Abstract
BackgroundDiabetes is increasing in incidence, morbidity and treatment costs globally, hence prevention strategies need to be explored. Animal studies and some human data have shown that zinc can improve glycaemic control, but the impact of this effect in a pre-diabetic population remains uncertain. This study is designed to investigate whether zinc gluconate and lifestyle coaching can improve glucose handling and ultimately reduce diabetes incidence in an at-risk pre-diabetic population in Australia.Methods/designThe study will be a randomised, placebo-controlled, double-blind clinical trial. The study will be conducted at the Hunter New England Local Health District New South Wales (NSW), Australia. Pre-diabetic (haemoglobin A1c [HbA1c] 5.7–6.4) male and female participants (n = 410) aged 40–70 years will be recruited through the Diabetes Alliance Network, a collaboration of diabetes specialists and general practitioner practices. All participants will be given routine care to encourage healthy lifestyle changes using a telephone coaching service (Get Healthy Information and Coaching Service, NSW Health) and then randomised to receive a supplement, either zinc gluconate (equivalent to 30 mg of elemental zinc) or placebo of identical appearance for 12 months. The identity of the supplements will be blinded to both research personnel and the participants. Participants will be asked to complete medical, lifestyle and dietary surveys and will have baseline and final visits at their general practitioner practice. Primary outcomes will be HbA1c and insulin sensitivity collected at baseline and at 1, 6 and 12 months; secondary outcomes will include fasting blood glucose, fasting cholesterol, blood pressure and body mass index. The primary efficacy endpoint will be judged at 6 months.DiscussionThis study will generate new evidence about the potential for health coaching, with or without zinc supplementation, to improve glucose handling and ultimately to reduce progression from pre-diabetes to diabetes.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12618001120268. Registered on 6 July 2018.
Highlights
Diabetes is increasing in incidence, morbidity and treatment costs globally, prevention strategies need to be explored
The online database will have in-built structures to ensure data are entered appropriately and in a quality fashion. This trial sets out to explore whether a new model of care for preventing diabetes in an at-risk Australian population can delay or prevent the onset of diabetes
Their dietary intakes are different, and they are more likely to have an underlying zinc deficiency compared with the overall Australian population
Summary
Diabetes is increasing in incidence, morbidity and treatment costs globally, prevention strategies need to be explored. This study is designed to investigate whether zinc gluconate and lifestyle coaching can improve glucose handling and reduce diabetes incidence in an at-risk pre-diabetic population in Australia. It is known that 90–95% of diabetes cases are type 2 diabetes mellitus (T2DM), which is a preventable and modifiable disease [1]. Pre-diabetes mellitus (PreDM) is a potentially reversible condition of impaired glucose handling. It is increasingly being diagnosed on the basis of a haemoglobin A1c (HbA1c) measurement, given the low coefficient of variation of this test [4]. The natural history of PreDM is variable; progression to T2DM occurs in ~ 25%; the abnormal glycaemic state remains in 50%; and reversion to normal glycaemic state occurs in 25% over 3–5 years [5]. The progression of disease through the pre-diabetic phase provides an opportunity to intervene to reduce or delay the onset of frank diabetes
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