Continuous Glucose Monitoring (CGM) With a Low Carbohydrate Diet to Reduce Weight in Patients With Pre-Diabetes

• Feasibility and acceptability of pre-diabetic patients to wear CGM sensors and record diet, exercise and side effects on a low carbohydrate diet[ Time Frame: start of recruitment up to 3 months ]
  Successful recruitment completed within 3 months
• Feasibility and acceptability of pre-diabetic patients to wear CGM sensors and record diet, exercise and side effects on a low carbohydrate diet[ Time Frame: completed within 60 days of enrollment ]
  Successful sensor wears time 20/22 days, Data retrieved from sensor successfully
• Weight change[ Time Frame: day 11 (visit 2), day 22 (visit 3) ]
  Pounds
• Change in Percentage of time glucose is above 140[ Time Frame: 33 days after day 1 ]
  Shown in reports provided by CGM sensor data
• Side effects of low carbohydrate eating and Continuous Glucose Monitoring[ Time Frame: Approximately 5 days each new sensor is placed (days 5 and 16) ]
  Health check Phone call survey. Frequency table of specific side effects reported.
• Side effects of low carbohydrate eating and Continuous Glucose Monitoring[ Time Frame: days 11 through 22 ]
  Patient side effect log. Frequency table of specific side effects reported.
• Knowledge of Low Carbohydrate Eating[ Time Frame: baseline, day 22 ]
  Low Carbohydrate Knowledge Scale, correct responses will be added for a total score at each time frame and calculated to see if there is a change.
• Change in cravings and fatigue[ Time Frame: up to 22 days ]
  Food logs. Craving rating (1 to 5, averaged over 10 day sensor wear time), between sensor wear time 2 and sensor wear time 1.
• Intention to continue Low Carbohydrate eating[ Time Frame: day 22 ]
  Question on the completion survey
• Utility of CGM feedback for changing diet[ Time Frame: 60 days (30 days after visit 3 completion) ]
  Qualitative Interview

This study will recruit pre-diabetic patients to see if continuous glucose monitoring (CGM) with a low carbohydrate diet can reduce the percentage of time the CGM readings are above the normal range. Through this study it will demonstrate the feasibility of using CGM with a low carbohydrate diet to reduce weight and risk of developing diabetes in patients with pre-diabetes. Patients that appear to be eligible will be recruited from Michigan Medicine in the Family Medicine Clinic at the Livonia Center.

• Other: Normal Diet
  Phase I (regular diet): all participants will eat their normal diet and will log their food.
• Other: Low carb diet
  Phase II (low carb diet): participants will be asked to eat a low carb diet and log their food
• Device: CGM with no real time feedback
  Phase I will collect CGM without real time feedback
• Device: CGM with real time feedback)
  Phase II participants will be asked to scan their sensor at least every eight hours and document their blood sugar before and two hours after eating as well as before breakfast and before going to bed.
• Behavioral: Education material
  Phase I: participants will be given the book Always Hungry and be asked to read chapters 1-5 after a health check phone call approximately 5 days after the sensor is placed. Phase II: participants will be taught about carbohydrates and the benefits and side effects. Additionally, they will be given multiple resources to assist them regarding carbohydrates as well as a book entitled "The Calorie King, Calories, Fat, and Carbohydrates." Groceries will also be delivered for 2 recipes that the participants choose from to make.

• Experimental: Normal Diet + CGM then low carb + CGM
  Phase I (part 1) - regular diet: Patients will wear a CGM sensor (with no real time feedback) for 11 days; document what they eat on a food log; and rate their postprandial fatigue and cravings. Phase II (part 2) - low carb diet: Patients will wear a CGM sensor (with real time feedback) for 11 days; document what they eat on a food log; and rate their postprandial fatigue and cravings; document their blood sugar before and two hours after eating (as well as before breakfast and before going to bed).