advice sounds simple, in daily practice it is very difficult to achieve lasting weight loss. Delaying the absorption of food, as by the Endobarrier™ duodenal-jejunal bypass liner, or time-limited food intake could help. A thorough exploration of clinical parameters by means of physical examination, blood sampling and dual-energy X-ray absorptiometry when using the Endobarrier™ and during fasting may help to personalize and adapt dietary recommendations for people with type 2 diabetes. The aim of this work was to explore different ways of modulating metabolism in people with type 2 diabetes and to test their practical application. The Endobarrier pilot study of 10 people investigated the effects of implantation of the duodenal-jejunal bypass liner (Endobarrier™) on the glucose metabolism in people with obesity and type 2 diabetes. The Endobarrier™ was implanted for 36 weeks and the effects on blood glucose and weight were studied. At 24 weeks after explantation, the parameters were measured again to investigate the longer-term effects after removal of the Endobarrier™. The PhD thesis project "Interfast 2" investigated the effect of 12 weeks of intermittent fasting compared to standard therapy in people with insulin-treated type 2 diabetes mellitus. It was an unblinded, randomized controlled trial with 46 people. The fasting group practiced intermittent fasting on 3 non-consecutive days (75% caloric restriction) but had no caloric restriction on the remaining 4 days. The primary objective was to investigate the effects of intermittent fasting in people with insulin-treated T2DM. The secondary objective of this study was to identify clinical and metabolic changes in individuals with T2DM after intermittent fasting. The Endobarrier™ achieved weight loss as early as 4 weeks, which was maintained throughout 9 months of follow-up and persisted 6 months after explantation. In the Interfast 2 study, there was a reduction in HbA1c, weight and insulin dose in the fasting group compared to the control group. In the fasting group, both muscle and bone mass were preserved with a significant reduction in fat mass. Exercise and resting metabolic rate were comparable in both groups and did not change significantly over the study period. Intermittent fasting is a viable dietary option for individuals with insulin-treated T2DM with the prospect of lowering HbA1c levels while reducing total daily insulin dose and body fat. Both the Endobarrier™ and intermittent fasting offer non-pharmacological treatment options for individuals to control their body weight and blood glucose.