Differential effects of lifestyle interventions on continuous glucose monitoring metrics in persons with type 2 diabetes: Potential for personalised treatment

Aims: The effects of lifestyle on glucose metabolism significantly differ between individuals. Hyperglycaemia in type 2 diabetes is driven by tissue-specific insulin resistance and reduced beta-cell capacity, whose relative contribution varies between persons, potentially affecting the impact of lifestyle interventions. We quantified effects of lifestyle on continuously measured glucose (CGM) metrics and evaluated how these differ between type 2 diabetes subtypes. Materials and methods: This is a repeated-measures study with 40 persons with type 2 diabetes. Participants wore a CGM for 11 self-monitoring periods of 4 days, of which 3 were control and 4 were duplicated intervention periods (2× low carbohydrate diet, 2× Mediterranean diet, 2× walking after each meal and 2× 'active day' (hourly 5-min exercise bouts)). The order of the intervention periods was randomised. Tissue-specific insulin resistance and beta-cell function were quantified using an OGTT and were used to assign participants to diabetes subtypes or 'diabetypes'. A linear mixed effects model quantified lifestyle impact on CGM metrics. Results: On average, a low carbohydrate diet, walking after meals, and an active day, but not the Mediterranean diet, resulted in lower mean glucose (-0.95 (CI: -1.13, -0.77), -0.28 (CI: -0.46, -0.1), -0.2 (CI: -0.38, -0.02) and -0.13 (CI: -0.13, 0.05) mmol/L, respectively) as compared with control (8.73 mmol/L, CI: 8.02-9.44) in participants who did not restrict carbohydrate intake at baseline. Preliminary analysis suggests the magnitude and direction of effects may vary between diabetypes. Conclusions: Traditional lifestyle interventions improved CGM metrics within 4 days. Preliminary analysis suggests the effects may vary depending on the diabetes phenotype.