Using Early Time-Restricted Feeding and Timed Light Therapy to Improve Glycemic Control in Adults with Type 2 Diabetes
Abstract
Relevance to Topics Areas and Areas of Encouragement: We will conduct a clinical trial on type 2 diabetes, which affects nearly 25% of Veterans. We will investigate two circadian-based therapies that may improve blood sugar control, reduce diabetes complications, and explain the heterogeneity of type 2 diabetes. These therapies may also improve sleep and circadian disruption, as well as optimize nutrition in low-resource settings. Rationale: The human body has a set of internal clocks called the circadian system. These circadian clocks help regulate blood sugar and metabolism. However, in adults with type 2 diabetes, the clocks are both mistimed and weakened. Mistiming arises because two different stimuli — light and food — affect the circadian system. Light exposure sets the time zone of the central clock in the brain, while food sets the time zones of the clocks in the rest of the body. As a result, whenever meals or light exposure is ill-timed — such as by eating later in the day or by light exposure at night — the clocks become out of sync. And when the clocks are out of sync, blood sugar worsens. Conversely, we and other scientists have found that improving the timing or synchrony of the circadian clocks through well-timed meals and bright light exposure improves blood sugar control and reduces body fat. For instance, we recently found a form of intermittent fasting where dinner is eaten by mid-afternoon (a practice called early time-restricted feeding) improves an indicator of blood sugar control by 24% within only 5 weeks and lowers glucose levels across the day within only 4 days. Similarly, morning bright light therapy improves blood sugar control, improves sleep quality, and increases fat burning. Objective: In this clinical trial, we will test for the first time whether early time-restricted feeding (eTRF) and/or timed bright light therapy can improve blood sugar control in adults with type 2 diabetes. In addition, we will determine whether the two therapies can improve circadian clocks, sleep quality, weight loss, cardiovascular health, quality of life, and psychological health. We will also determine which patients benefit the most from these therapies. Study Design: In this study, 344 Veterans and civilians aged 30-80 with insulin-independent type 2 diabetes will receive one of four treatments: (1) no therapy, (2) eTRF only, (3) timed light therapy only, and (4) both eTRF and timed light therapy. Participants will follow their assigned treatment for 16 weeks. Individuals assigned to the eTRF therapy will eat during a 7- to 8-hour period starting early in the day. Individuals assigned to timed light therapy will use a bright light box for 60 minutes/day between 7 a.m. and 3 p.m., use blue light-blocking glasses an hour before bedtime, and use blackout curtains at night. We will determine the individual and combined effects of the two therapies on blood sugar control, the circadian system, sleep, weight loss, cardiovascular disease risk factors, quality of life, and psychological health. Importance: This study is important because it will be the first clinical trial to test whether eTRF and/or timed light therapy can be used as therapies to treat type 2 diabetes. It will also help develop circadian-based therapies to treat several other diseases and conditions. Impact: About 9.3% of U.S. adults and nearly 25% of Veterans have type 2 diabetes, making it the second most common chronic disease among Veterans. Moreover, 15%-20% of Veterans have psychiatric conditions, and up to 50% have sleep disorders. This study therefore has the potential for large-scale impact. First, if this study is successful, then meal timing and/or timed light therapy can be used to improve blood sugar control in adults with type 2 diabetes, reduce the need for diabetes medications, and reduce diabetes complications. About 1 in 3 U.S. adults has prediabetes, and we expect adults with prediabetes would
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910558
Entities
People
- Courtney Peterson
Organizations
- United States Army
- University of Alabama at Birmingham