Effectiveness of the Personalized Responses & Integrated Systems for Metabolism (PRISM) on Improving Insulin Resistance Among Adults With Metabolic Syndrome: A Pilot Study (PRISM-I)

Insulin resistance will be assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), calculated as:

HOMA-IR = (fasting plasma insulin × fasting plasma glucose) / 22.5

Higher HOMA-IR values indicate greater insulin resistance, whereas lower values indicate improved insulin sensitivity (reduced insulin resistance).

Glycated haemoglobin (HbA1c) reflects average blood glucose levels over the preceding two to three months and is measured using standard laboratory blood analysis. Higher values indicate poorer long-term glycaemic control.

Fasting blood glucose is a biochemical measure of blood glucose concentration after an overnight fast, measured using standard laboratory blood analysis. Higher values indicate poorer glycaemic control.

Fasting plasma insulin is a biochemical marker measured using standard laboratory blood analysis following an overnight fast. Higher values indicate greater insulin resistance and impaired glucose metabolism.

Total cholesterol is a lipid biomarker measured using standard laboratory blood analysis to assess overall blood cholesterol levels. Higher values indicate poorer lipid profiles and increased cardiometabolic risk.

High-density lipoprotein cholesterol (HDL-C) is a lipid biomarker measured using standard laboratory blood analysis to assess protective cholesterol levels. Lower values indicate poorer lipid profiles and increased cardiometabolic risk.

Low-density lipoprotein cholesterol (LDL-C) is a lipid biomarker measured using standard laboratory blood analysis to assess atherogenic cholesterol levels. Higher values indicate poorer lipid profiles and increased cardiovascular risk.

The total cholesterol to HDL cholesterol ratio is calculated from standard laboratory blood analysis and is used to assess cardiovascular risk. Higher values indicate a poorer lipid profile and increased cardiometabolic risk.

Triglycerides are a lipid biomarker measured using standard laboratory blood analysis to assess circulating triglyceride levels. Higher values indicate poorer lipid profiles and increased cardiometabolic risk.

Lipoprotein(a) is an advanced lipid biomarker measured using standard laboratory blood analysis to assess inherited cardiovascular risk. Higher values are associated with increased risk of atherosclerotic cardiovascular disease

Apolipoprotein A1 (ApoA1) is a lipid biomarker measured using standard laboratory blood analysis to assess the major protein component of HDL cholesterol. Higher values generally indicate a more favourable lipid profile.

Apolipoprotein B (ApoB) is a lipid biomarker measured using standard laboratory blood analysis to assess the number of atherogenic lipoprotein particles. Higher values indicate increased cardiovascular risk.

The Apolipoprotein B/A1 ratio is calculated from standard laboratory blood analysis and reflects the balance between atherogenic and protective lipoproteins. Higher values indicate increased cardiovascular risk

High-sensitivity C-reactive protein (hs-CRP) is an inflammatory biomarker measured using standard laboratory blood analysis to assess low-grade systemic inflammation. Higher values indicate greater systemic inflammation and increased cardiometabolic risk.

Total protein is measured using standard laboratory blood analysis to assess the combined concentration of albumin and globulins in blood.

Albumin is a plasma protein measured using standard laboratory blood analysis to assess nutritional status and liver function. Lower values may indicate impaired liver function, malnutrition, or inflammation.

Globulin is measured using standard laboratory blood analysis to assess immune and inflammatory proteins in the blood.

The albumin-to-globulin (A/G) ratio is calculated from serum albumin and globulin concentrations and is used to assess liver function, nutritional status, and inflammatory conditions.

Bilirubin is measured using standard laboratory blood analysis to assess liver function and bilirubin metabolism.

Alkaline phosphatase (ALP) is a liver enzyme measured using standard laboratory blood analysis to assess liver and biliary tract function.

Alanine aminotransferase (ALT/SGPT) is a liver enzyme measured using standard laboratory blood analysis to assess liver cell injury.

Aspartate aminotransferase (AST/SGOT) is a liver enzyme measured using standard laboratory blood analysis to assess liver and muscle cell injury. Higher values may indicate liver damage or other tissue injury.

Both systolic and diastolic blood pressure will be assessed.

The Montreal Cognitive Assessment is a validated screening instrument designed to detect mild cognitive impairment. It assesses multiple cognitive domains, including attention and concentration, executive function, memory, language, visuospatial skills, abstraction, calculation, and orientation. Total scores range from 0 to 30, with higher scores indicating better cognitive function.

Hand grip strength will be measured using a Jamar dynamometer as an indicator of muscle strength. Higher values indicate greater muscle strength.

Body mass index (BMI) will be calculated as weight (kg)/height² (m²). Lower values indicate lower overall adiposity.

Percentage body fat will be estimated using bioelectrical impedance analysis (InBody 120). Lower values indicate lower adiposity.

Measured using InBody 120.

Visceral fat level will be estimated using bioelectrical impedance analysis (InBody 120). Lower values indicate reduced visceral adiposity.

A Body Shape Index (ABSI) is calculated from waist circumference, height, and body weight to assess central adiposity independently of BMI. Higher values indicate greater abdominal obesity and cardiometabolic risk.

Body Roundness Index (BRI) is calculated from height and waist circumference to estimate body fat distribution and central adiposity. Higher values indicate greater abdominal adiposity and cardiometabolic risk.

The Three-Factor Eating Questionnaire-Revised 18 is a validated self-administered instrument used to assess eating-related behaviours. It measures three domains: cognitive restraint, uncontrolled eating, and emotional eating. Scores are calculated separately for each domain and transformed to a 0-100 scale, with higher scores indicating greater levels of the respective eating behaviour.

The International Physical Activity Questionnaire - Short Form is a validated self-administered questionnaire used to assess self-reported physical activity levels over the previous 7 days. It captures the frequency and duration of walking, moderate-intensity activity, vigorous-intensity activity, and time spent sitting. Responses are used to calculate total physical activity expressed as MET-minutes/week. There is no fixed minimum or maximum score; higher MET-minutes/week indicate higher levels of physical activity.

The Generalized Anxiety Disorder 7-item questionnaire is a validated self-administered screening instrument used to assess the frequency of anxiety symptoms over the previous 2 weeks. Total scores range from 0 to 21, with higher scores indicating greater anxiety symptom severity.

The Patient Health Questionnaire-9 is a validated self-administered screening instrument used to assess the frequency of depressive symptoms over the previous 2 weeks. Total scores range from 0 to 27, with higher scores indicating greater depressive symptom severity.

The Perceived Stress Scale-10 is a validated self-administered questionnaire used to assess the degree to which individuals perceive situations in their lives as stressful over the previous month. Total scores range from 0 to 40, with higher scores indicating greater perceived stress.

The Big Five Inventory-44 is a validated self-administered questionnaire used to assess personality across five domains: openness, conscientiousness, extraversion, agreeableness, and neuroticism. Scores are calculated separately for each domain; there is no overall total score. Domain scores are typically calculated as the mean of the items within each domain and range from 1 to 5, with higher scores indicating greater expression of the respective personality trait. As this is a descriptive measure of personality, higher scores do not represent universally better or worse outcomes.

The Sleep Hygiene Index is a validated 13-item self-administered questionnaire that assesses behaviours associated with sleep hygiene. Total scores range from 13 to 65, with higher scores indicating poorer sleep hygiene practices.

Resting heart rate measured using the Oura Ring. Resting heart rate represents the average heart rate during periods of rest. Lower values generally indicate better cardiovascular fitness.

Heart rate variability measured using the Oura Ring. HRV reflects variation in the time interval between successive heartbeats and is an indicator of autonomic nervous system function. Higher values generally indicate better autonomic regulation and recovery.

Heart rate recovery measured using the Oura Ring. Heart rate recovery represents the reduction in heart rate following physical activity and reflects cardiovascular recovery capacity. Higher values indicate faster recovery and better cardiovascular fitness.

Sleep duration measured using the Oura Ring. Sleep duration represents the total amount of sleep obtained per night. Higher values generally indicate longer sleep duration.

Sleep quality score measured using the Oura Ring. Scores range from 0 to 100, with higher scores indicating better sleep quality.

Daily step count measured using the Oura Ring. Step count represents the total number of steps accumulated per day. Higher values indicate greater daily physical activity.

Activity intensity minutes measured using the Oura Ring. This metric represents the daily duration of moderate-to-vigorous physical activity. Higher values indicate greater participation in physical activity.

Energy expenditure measured using the Oura Ring. This metric represents the estimated daily energy expenditure from physical activity. Higher values indicate greater energy expenditure.

Mean glucose concentration measured using continuous glucose monitoring. Mean glucose represents the average glucose concentration over the monitoring period. Lower values generally indicate better glycaemic control.

Coefficient of variation of glucose measured using continuous glucose monitoring. CV reflects glucose variability relative to mean glucose concentration. Lower values indicate more stable glucose levels and better glycaemic control.

Percentage of time spent below the target glucose range (<3.9 mmol/L), measured using continuous glucose monitoring. Lower values indicate less time spent in hypoglycaemia and better glycaemic control.

Percentage of time spent within the target glucose range (3.9-10.0 mmol/L), measured using continuous glucose monitoring. Higher values indicate better glycaemic control.

Percentage of time spent above the target glucose range (>10.0 mmol/L), measured using continuous glucose monitoring. Lower values indicate less hyperglycaemia and better glycaemic control.

Postprandial glucose excursion measured using continuous glucose monitoring. PPGE is calculated as the difference between peak glucose concentration and pre-meal glucose concentration within 2 hours after the start of a meal. Higher values indicate greater postprandial glucose excursions.

Incremental area under the glucose curve measured using continuous glucose monitoring. iAUC represents the area under the glucose curve above the pre-meal baseline during the 2-hour period following a meal. Higher values indicate greater overall postprandial glucose exposure.