Aim: To compare the impact of two long‐term weight‐maintenance diets, a high protein (HP) and low glycaemic index (GI) diet versus a moderate protein (MP) and moderate GI diet, combined with either high intensity (HI) or moderate intensity physical activity (PA), on the incidence of type 2 diabetes (T2D) after rapid weight loss. Materials and Methods: A 3‐year multicentre randomized trial in eight countries using a 2 x 2 diet‐by‐PA factorial design was conducted. Eight‐week weight reduction was followed by a 3‐year randomized weight‐maintenance phase. In total, 2326 adults (age 25‐70 years, body mass index ≥ 25 kg/m ² ) with prediabetes were enrolled. The primary endpoint was 3‐year incidence of T2D analysed by diet treatment. Secondary outcomes included glucose, insulin, HbA1c and body weight. Results: The total number of T2D cases was 62 and the cumulative incidence rate was 3.1%, with no significant differences between the two diets, PA or their combination. T2D incidence was similar across intervention centres, irrespective of attrition. Significantly fewer participants achieved normoglycaemia in the HP compared with the MP group ( P < .0001). At 3 years, normoglycaemia was lowest in HP‐HI (11.9%) compared with the other three groups (20.0%‐21.0%, P < .05). There were no group differences in body weight change (−11% after 8‐week weight reduction; −5% after 3‐year weight maintenance) or in other secondary outcomes. Conclusions: Three‐year incidence of T2D was much lower than predicted and did not differ between diets, PA or their combination. Maintaining the target intakes of protein and GI over 3 years was difficult, but the overall protocol combining weight loss, healthy eating and PA was successful in markedly reducing the risk of T2D. This is an important clinically relevant outcome.

Background: Elevated maternal blood glucose concentrations may contribute to macrosomia, adiposity, and poorer vascular health in the offspring.Object

The influence of maternal macronutrient balance and dietary glycemic index (GI) on neonatal body composition has received little study. We hypothesized that the overall quantity and quality of macronutrients, particularly carbohydrate, in the maternal diet could have trimester-specific effects on neonatal growth and body composition in women at risk of gestational diabetes. Maternal diet was assessed using 3-day food records in mid (n = 96) and late (n = 88) pregnancy as part of the GI Baby 3 study. Neonatal body composition was assessed by air-displacement plethysmography within 48 h of birth, adjusted for length, and expressed as fat mass index (FMI) and fat-free mass index (FFMI). In mid pregnancy, higher maternal intake of carbohydrate energy was negatively correlated with infant FFMI (p = 0.037). In late pregnancy, higher dietary GI was associated with lower FFMI (p = 0.010) and higher carbohydrate energy predicted lower FMI (p = 0.034). Higher fat intake (%E) and saturated fat, but not protein, also predicted neonatal body composition (higher FFMI in mid pregnancy and higher FMI in late pregnancy). Depending on pregnancy stage, a high carbohydrate-low fat diet, particularly from high glycemic sources, may reduce neonatal indices of both lean mass and adiposity.

Background/Objectives: Dietary protein and carbohydrate affect postprandial glycemia in individuals with type 1 diabetes (T1D). This paper aimed to determine the relationship between the types of dietary protein (Study 1) and carbohydrate (glycemic index; GI, Study 2) and postprandial glycemia. Methods: Two acute randomized crossover trials were conducted in adults with T1D comparing postprandial glycemia for test meals varying by protein type (n = 16 adults; 5 meals: egg, beef, chicken, salmon or whey (all 30 g protein), each served with fried rice (45 g carbohydrate) or GI (n = 8 adults, high or low GI bread, GI 52% vs. 76%) with peanut butter (19 g protein, 30 g fat). Insulin was dosed based on usual individualized insulin: carbohydrate ratio and capillary blood glucose levels (BGL) measured from 30 min pre- to 5 h postprandially in 15–30 min intervals. Results: Study 1: Postprandial glycemia varied over an almost 2-fold range, however responses were highly variable and there were no significant differences between sources (iAUCglucose Chicken: 203 ± 66 mmol·min/L, Egg: 263 ± 100 mmol·min/L, Beef: 309 ± 89 mmol·min/L, Salmon: 338 ± 83 mmol·min/L and Whey: 397 ± 115 mmol·min/L respectively, p > 0.05). Hypoglycemia (≤3.5 mmol/L) occurred at least once per protein type (chicken: 6/16 participants, egg 2/16, beef 3/16, salmon 1/16, whey 2/16). However, there were no statistically significant differences in the risk of hypoglycemia between protein sources (p > 0.05). Study 2: Postprandial glucose response curves were virtually identical for high GI and low GI, and the incremental area under the curve (iAUC) for glucose was not statistically significant after 1 h (p = 0.185), 3 h (p = 0.538) or 5 h (p = 0.694) following the meal. Conclusions: Clinical practice guidelines and insulin dosing algorithms likely do not need to consider differences in protein sources or in GI in the context of a high fat, high protein meals, for individuals with T1D.

Introduction: To establish a possible effect of Lycra sleeves, accurate recording of wear time is critical. The aim of this study was to test whether an accelerometer-embedded Lycra sleeve can measure wear compliance and record upper-limb (UL) movements/activity in people with stroke. Methods: Seven adults with stroke resulting in unilateral UL weakness were approached for participation in this study as a convenience sample, and five participants were recruited. Participants wore accelerometer-embedded Lycra sleeve on their affected arm for 8 to 10 hrs/d for 14 days and were prescribed four simple UL exercises. They completed a diary to record daily sleeve wear time and exercise times. Upper-limb function, shoulder muscle strength, range of movement, and pain were assessed at days 1 and 14. Results: Seven participants were approached, and five participants (72 ± 10 years) were recruited. The mean time since stroke was 20 months. Using an acceleration movement threshold of 0.01 g (g = acceleration of gravity) and the constructed algorithm, the sleeve donning and doffing time was identified. The mean accelerometer and diary-recorded wear time were 11.64 hrs/d (SD, 2.64) and 11.27 hrs/d (SD, 2.03), respectively. Individual spikes above threshold indicated UL activity but could not distinguish participant-recorded exercises from daily UL use. Arm function showed improvement in three of five participants. Conclusions: Accelerometers provide a practical method to record wear time of a Lycra sleeve, overcoming the necessity for patients to keep diaries, which can often be unreliable. A more sensitive accelerometer that can detect the direction of the acceleration and movement should be considered in future studies. Clinical Relevance: Accelerometers provide accurate data on Lycra sleeve wear time and may help with monitoring adherence.

BACKGROUND: International trials have demonstrated the success of paediatric, general population screening for type 1 diabetes (T1D) using either genetic risk-stratified or population-wide autoantibody screening. As the optimal approach is uncertain, we aimed to assess uptake, feasibility and acceptability of three models for population-wide, routine T1D screening among Australian children. METHODS: A non-randomised cluster-controlled implementation study comparing three T1D screening models: Cohort 1) Genetic risk-stratified screening offered alongside existing Newborn Bloodspot Screening, with autoantibody follow-up from age 11 months in at-risk children; Cohort 2) Genetic risk-stratified screening among infants (6–12 months), in community/at-home using saliva swabs, with autoantibody follow-up from age 10 months in at-risk children; and Cohort 3) Autoantibody-only screening among children aged 2, 6 or 10 years, in community/at-home/school using capillary dried bloodspots. Screening uptake was the primary outcome. Parental surveys were completed at screening and after result notification. FINDINGS: Of 6,698 children registered for screening, 4,369 children (65%) were screened. Uptake rates were Cohort 1: 86% (n=1,962 screened/2,287 registered), Cohort 2: 63% (n=1,367/2,157), and Cohort 3: 46% (n=1,040/2,254; in-school subset: 90% (n=60/67); p49; Cohort 1: 50%, n=27/54; Cohort 2: 54%, n=59/110; Cohort 3: 29%, n=2/7). Overall, parents were highly satisfied and supported population screening, with ≥95% agreeing screening was worthwhile, acceptable, and should be available to all children (n=3,432). INTERPRETATION: Paediatric, population T1D screening is feasible and acceptable to Australian families. Uptake was highest for newborn genetic risk-stratified screening and, potentially, school-based autoantibody-only screening. Broader consideration of recall rates, efficacy and cost-effectiveness will help inform the optimal screening model.FUNDING: Breakthrough T1D Australia and International.