Table 1.
Type 2 diabetes subgroup (process) dependent diagnosis–intervention strategies.
| T2D subgroups (see Figure 2, based on processes involved) | Diagnosis (i.e., parameters of the biopassport) | Potential interventions |
|---|---|---|
| 1. Pancreatic β-cell function (impaired insulin secretion) | Oral glucose tolerance test (OGTT) or challenge test: disposition index | Fasting-mimicking diet (FMD); β-cell protective nutrients (MUFA, protein, vit. K, Mg, leucine); β-cell protective drugs (TZDs, GLP-1 analogs, DPP4-inhibition) |
| 2. Muscle insulin resistance (decreased glucose uptake) | OGTT or challenge test: muscle IR index, HbA1C, 2-h glucose | Physical activity (resistance training); Mediterranean diet; low-glycemic index diet; low-carb diet; low refined sugar; fiber (arabinoxylan, alpha-cyclodextrin, resistant starch, beta-glucans) |
| 3. Hepatic insulin resistance (decreased glucose uptake, but increased production and release) | OGTT or challenge test: hepatic IR index, fasting glucose | Low (saturated) fat diet; weight loss; very low-caloric diet; intermittent fasting; wholegrain; choline; carnitine; resveratrol; cinnamon extract; metformin |
| 4. Adipocyte insulin resistance and lipotoxicity | Basal adipocyte insulin resistance index, non-esterified fatty acids, visceral and ectopic fat percentage | Intermittent fasting; FMD; α-lipoic acid; poly-unsaturated fatty acid/SFA balance; omega-3 FAs; TZDs; acipimox |
| 5. Vasculature | Blood pressure, LDL-cholesterol, HDL-cholesterol, fasting, and post-prandial triglycerides | DASH diet; low-sodium diet; wholegrain; fiber (pectin, β-glucan); beet root (extract); lycopene; Vit. C; Vit. K; cocoa flavonols; hydroxytyrosol (olive oil); monacolin K; coenzyme Q10; grape seed extract; chitosan/phytosterols; L. reuteri NCIMB 30242; statins; blood pressure lowering medication |
| 6. Chronic low-grade inflammation | CRP, total leukocytes, cytokines | Physical activity; fish oil/n-3 fatty acids; Vit. D; Vit E.; Mg; flavonoids; curcuminoids; salicylates; TNF-α inhibitors |
Currently, six processes involved in T2D are identified, and for each of them a biomarker approach to quantify the process, and an intervention strategy to optimize/restore, is suggested.