Prediabetes
Conditions
Keywords
Older Adults, Postprandial Glucose, Continuous Glucose Monitoring, Physical Activity
Brief summary
This study will examine whether eating lunch and dinner at a subsidized community dining site affects postmeal walking and blood glucose patterns in older adults. Participants will be community-dwelling adults aged 60 to 79 years who are eligible for a local elderly meal subsidy and have prediabetes or elevated blood glucose risk. Each participant will complete two 6-day meal conditions in random order. In one condition, participants will eat lunch and dinner at home. In the other condition, participants will eat lunch and dinner at a subsidized community dining site. Participants will wear a continuous glucose monitor and an activity tracker so the study team can measure postmeal glucose levels, daily glucose patterns, and steps after meals. The study will compare community dining with home eating to determine whether community dining increases postmeal walking, improves postmeal glucose responses, and affects loneliness and meal experience.
Detailed description
Subsidized community dining programs are designed to improve access to affordable meals for older adults, but they may also influence daily movement, social interaction, and metabolic health. Eating at a community dining site may encourage older adults to leave home, walk before or after meals, and interact with others in a shared meal environment. This study will evaluate subsidized community dining as a real-world meal setting rather than as a prescribed exercise or dietary treatment. Participants will complete both study conditions: home eating and community dining. During the community dining condition, participants will eat lunch and dinner at a subsidized community dining site. During the home-eating condition, participants will eat lunch and dinner at home using meals designed to approximate the energy and macronutrient composition of the community dining meals. The study will use continuous glucose monitoring and wearable activity tracking to measure postmeal glucose responses, daily glucose profiles, and postmeal steps under free-living conditions. No walking target will be prescribed. After each lunch and dinner, participants will be free to walk, sit, rest, remain at the dining site, or return home according to their usual preference. The study will also assess loneliness and meal-condition experience to explore whether the dining setting affects social and experiential aspects of eating. Findings may help determine whether subsidized community dining can function not only as food assistance, but also as community-based infrastructure that supports healthy aging.
Interventions
BEHAVIORALSubsidized Community Dining
Participants will eat lunch and dinner at a subsidized community dining site for 6 days. No walking target or exercise prescription will be given. After each meal, participants will be free to walk, sit, rest, remain at the dining site, or return home according to their usual preference.
BEHAVIORALHome Eating
Participants will eat lunch and dinner at home for 6 days using a standardized Chinese meal rotation designed to approximate the energy and macronutrient composition of the community dining meals.
Sponsors
Yang Zhang
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
This is an open-label study because participants and study staff cannot be masked to whether meals are consumed at home or at the community dining site. Glucose and activity data will be processed using coded condition labels when feasible.
Intervention model description
Participants will complete both meal conditions in a randomized two-sequence, two-period crossover design. One sequence will complete 6 days of home eating followed by 6 days of subsidized community dining. The other sequence will complete 6 days of subsidized community dining followed by 6 days of home eating.
Eligibility
Sex/Gender
ALL
Age
60 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Community-dwelling adults aged 60 to 79 years * Eligible for the local elderly meal subsidy * Prediabetes or elevated glycemic risk, defined as HbA1c 5.7% to 6.4% or fasting plasma glucose 100 to 125 mg/dL * Able to consume meals orally * Able to walk independently without a walking aid * Able to attend the community dining site safely * Able and willing to wear a continuous glucose monitor and activity tracker * Able and willing to follow the home-meal plan and study procedures * Able to provide written informed consent
Exclusion criteria
* HbA1c ≥6.5% or fasting plasma glucose ≥126 mg/dL * Diagnosed diabetes * Use of insulin or glucose-lowering medication * Severe cognitive impairment * Acute illness or recent hospitalization * Severe gastrointestinal disease affecting usual food intake or gastric emptying * Severe renal, hepatic, cardiovascular, or neurologic disease that would make participation unsafe * Skin conditions preventing continuous glucose monitor use * Food allergy or dietary restrictions incompatible with the standardized meal plan
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Meal-Level 0- to 90-Minute Postprandial Glucose Incremental Area Under the Curve | Study Days 2-13; fixed premeal baseline window through 90 minutes after completion of each lunch and dinner during the 12-day randomized meal-condition period. | Postprandial glucose incremental area under the curve (iAUC) will be calculated for each lunch and dinner from exported timestamped continuous glucose monitoring data using the trapezoidal rule. Baseline glucose will be defined as the mean continuous glucose monitoring value during the fixed 30-minute premeal baseline window. The postprandial calculation window will extend from meal completion through 90 minutes after meal completion. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Meal-Level 0- to 90-Minute Postmeal Step Count | Study Days 2-13; from meal completion through 90 minutes after completion of each lunch and dinner during the 12-day randomized meal-condition period. | Postmeal step count will be obtained from the wearable-device activity session started immediately after meal completion and stopped 90 minutes later. This outcome will be assessed separately after lunch and dinner. |
| Meal-Level Peak Postprandial Glucose | Study Days 2-13; from meal completion through 90 minutes after completion of each lunch and dinner during the 12-day randomized meal-condition period. | Peak postprandial glucose will be defined as the highest continuous glucose monitoring value during the 90-minute postmeal window after each lunch and dinner. |
| Meal-Level Time to Peak Postprandial Glucose | Study Days 2-13; from meal completion through 90 minutes after completion of each lunch and dinner during the 12-day randomized meal-condition period. | Time to peak postprandial glucose will be defined as the time, in minutes, from meal completion to the highest continuous glucose monitoring value during the 90-minute postmeal window after each lunch and dinner. |
| Daily 24-Hour Mean Glucose | Study Days 2-13; over each 24-hour analytic day during the 12-day randomized meal-condition period. | The 24-hour mean glucose will be calculated for each analytic day using valid continuous glucose monitoring readings. |
| Daily Time Above Range | Study Days 2-13; over each 24-hour analytic day during the 12-day randomized meal-condition period. | Time above range will be calculated for each analytic day as the percentage of valid continuous glucose monitoring readings above 7.8 mmol/L. |
| Daily Combined Postmeal Steps | Study Days 2-13; summed across the lunch and dinner 90-minute postmeal windows on each 24-hour analytic day during the 12-day randomized meal-condition period. | Daily combined postmeal steps will be calculated as the sum of 0- to 90-minute postmeal steps after lunch and dinner on the same analytic day. |
| Total Daily Steps | Study Days 2-13; over each 24-hour analytic day during the 12-day randomized meal-condition period. | Total daily steps will be obtained from the wearable activity tracker for each analytic day. |
| End-of-Condition Loneliness Score | Baseline and end of each 6-day meal condition during the 12-day randomized meal-condition period. | Loneliness will be assessed using the 6-item De Jong Gierveld Loneliness Scale. The total score ranges from 0 to 6, with higher scores indicating greater loneliness. The scale will be administered at baseline and at the end of each 6-day meal condition. End-of-condition loneliness scores will be compared between the home-eating and community-dining conditions. |
| End-of-Condition Meal-Condition Experience and Satisfaction Score | End of each 6-day meal condition during the 12-day randomized meal-condition period. | Meal-condition experience and satisfaction will be assessed using a study-specific 4-item scale covering relaxation during meals, comfort of the meal environment, opportunities for communication, and willingness to go outdoors and be active. Each item will be rated on a 5-point Likert scale. The mean score ranges from 1 to 5, with higher scores indicating a more favorable meal-condition experience. |
Countries
China
Contacts
CONTACTMeng-Qi Zhen, MA
STUDY_CHAIRYang Zhang, PhD
Outcome results
None listed