Effects of Dietary Instructions Including Meal-Sequence for Prediabetes Subjects—Comparison with Conventional Approach
Authors: YABE DAISUKE , KUWATA HITOSHI , FUJIWARA YUUKA , MUROTANI KENTA , ITO SANAE , ASANO HIROSHI , MISHIMA HIDEYUKI , TAKASE HIDETO , OOTA NORIYASU , SEINO YUSUKE , HAMAMOTO YOSHIYUKI , KUROSE TAKESHI , SEINO YUTAKA 
Published: June 2018

Aims: In addition to total energy intake and nutritional balance, meal-sequence is an emerging focus in dietary instructions for individuals with diabetes. However, the effectiveness of dietary instructions including meal-sequence among prediabetes subjects awaits investigation.
Methods: The experiment was a multi-center, open label, cluster randomized trial. Prediabetes subjects received conventional dietary instructions (Group A) or dietary instructions including meal-sequence (Group B) after randomization and were monitored for their observance of the designated dietary instructions by public nurses through e-mail every month. Before and 6 months after dietary instructions, the subjects received physical and blood examinations as well as food frequency questionnaires.
Results: A total of 29 prediabetes subjects completed the study. Bodyweight was reduced in Group B, along with reduced total energy and fat intake 6 months after dietary instructions. Visceral fat was reduced in both groups, while FPG was reduced only in Group B. HbA1c and 1, 5-anhydroglucitol were largely unchanged in both groups.
Conclusion: The current findings show that dietary instructions including meal-sequence are more effective than conventional instructions in reducing bodyweight among prediabetes subjects.Changes of selected outcome measures (*, p&lt;0.05 vs. Group A; #, p&lt;0.05 vs. 0 month)Group A (n=11)Group B (n=18)0 month6 monthDelta0 month6 monthDeltaBMI (kg/m2)25.6±0.3925.9±0.500.32±0.1626.1±0.5926.0±0.74-0.17±0.15*Bodyweight (Kg)75.7±1.576.6±1.60.90±0.4879.7±2.279.2±2.1-0.53±0.48*Visceral fat area (cm2)153.5±5.5140.9±9.0-12.6±5.4#159.2±7.0149.5±5.8-9.7±4.1#Fasting plasma glucose (mg/dL)111.0±4.9107.4±5.5-3.6±2.4115.6±2.3109.3±2.9-6.3±1.9#HbA1c (%)6.00±0.176.07±0.150.07±0.075.94±0.085.99±0.080.05±0.041, 5-anhydroglucitol (µg/mL)21.84±2.8320.71±2.74-1.13±0.5220.59±2.2020.42±2.29-0.17±0.34

Disclosure
D. Yabe: Speaker's Bureau; Self; MSD K.K., Novo Nordisk Pharma Ltd., Takeda Pharmaceutical Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd.. Research Support; Self; Nippon Boehringer Ingelheim Co. Ltd., Eli Lilly and Company, MSD K.K., Ono Pharmaceutical Co., Ltd., Arkray, Inc., Taisho Toyama Pharmaceutical Co., Ltd., Novo Vordisk Pharma Ltd., Takeda Pharamaceutical Co., Ltd.. H. Kuwata: None. Y. Fujiwara: None. K. Murotani: None. S. Ito: None. H. Asano: None. H. Mishima: Employee; Self; Kansai Electric Power Co.,Inc. H. Takase: Employee; Self; Kao Corporation. N. Oota: Employee; Self; Kao Corporation. Y. Seino: None. Y. Hamamoto: None. T. Kurose: Consultant; Self; Sanofi, Ono Pharmaceutical Co., Ltd.. Other Relationship; Self; Abbott. Consultant; Self; Taisho Pharmaceutical Co., Ltd.. Other Relationship; Self; Takeda Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Novartis Pharma K.K. Y. Seino: Speaker's Bureau; Self; MSD K.K., Kao Corporation, Taisho Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Taisho Toyama Pharamceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Nippon Becton Dickinson Co., Ltd., Novo Nordisk Pharma Ltd.. Research Support; Self; Terumo Medical Corporation, Bayer Yakuhin, Ltd., Boehringer Ingelheim GmbH, Arkray, Inc., Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Novo Nordisk Pharma Ltd..