Saim Mahmood Khan, MBBS; Jawairya Muhammad Hussain, MBBS; Iman Azam, MBBS
WMJ. 2024;123(4):247.
Having read “Feasibility Study of a Low-Carbohydrate/Time-Restricted Eating Protocol for Insulin-Using Type 2 Diabetic Patients” by Zimmermann et al,1 we acknowledge the significant effort and valuable contributions made in this area of research. The writers’ outstanding work provides a strong basis, and our suggestions are meant to expand its impact and reach in this area.
Diabetes is a major health problem and a significant risk factor for cardiovascular diseases, chronic kidney disease, peripheral arterial disease, and diabetic retinopathy.2 Behind these interventions’ clinical outcomes, the article could benefit from a deeper exploration of the mechanistic underpinnings.
Different mediators, such as insulin-like growth hormone receptor, growth factor-1, and insulin-like growth factor binding protein, affect carbohydrate metabolism under the influence of growth hormone secretions. These growth hormone mediators may have a direct or indirect effect on insulin sensitivity and insulin secretion, which could lead to type 2 diabetes formation and its natural history.3 Addressing the effect of growth hormone on this method could have improved the study, especially given the wide age range of 18 to 80 years among the participants.
Although the study covers a range of measures, such as A1C levels, body weight, and mental well-being, thorough analysis of further relevant factors like mean glucose level, time in euglycemic range, medication effect score,1,2 body composition (measured by dual-energy x-ray absorptiometry), plasma lipid levels, dietary intake, dietary adherence, and weekly adverse events among the time-restricted eating could have further enhanced the research.4 Also, the study does not consider potential confounders, such as lifestyle changes or drug changes made outside the prescribed regimen, because an intensive diet intervention maintained glycemic control in individuals with type 2 diabetes, averting an increased requirement for glucose-lowering medication.5
To develop new approaches for improving patient outcomes, understanding how a low-carbohydrate/time-restricted eating regimen affects the gut microbiota’s composition and function could be crucial. The possible role of gut bacteria in modulating this link is a chance to investigate, even though how glycemic management in insulin affected by nutrition has been studied extensively.
REFERENCES
- Zimmermann PN, Baier Manwell LM, Osman F, Feldstein D. Feasibility study of a low-carbohydrate/time-restricted eating protocol for insulin-using type 2 diabetic patients. WMJ. 2024;123(1):11-17.
- Suthutvoravut U, Anothaisintawee T, Boonmanunt S, et al. Efficacy of time-restricted eating and behavioral economic intervention in reducing fasting plasma glucose, HbA1c, and cardiometabolic risk factors in patients with impaired fasting glucose: a randomized controlled trial. Nutrients. 2023;15(19):4233. doi:10.3390/nu15194233
- Lu C, Wolfs D, El Ghormli L, et al. Growth hormone mediators and glycemic control in youths with type 2 diabetes: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2024;7(2):e240447. doi:10.1001/jamanetworkopen.2024.0447
- Pavlou V, Cienfuegos S, Lin S, et al. Effect of time-restricted eating on weight loss in adults with type 2 diabetes: a randomized clinical trial. JAMA Netw Open. 2023;6(10):e2339337. doi:10.1001/jamanetworkopen.2023.39337
- Johansen MY, MacDonald CS, Hansen KB, et al. Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. JAMA. 2017;318(7):637-646. doi:10.1001/jama.2017.10169