Time-restricted eating and user involvement are the basis of a research project that may make day-to-day life easier for people living with type 2 diabetes

Jonas Salling Quist, MSc and PhD, is investigating whether a simple lifestyle change involving eating habits can have a positive impact on the body and on quality of life. Users’ needs and their responses have been a big influence on the research from the outset.

At a conference in Belfast in 2016, Jonas Salling Quist gave a presentation about his PhD research. He was about to complete the project at the University of Copenhagen, where he had been researching the effect of 6 months’ training on energy balance and appetite regulation in overweight and severely overweight people.

At the gala dinner, he sat next to Professor Kristine Færch from Steno Diabetes Center Copenhagen. He told her about his studies and mentioned how, although participants started out highly motivated, practical circumstances and everyday logistics were challenging when it came to maintaining the training activity. They also talked about a new research project in California that had shown that time-restricted eating led to weight loss in people with overweight and obesity. In the study, participants had eaten within a 10-hour period each day for 16 weeks, with no other restrictions. After  the intervention, it turned out that participants were interested in continuing with time-restricted eating and that they had maintained their weight loss at one-year follow-up.

Simple lifestyle change with potential impact in prevention and treatment of type 2 diabetes
It sounded really positive that such a simple lifestyle change could have such great potential in the prevention and treatment of obesity and lifestyle-related diseases such as type 2 diabetes. However, further research and bigger studies were needed, and the two researchers picked up the baton. Together with Danish and foreign researchers, they applied for and received financial support in the form of a Steno Collaborative Grant from the Novo Nordisk Foundation.

After his PhD, Jonas Salling Quist started work at Steno Diabetes Center Copenhagen, where he and Kristine Færch set up the research project ‘Effects of time-restricted eating on behaviour and metabolism in overweight individuals at high risk of type 2 diabetes - the RESET study”, which is studying changes in body weight, metabolism etc. when participants with overweight and at high risk of developing type 2 diabetes live with time-restricted eating or their usual lifestyle. 75 of 100 participants have been recruited for the study, which the researchers hope to be able to complete in early 2022.

‘I feel I’m incredibly privileged. There is tough competition in research, so I am happy and grateful that we have succeeded in attracting funding for RESET and now the RESET2 study as well. In the RESET2 study, we will investigate whether time-restricted eating is effective in the treatment of type 2 diabetes. Among other things, we will focus more on user involvement, and we will involve the target group early in the process in connection with the design of the study. The RESET2 project will be in three phases: user involvement in the design of the intervention (which we started in August), a pilot study and a randomised controlled trial. The participants will have support along the way, and their input is important there. For example, is it phone calls that they need, or conversations with healthcare staff or with others in the group?’, explains Jonas Salling Quist.

New knowledge reflected in adjusted pilot project
Many people find losing weight and keeping it off challenging, especially if there are lots of dos and even more don’ts. Time-restricted eating is an eating pattern in which food must be consumed within a limited time interval, e.g. 10 hours a day, and with no other restrictions as to the composition or quantity of the diet. This appears to be a manageable lifestyle change, and the positive results of previous studies support it. In the RESET2 project, the target group has been expanded to a total of around 260 overweight people with type 2 diabetes. The plan is to initiate a 3-month pilot project after the summer holiday. Precisely because the research team is using lessons learnt and knowledge gained from interviews with RESET participants and user involvement in phase 1 of RESET2, this pilot project is being adjusted.

‘Initially, the pilot-intervention was going to last 30 days, but instead it will be 2 months so that in the first two months the participants can gain experience of strict time-restricted eating and have time to see what sort of support they need, and when. To a certain extent, they need to be kept at it, and they themselves need to have some influence on that. We think it will boost their motivation and maintenance. As the main study in the RESET2 project is a 1-year randomised controlled trial, it’s important to have an insight into how we can give participants the best possible support. As the intention is that the intervention should be workable in clinical practice, it is important that the support components are realistic in terms of the time and resources involved in treatment’, says Jonas Salling Quist of the project, which is taking place at Steno Diabetes Center Copenhagen and Hvidovre Hospital.

Researching to make life easier
While studying for his Master’s in Human Nutrition at the University of Copenhagen, Jonas Salling Quist realised that research was to be his calling in life. So, when he had the opportunity to gain a PhD, he took it. It was a resource-intensive study, and the challenges faced along the way by participants who lost their motivation and experienced challenges in terms of maintenance would prove to be important knowledge in Jonas Salling Quist’s future research.

‘To me, the aim of my research is to create and design interventions for people with or at risk of type 2 diabetes that improve their health and quality of life by being simple and feasible, so that they become as natural a part as possible of their daily routine. I am also interested in understanding the behavioural and biological mechanisms that can go toward explaining the effects of the interventions’, says Jonas Salling Quist.

Read about Jonas Salling Quist’s postdoc project: ‘Time-restricted eating and food reward in type 2 diabetes’

The RESET and RESET2 studies are supported by the Novo Nordisk Foundation, and Jonas Salling Quist has received support for RESET2 from the Danish Diabetes Academy and the Danish Diabetes Association.

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By Pernille Fløjstrup Andersen, Communications Officer, Danish Diabetes Academy.