Information for Researchers
About the Collaboration
ON LiMiT is a national scientific collaboration between researchers from Steno Diabetes Center Aarhus, Copenhagen, and Odense, the University of Copenhagen, and Bispebjerg Hospital.
Goals and Ambitions
The goal is to develop and test a cost-effective strategy for diabetes remission, which can be implemented in Denmark and internationally. The project emphasizes sustainable solutions and collaboration between the healthcare sector and municipalities. The project paves the way for new strong national and international research collaborations within the field.
The hope is that the ON LiMiT trial will be informative for health authorities and national and international diabetes associations. It has the potential to be transformative and change current guidelines for type 2 diabetes. The involvement of Steno Diabetes Centers, general practitioners, and municipalities, along with an ambition to include local sports facilities to promote physical exercise in the trial, will set a new standard for future multi-sector collaborations in the management of type 2 diabetes.
Access to Data
During the trial, samples will be collected and stored in a biobank. This will enable later biochemical, proteomic, genomic, and metabolic analyses as well as future projects.
The focused collection of biological, personal, and registry-based results will be an enormous data resource for future research. We anticipate that the impact of the ON LiMiT trial’s unique interventions will affect central health parameters, including anthropometry, metabolic risk markers, and, not least, the participants’ quality of life. Our centralized biobank and data storage allow us to perform advanced association analyses, for example linking genetic profiles to metabolic and physiological traits, comorbidities, and subjective sensations and preferences in this large study. Additionally, the large dataset will be used to connect with other large intervention trials. The potential of linking large study databases within nutritional science may prove to be transformative and further strengthen human nutritional science.
Scientific Background
Although calorie restriction can lead to remission of type 2 diabetes, the underlying mechanisms of type 2 diabetes can also be influenced by changes in dietary composition. There is currently an intense debate among experts about whether carbohydrate-reduced diets, which contain fewer carbohydrates and more protein and fat, or diets based on national dietary guidelines (for example, the official Danish dietary guidelines), which are higher in carbohydrates and lower in fat and protein, should be recommended for people with type 2 diabetes. Furthermore, the significant environmental impact of current food systems emphasizes the need for a dietary transition toward more plant-based diets, which is reflected in the official dietary guidelines for the Danish population.
Despite the fact that type 2 diabetes is characterized by impaired carbohydrate metabolism and that considerable emphasis has been placed on more carbohydrate-reduced diets, both European and American authorities recommend a wide range of carbohydrate intake, provided that individuals consume high amounts of dietary fiber and limit their intake of sugar and saturated fat. Notably, the recommended diets include both:
- Carbohydrate-reduced diets (defined as 25-30 E% from carbohydrates).
- The New Nordic Diet, which provides abundant amounts of carbohydrates (>50 E%).
Moreover, carbohydrate-rich diets have shown almost equivalent effects on glycemic control and weight loss compared with carbohydrate-reduced diets in people with type 2 diabetes. This underscores the need for further research, especially regarding their impact on weight-loss maintenance and diabetes remission. The diverse recommendations therefore create challenges in identifying the optimal diet for people with type 2 diabetes. This is relevant when the goal is long-term remission while also considering the environmental impact of dietary choices for both healthcare professionals and people with type 2 diabetes in their efforts to identify the optimal dietary approach.
There is strong evidence that physical activity reduces the risk of type 2 diabetes, improves body weight regulation, and that intensive exercise in combination with weight loss is effective in achieving type 2 diabetes remission.
Research Questions
Whether a carbohydrate-reduced diet, a carbohydrate-rich diet, or both are beneficial for people with type 2 diabetes after VLCD-induced weight loss is unknown. The effects of combining carbohydrate-reduced or carbohydrate-rich diets with exercise on type 2 diabetes remission and weight-loss maintenance are currently unknown. Therefore, it is necessary to thoroughly investigate diet-induced weight loss, macronutrient composition, and exercise to optimize the management of weight loss and glycemic control.