Findings from a trio of clinical trials suggest that fasting blood sugar and fasting insulin levels — two types of “biomarkers” — can be used to customize weight loss diets for people with pre-diabetes and type 2 diabetes, according to a news release from the University of Copenhagen.
The release doesn’t say how effective the biomarkers, which like surrogate markers are representative stand-ins for actual health outcomes, were in predicting and bringing about weight loss. (Read our explainer on the downsides of surrogate markers here.) The release would have been greatly improved had it included some numbers available from the published report which explained the benefits, provided some cost considerations for this type of personalized treatment, and included information on study funders and potential conflicts of interest.
Diabetes is the seventh leading cause of death in the United States, according to the Centers for Disease Control and Prevention. A tailored program to help people with diabetes reach weight loss goals more efficiently could be helpful.
The release gives no indication of how expensive it would be for the average person to use these markers for customizing their weight loss program. There is no mention of how much the testing would cost, (and of importance to US audiences, whether insurance would cover the expense), how often patients would need to be tested in order to ensure efficient weight loss, and what fees would be charged by doctors and dietitians to interpret the results and guide the weight loss effort.
Since the main claim being made is the value of using biomarkers to personalize a weight loss plan the release should have included some basic facts about how much weight study volunteers lost by following a personalized eating plan. How did their weight loss compare to others not on the personalized plan?
The release included some specifics about the meal plans studied. “The findings suggest that for most people with prediabetes, a diet rich with vegetables fruits and whole grains should be recommended for weight loss and could potentially improve diabetes markers. For people with type 2 diabetes, the analysis found that a diet rich in healthy fats from plant sources would be effective for achieving weight loss. These diets could also be effective independent of caloric restriction.” We’d like to see some numbers attached to these claims.
It seems unlikely that personalizing a weight loss plan could cause significant harm. The most tangible downside is likely to be time and money wasted on a plan that might not be more effective than standard dietary advice. Still, a small risk of complications resulting from repeated blood draws or finger sticks is possible since glucose and insulin concentrations are measured from blood samples.
The release tells readers these findings are from three randomized clinical trials, and that the combined sample included more than 1,200 people. It doesn’t give any details, however, about what treatment the control groups received, how long the clinical trials lasted, or any demographic description of participants. There is also no mention of the fact that these three clinical trials were conducted using very different methods with different interventions, which should warrant caution when lumping all study participants into one big group.
All of this information is provided in the published study and it’s unfortunate the release did not likewise include some of these facts to help readers assess the value of biomarkers in diet planning.
No disease mongering is evident in this release.
The release does not state the funder of the research. A deeper dive into the full-text publication of the research revealed that the study was funded by Gelesis Inc., a biotechnology company working to develop therapies to induce weight loss and improve glycemic control in overweight and obese patients.
The release notes that the researchers are looking at other types of biomarkers, including gut microbiota, and at “genomics approaches” that might aid in creating personalized diet plans.
The two biomarkers are said to be a simple alternative to other means of customizing dietary plans for persons with pre-diabetes or type 2 diabetes.
How do you know what kind of diet you’re supposed to eat based on your biomarker profile? Presumably you’re prescribed a diet and told what to eat. But if you’re a consumer, how do you know what that diet is? In other words, how do you benefit from this? Is someone selling personalized nutrition recommendations based on these biomarkers?
The idea that vegetables, fruits, whole grains, and healthy fats should be recommended for weight loss is hardly new. And yet the release frames these results as “potentially [leading] to a breakthrough in personalized nutrition.” We’d need more proof of tangible benefits before agreeing with that characterization.
Calling the findings a “breakthrough in personalized nutrition” seems unjustified given we’re provided no results.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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