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The Effect of an Online Plant-Based Dietary Program on Cardiovascular Risk Factors in Persons With Type 2 Diabetes Mellitus: A Randomized Controlled Trial (Plate-DM)

Primary Purpose

Diabetes Mellitus, Type 2, Diet, Vegetarian, Diet, Vegan

Status
Recruiting
Phase
Not Applicable
Locations
Netherlands
Study Type
Interventional
Intervention
12-week plant-based dietary program
Usual Diet
Sponsored by
UMC Utrecht
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 2

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria Diagnosis of Type 2 Diabetes made by a physician Using oral glucose-lowering medication and/or an insulin regime with a stable dose during at least the last two months before the screening visit; Diagnosis of type 2 diabetes was made more than one year ago Age of 18 years or older on the day of signing the informed consent form. When the patients is also using lipid-lowering and/or blood pressure-lowering medication, than the dose should be stable for at least two months before the screening. Exclusion criteria Insulin-dependent type 2 diabetes in combination with hypoglycemia unawareness. Hypoglycemia unawareness is defined as the onset of hypoglycemia before the appearance of autonomic symptoms or failure to recognize hypoglycemia. Two or more episodes of severe hypoglycemia (glucose < 3 mmol/L) during the last 3 months; Uncontrolled T2D, defined as a HbA1c >86 mmol/mol (>10%); Uncontrolled hypertension, defined as an office systolic blood pressure ≥ 180mmHg; Inability to attend at least 60% of the scheduled meetings; Pregnancy or a wish to get pregnant during the study period; Diagnosis of familial hypercholesterolemia; Being diagnosed with osteoporosis. Known vitamin B12 deficiency, defined as serum vitamin B12 <130 pmol/L or using vitamin B12 supplements prescribed by a physician; Known iron deficiency defined as a serum ferritin < 25µg/L for males or < 20µg/L for females or using iron supplements prescribed by a physician;; The presence of any disease for which the patients uses a specific diet and where transitioning to a plant-based diet might lead to unfavorable effects on this disease as judged by the research team and/or the treating physician. An exception is a salt-restricted diet for hypertension; Current or planned participation in any other interventional study within 30 days of signing the informed consent form; Any medical, social or physiological circumstance which might interfere with the study, based on judgement by the principal investigator.

Sites / Locations

  • Department of Vascular Medicine UMC UtrechtRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

An online 12 week plant-based dietary program

Usual Diet

Arm Description

Outcomes

Primary Outcome Measures

Change in HbA1c (mmol/mol)
Composite of Estimated relative CVD risk (based on change in LDL-c , SBP and HbA1c)

Secondary Outcome Measures

Calculated absolute CVD risk reduction (%)
Using baseline parameters (e.g. baseline LDL-C, BP, HbA1c, manifest CVD, duration of diabetes) and the risk prediction model DIAL2/SCORE-2(OP), the absolute CVD risk at baseline is calculated. The expected absolute risk reduction is calculated using changes in CVD risk profile after 12 and 24 weeks
HbA1c and estimated change in absolute and relative CVD risk (based on change in LDL-c, SBP and HbA1c)
Per-protocol analysis
Glycemic control (HOMA2-IR, HOMA2-B%, TyG-index, NAFLD Score)
Lipids and lipoprotein profile
Composition and concentration of lipoproteins and lipids, including total cholesterol, HDL-cholesterol, apolipoprotein-B, LDL-C and triglycerides
Blood pressure (systolic and diastolic)
Inflammatory profile (CRP, neutrophil and lymphocyte count)
Quality of life(EQ-5D, self-perceived stress,and DDRQOL-R(-9), medication use)
Anthropometric measurements (BMI, hip/waist ratio)
Adherence (dietary index)
Rate of Vitamin B12 and ferritin deficiency

Full Information

First Posted
December 27, 2022
Last Updated
March 8, 2023
Sponsor
UMC Utrecht
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1. Study Identification

Unique Protocol Identification Number
NCT05777746
Brief Title
The Effect of an Online Plant-Based Dietary Program on Cardiovascular Risk Factors in Persons With Type 2 Diabetes Mellitus: A Randomized Controlled Trial
Acronym
Plate-DM
Official Title
The Effect of an Online Plant-Based Dietary Program on Cardiovascular Risk Factors in Persons With Type 2 Diabetes Mellitus: A Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 29, 2022 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
June 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
UMC Utrecht

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Persons with Type 2 Diabetes (T2D) are at an increased risk of cardiovascular disease (CVD) and mortality. Dietary changes are recommended by guidelines to treat T2D and reduce risk of CVD. Plant-based diets eliminate certain (i.e. vegetarian diet) or eliminate all animal based products (i.e. vegan diet). Clinical trials with plant-based diets have not looked at incidence of CVD as a (primary) outcome, but at intermediate outcomes of cardiovascular risk. A meta-analysis of 8 trials including 369 persons with T2D found an effect of a plant-based diet on glycated hemoglobin (HbA1c) of -0.29% [95% CI: -0.45, -0.12%] relative to mostly (omnivorous) low-fat diets or usual diet. The 95%CI ranged from what the authors had defined as clinically trivial to clinically relevant. For lipids, a network meta-analysis in persons with T2D compared the effect of a plant-based diet to a (omnivorous) low fat diet (274 patients allocated to a plant-based diet vs 2047 patients allocated to low fat diets). Compared to omnivorous low fat diets, the mean effect of plant-based diets on LDL-Cholesterol was -0.33 mmol/L [95%CI:- 0.55, - 0.12]. However, the quality of the evidence for this estimate was graded as low, mainly due to imprecision and within-study-bias. Furthermore, plant-based diets might reduce blood pressure (BP). However, while vegetarian diets reduce BP in patients with and without hypertension, for vegan diets the effect was only significant in patients with a systolic BP>130mmHgz (see section 1.4.3). Additionally, the effect of plant-based diets on inflammation, which might also be causally related to CVD risk in persons with T2D, has not been reported in trials with persons with T2D. Furthermore, most clinical trials of plant-based diets in persons with T2D have used resource intensive interventions, like weekly group meetings and cooking sessions. The effect of an online plant-based dietary intervention, which is more scalable, has not been reported in clinical trials. Lastly, factors influencing adherence in these trials have not been reported. In summary, plant-based diets likely lower CVD risk by lowering HbA1c, LDL cholesterol and potentially blood pressure in persons with T2D. However, estimated effect sizes are imprecise and the effect on inflammation is still unknown. Furthermore, trials to date have used resource intensive interventions. Thus, the present trial aims to study the effect of a primarily online plant-based dietary program on (cardio)vascular risk factors in persons with T2D. Additionally, adherence and factors influencing adherence will be investigated. Participants will be randomized to the intervention or control group. The intervention group will be guided to transition to a plant-based dietary pattern using an online platform and online sessions. Researchers will compare the intervention group to the control group, that continues with usual diet, to see if the cardiovascular risk profile of the intervention group improves.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2, Diet, Vegetarian, Diet, Vegan, Cardiometabolic Risk Factors, Cholesterol, LDL, Blood Pressure, Glycemic Control, Diet Therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
InvestigatorOutcomes Assessor
Masking Description
An investigator and outcome assessor blinded design is chosen to reduce bias. All investigators collecting data by physical examination will be blinded to the allocation of the patients. Similarly, lab technicians performing the blood measurements will be blinded to the patient allocation. Lastly, the statistical analyses will be performed blinded to the allocation of patient groups.
Allocation
Randomized
Enrollment
140 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
An online 12 week plant-based dietary program
Arm Type
Experimental
Arm Title
Usual Diet
Arm Type
Other
Intervention Type
Behavioral
Intervention Name(s)
12-week plant-based dietary program
Intervention Description
a 12-week plant-based dietary program consisting of information via an online platform, online guidance by dieticians and in online peer support groups. Patients will aim to maximize their intake of plant-based products while reducing their of animal products as much as possible.
Intervention Type
Behavioral
Intervention Name(s)
Usual Diet
Intervention Description
Patients in the control group continue with their usual diet and/or usual dietary care. Patients in the control group will be offered access to the online platform at 24 weeks.
Primary Outcome Measure Information:
Title
Change in HbA1c (mmol/mol)
Time Frame
Week 12
Title
Composite of Estimated relative CVD risk (based on change in LDL-c , SBP and HbA1c)
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Calculated absolute CVD risk reduction (%)
Description
Using baseline parameters (e.g. baseline LDL-C, BP, HbA1c, manifest CVD, duration of diabetes) and the risk prediction model DIAL2/SCORE-2(OP), the absolute CVD risk at baseline is calculated. The expected absolute risk reduction is calculated using changes in CVD risk profile after 12 and 24 weeks
Time Frame
Week 12, 24 and 36
Title
HbA1c and estimated change in absolute and relative CVD risk (based on change in LDL-c, SBP and HbA1c)
Description
Per-protocol analysis
Time Frame
Week 12, 24 and 36
Title
Glycemic control (HOMA2-IR, HOMA2-B%, TyG-index, NAFLD Score)
Time Frame
Week 12 and 24
Title
Lipids and lipoprotein profile
Description
Composition and concentration of lipoproteins and lipids, including total cholesterol, HDL-cholesterol, apolipoprotein-B, LDL-C and triglycerides
Time Frame
Week 12 and 24
Title
Blood pressure (systolic and diastolic)
Time Frame
Week 12 and 24
Title
Inflammatory profile (CRP, neutrophil and lymphocyte count)
Time Frame
Week 12 and 24
Title
Quality of life(EQ-5D, self-perceived stress,and DDRQOL-R(-9), medication use)
Time Frame
Week 12 and 24
Title
Anthropometric measurements (BMI, hip/waist ratio)
Time Frame
Week 12, 24 and 36
Title
Adherence (dietary index)
Time Frame
Week 12, 24 and 36
Title
Rate of Vitamin B12 and ferritin deficiency
Time Frame
Week 12 and 24
Other Pre-specified Outcome Measures:
Title
Subgroup analysis
Description
Subgroups will be made on the basis of baseline characteristics (e.g. age, level of education, gender, presence of hypertension, duration of T2D, use of insulin, BMI, HbA1c)
Time Frame
Week 12 and 24
Title
Effect modification by diabetes subtype and adherence to the plant-based diet
Time Frame
Week 12 and 24
Title
Determinants of adherence
Description
Patient characteristics
Time Frame
Week 12 and 24
Title
Determinants of adherence
Description
Based on outcome of the Food Choice questionnaire
Time Frame
Week 12 and 24
Title
Determinants of adherence
Description
Based on outcome of the Self-Efficacy questionnaire
Time Frame
Week 12 and 24
Title
Determinants of adherence
Description
Based on outcome of the in-group identification questionnaire
Time Frame
Week 12 and 24
Title
Effect of the 12-week online dietary program on the CVD risk profile in the control group
Time Frame
Week 36
Title
Incident Hypoglycemia
Description
Incidence of mild and severe hypoglycemia
Time Frame
Week 12 and 24
Title
Physical Activity (Metabolic Equivalent Tasks)
Description
Measured using the SQUASH questionnaire
Time Frame
Week 12 and 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria Diagnosis of Type 2 Diabetes made by a physician Using oral glucose-lowering medication and/or an insulin regime with a stable dose during at least the last two months before the screening visit; Diagnosis of type 2 diabetes was made more than one year ago Age of 18 years or older on the day of signing the informed consent form. When the patients is also using lipid-lowering and/or blood pressure-lowering medication, than the dose should be stable for at least two months before the screening. Exclusion criteria Insulin-dependent type 2 diabetes in combination with hypoglycemia unawareness. Hypoglycemia unawareness is defined as the onset of hypoglycemia before the appearance of autonomic symptoms or failure to recognize hypoglycemia. Two or more episodes of severe hypoglycemia (glucose < 3 mmol/L) during the last 3 months; Uncontrolled T2D, defined as a HbA1c >86 mmol/mol (>10%); Uncontrolled hypertension, defined as an office systolic blood pressure ≥ 180mmHg; Inability to attend at least 60% of the scheduled meetings; Pregnancy or a wish to get pregnant during the study period; Diagnosis of familial hypercholesterolemia; Being diagnosed with osteoporosis. Known vitamin B12 deficiency, defined as serum vitamin B12 <130 pmol/L or using vitamin B12 supplements prescribed by a physician; Known iron deficiency defined as a serum ferritin < 25µg/L for males or < 20µg/L for females or using iron supplements prescribed by a physician;; The presence of any disease for which the patients uses a specific diet and where transitioning to a plant-based diet might lead to unfavorable effects on this disease as judged by the research team and/or the treating physician. An exception is a salt-restricted diet for hypertension; Current or planned participation in any other interventional study within 30 days of signing the informed consent form; Any medical, social or physiological circumstance which might interfere with the study, based on judgement by the principal investigator.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
F.L.J. Visseren, MD PhD
Phone
+31 88 7555555
Email
f.l.j.visseren@umcutrecht.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Lukas Hoes, MD
Email
l.l.f.hoes-4@umcutrecht.nl
Facility Information:
Facility Name
Department of Vascular Medicine UMC Utrecht
City
Utrecht
ZIP/Postal Code
3584 CX
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frank LJ Visseren, MD PhD
Phone
+31 88 7555555
Email
F.L.J.Visseren@umcutrecht.nl
First Name & Middle Initial & Last Name & Degree
Frank LJ Visseren, MD PhD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Request for IPD should be directed to the PI. The PI will judge whether request are appropriate and can be granted within the existing rules and regulations.
Links:
URL
https://www.umcutrecht.nl/nl/wetenschappelijk-onderzoek/plate-dm
Description
Plate-DM UMC Utrecht

Learn more about this trial

The Effect of an Online Plant-Based Dietary Program on Cardiovascular Risk Factors in Persons With Type 2 Diabetes Mellitus: A Randomized Controlled Trial

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