Validation of the Snouda Metabolic Score for Phenotyping and Guiding Reversal in Type 2 Diabetes

Type 2 Diabetes Mellitus (T2DM) is a heterogeneous metabolic disorder driven by multiple overlapping physiological dysfunctions. Standard clinical management focuses on glycemic control through pharmacotherapy but does not address the underlying mechanistic drivers of the disease. This results in lifelong medication dependency and progressive disease burden rather than reversal.

The Snouda Metabolic Score (SMS) is a hybrid composite-to-binary diagnostic instrument designed to phenotype T2DM patients across five mechanistic pillars: (A) Insulin Resistance and Hyperinsulinemia, (B) Chronic Low-Grade Inflammation, (C) Hormonal and HPA Axis Dysregulation, (D) Gut Microbiome Dysbiosis, and (E) Mitochondrial Dysfunction and Oxidative Stress. Each pillar is scored using a combination of objective laboratory biomarkers (weighted 60%) and clinician-administered patient-reported secondary criteria (weighted 40%), generating a Confirmed Phenotype code that guides precision protocol targeting.

This prospective interventional study enrolls 50 adult participants with confirmed T2DM. Following SMS phenotyping at baseline, participants are assigned to a 24-week personalized intervention protocol matched to their Confirmed Phenotype. The intervention comprises four components: (1) a structured dietary protocol based on phenotype (low-carbohydrate, anti-inflammatory, or mitochondrial support diet); (2) a progressive exercise protocol; (3) targeted nutritional supplementation based on identified deficiencies; and (4) optional structured intermittent fasting with full safety protocols.

Primary outcomes include change in HbA1c from baseline to Week 24, proportion of participants achieving T2DM remission (HbA1c less than 6.5% off glucose-lowering medication), and SMS phenotype classification accuracy. Secondary outcomes include changes in fasting insulin, C-peptide, hs-CRP, morning cortisol, body weight, waist circumference, blood pressure, and participant-reported quality of life.

The study is conducted entirely through the diabetesreversal.io digital platform. Participants complete the SMS assessment online, receive their personalized protocol through the platform, submit weekly check-ins, and upload self-measured physical assessments and blood glucose readings. Laboratory biomarker testing (Genesis Biomarker Panel) is performed at a local laboratory of the participant's choice at baseline and Week 24, with costs borne by the participant.

Safety oversight includes daily glucose monitoring protocols, a hypoglycemia escalation protocol, mandatory physician consultation prior to fasting periods, and independent medical monitoring of all serious adverse events. The study has received Deferred Approval from WCG Institutional Review Board (IRB Tracking Number 20261755).

Inclusion criteria

• Confirmed diagnosis of Type 2 Diabetes Mellitus (T2DM) by a licensed healthcare provider
• Age 18 years or older
• HbA1c between 6.5% and 11.0% at baseline
• Currently managed with lifestyle measures alone, or with oral glucose-lowering medications (metformin, SGLT2 inhibitors, DPP-4 inhibitors, or sulfonylureas)
• Ability to access and use the diabetesreversal.io digital platform
• Willingness to perform daily self-monitoring of blood glucose
• Willingness to complete laboratory blood tests (Genesis Biomarker Panel) at baseline and Week 24 at own expense
• Able to provide written informed consent

Exclusion criteria

• Type 1 Diabetes Mellitus or Latent Autoimmune Diabetes in Adults (LADA)
• Currently pregnant or breastfeeding
• Currently using insulin therapy
• Currently using GLP-1 receptor agonists (e.g., semaglutide, liraglutide)
• HbA1c greater than 11.0% at baseline
• History of severe hypoglycemia requiring third-party assistance in the past 12 months
• Active malignancy or receiving chemotherapy or radiation therapy
• Severe renal impairment (eGFR less than 30 mL/min/1.73m²)
• Severe hepatic impairment
• Active eating disorder
• Any condition that in the opinion of the investigator would make participation unsafe or interfere with study completion