Avaliação do consumo de frutas em pacientes com diabetes mellitus tipo 2 / Fruit consumption in patients with type 2 diabetes mellitus

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. O objetivo deste estudo foi avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico.Métodos: Foram incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Os pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados.Resultados: A média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. Os pacientes com maior consumo de frutas apresentaram maior ingestão de energia (p < 0,001), carboidratos (p < 0,001) e fibras (p = 0,006) e uma menor ingestão de proteínas (p = 0,015), lipídeos totais (p = 0,040) e seus tipos. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Foi observado ainda uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05).Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas.

Introduction: The impact of fruit consumption on the health of patients with type 2 diabetes mellitus (T2DM) warrants investigation. The aim of this study was to evaluate fruit consumption in patients with T2DM and to identify its association with glycemic control parameters.Methods: We included 197 outpatients with T2DM who underwent clinical, sociodemographic, anthropometric, laboratory, and food consumption assessments. A food frequency questionnaire was used to assess total food intake and fruit consumption. Patients with lower and higher fruit consumption (according to the median) were compared.Results: Average fruit consumption was 593.66 ± 330.74 g/day. Blood glucose (169.42 ± 70.83 vs. 158.62 ± 64.56 mg/dL; p = 0.273) and glycated hemoglobin (8.39 ± 1.68% vs. 8.68 ± 2.38%; p = 0.319) levels did not differ between the lower and higher fruit consumption groups, nor did the other variables. Patients with higher fruit consumption had a higher intake of energy (p < 0.001), carbohydrates (p < 0.001), and fibers (p = 0.006) but a lower intake of proteins (p = 0.015) and total and different types of lipids (p = 0.040). The higher consumption group had higher vitamin C (p < 0.001) and potassium (p < 0.001) intake and lower sodium intake (p = 0.001). We identified a negative correlation between fruit consumption and the diet's glycemic index (p = 0.05).Conclusion: Fasting blood glucose and glycated hemoglobin levels did not differ between the higher and lower fruit consumption groups.

Educational intervention to improve the competence of Mexican physicians to provide nutritional management for diabetes mellitus type 2 / Intervención educativa para mejorar la competencia de médicos mexicanos para manejar nutricionalmente diabetes mellitus Tipo 2

ABSTRACT Objective To evaluate the effect of a participative educational intervention on the clinical competence of Mexican family physicians regarding the nutritional management of patients with diabetes mellitus Type 2. Materials and Methods Quasi-experimental study with a before-and-after control group. Convenience sample included 60 family physicians distributed in two social security primary health care units, randomly selected: 30 in the "A" unit and 30 in the "B" unit. Unit "A" was assigned randomly as control group, and "B" unit as intervention group. The intervention consisted of a theoretical-practical course-workshop that lasted six months where real cases were discussed and solved. Clinical competence was evaluated by means of an instrument designed ex professo, with a maximum theoretical value of 100 and 94% reliability according to the Kuder-Richardson test. Medians of clinical competence were compared among groups, before and after intervention, using the Mann-Whitney U test, while frequencies distribution of clinical competence level were analyzed with the Kolmogorov-Smirnov test (p≤0.05). Results Overall medians and intervals for unit "A" were 28 (9-45) pre-intervention and 34 (11-51) pos-intervention, with before-after difference p>0.05; for unit "B", values were 32 (12-50) pre-intervention, 61 (36-82) pos-intervention, and before-after difference p≤0.05. No significant differences were found among groups pre-intervention (p>0.05), although they were observed pos-intervention (p≤0.05). Conclusions The educational intervention evaluated proved to improve, in a statistically significant way, the overall and by dimensions clinical competence level of Mexican family physicians for nutritional management of patients with diabetes mellitus type 2.(AU)

RESUMEN Objetivo Evaluar el efecto de una intervención educativa participativa sobre la competencia clínica de médicos familiares mexicanos para el manejo nutricio de pacientes con diabetes mellitus Tipo 2. Método Estudio cuasiexperimental con grupo control antes-después. Se estudió una muestra por conveniencia de 60 médicos familiares distribuidos en dos unidades médicas de atención primaria de seguridad social elegidas al azar, 30 en la "A" y 30 en la "B". La unidad "A" fue designada grupo control, y la "B" de intervención. La intervención consistió en un curso-taller teórico-práctico que duró seis meses, donde se discutieron y resolvieron casos reales. La competencia clínica se evaluó mediante un instrumento diseñado ex professo, con un valor teórico máximo de 100, y una fiabilidad de 94% según prueba de Kuder-Richardson. Se compararon las medianas de competencia clínica entre grupos antes y después mediante la prueba U de Mann-Whitney, y cinco las distribuciones de frecuencias de los niveles de competencia clínica mediante la prueba de Kolmogórov-Smirnov (p≤0,05). Resultados Medianas e intervalos de la calificación global: unidad "A" 28 (9-45) pre-intervención, 34 (11-51) pos-intervención, diferencia antes-después p≤0,05; unidad "B" 32 (12-50) pre-intervención, 61 (36-82) pos-intervención, diferencia antes-después p≤0,05. No se encontró diferencia significativa entre los grupos pre-intervención (p>0,05), y si pos-intervención (p≤0,05). Conclusiones La intervención educativa evaluada demostró mejorar, de forma estadísticamente significativa, el nivel de competencia clínica global y por dimensión, de médicos familiares mexicanos para el manejo nutricio de pacientes con diabetes mellitus tipo 2.(AU)

La alimentación para pacientes con diabetes mellitus de tipo 2 en tres hospitales públicos de Cundinamarca, Colombia / Feeding in adults with type II diabetes mellitus in three public hospitals in Cundinamarca, Colombia

Resumen Introducción. En el mundo y en Colombia, la diabetes mellitus de tipo 2 es una de las principales causas de morbimortalidad, y afecta principalmente a los hombres y mujeres mayores de 45 años. Un control inapropiado de la enfermedad puede desembocar en mayores complicaciones de salud y convertirla en una de las de más alto costo. El tratamiento incluye otros componentes, además del control de la glucemia, así como un seguimiento constante del personal médico, y actividades educativas dirigidas al paciente y a su familia. Objetivo. Caracterizar la alimentación de pacientes con diabetes mellitus de tipo 2 en tres hospitales públicos de Cundinamarca. Materiales y métodos. Se hizo un estudio descriptivo y transversal con 212 pacientes, el cual incluyó el análisis sociodemográfico, el de la frecuencia del consumo de alimentos y las prácticas alimentarias. Resultados. La mayoría de la población era mayor de 45 años y tenía un bajo nivel educativo; el 52 % contaba con un plan de alimentación, y solo el 8,9 % recibía orientación nutricional a cargo de un nutricionista. Predominó el consumo de carbohidratos y un bajo consumo de proteínas, vitaminas, minerales y fibra. El consumo de azúcares era menor en los pacientes que tenían un plan dietético (p<0,05). Conclusiones. La mayoría de los pacientes no recibía una alimentación adecuada. Se evidenció un deficiente cumplimiento del tratamiento dietético, así como limitaciones en la asesoría nutricional y barreras de acceso a los alimentos. Estos resultados contribuirán a mejorar las políticas de prevención y control de la diabetes mellitus de tipo 2 y las estrategias que tengan en cuenta el contexto sociocultural de los pacientes.

Abstract Introduction: Type II diabetes mellitus (DMII) is one of the main causes of morbidity and mortality both worldwide and in Colombia. It mainly affects men and women over 45 years of age. Inadequate control of this disease can generate greater health complications making it one of the most costly diseases in the country. Treatment includes activities other than glycemic control and requires constant monitoring by medical personnel and educational processes directed at the patient and his or her family. Objective: To characterize the feeding of patients with DMII in three public hospitals of Cundinamarca. Materials and methods: We conducted a cross-sectional descriptive study of 212 patients that analyzed sociodemographic characteristics, frequency of consumption and feeding practices. Results: Most of the population was over 45 years old and had a low educational level. In total, 52% had a dietary plan, but only 8.9% received nutritional guidance from a nutritionist. The consumption of carbohydrates predominated, with low consumption of proteins, vitamins, minerals, and fiber. The consumption of sugars was lower in patients with a dietary plan (p <0.05). Conclusions: Most of the patients did not have an adequate nutrition; moreover, there was low adherence to dietary treatment, weakness in nutritional counseling and barriers to food access. These results can contribute to improving policies for the prevention and control of DMII and strategies based on the sociocultural context of the patients.

Ejercicio intermitente y consejería nutricional mejoran control glicémico y calidad de vida en pacientes con diabetes mellitus tipo 2 / Effects of high-intensity interval training and nutritional education in patients with type 2 diabetes

Background: High-intensity interval training (HIIT) improves cardiometabolic markers, but its effects on the quality of life of patients with type 2 diabetes (T2D) is not well known. Aim: To determine the effects of a 12-week HIIT exercise program on cardiometabolic and quality of life variables of T2D patients. Material and Methods: Nine T2D women were assigned to a HIIT + nutritional education (GE) and 10, to a nutritional education alone group (GC). At baseline and after each intervention, anthropometric and body composition parameters using bio-impedance were assessed, and a blood sample was obtained to measure serum lipid levels, blood glucose and glycated hemoglobin. Quality of life was assessed using the SF-12 questionnaire adapted for the Chilean population. Results: There were no significant changes on the lipid profile variables in the GE group, although HDL cholesterol was increased significantly (p < 0.05) in the GC group. Total fat mass was decreased in the GE group from 43.5 ± 1.5 to 41.9 ± 1.5%, p < 0.01. Fasting glucose and glycated hemoglobin decreased in the GE group. There was a significant correlation between the decrease in total fat mass and that of glycated hemoglobin. There were significant increases in quality of life parameters; physical function, physical role, pain, general health, vitality, emotional role, mental health, and social function in the GE but not in the GC group. Conclusions: A 12-week program of HIIT plus nutritional education improves cardiometabolic and quality of life parameters on type 2 diabetics.

Low glycemic index diet reduces body fat and attenuates inflammatory and metabolic responses in patients with type 2 diabetes

ABSTRACT Objective The aim of this study was to verify the effects of glycemic index (GI) on body composition, and on inflammatory and metabolic markers concentrations in patients with type 2 diabetes. Subjects and methods In this randomized controlled parallel trial, twenty subjects (aged 42.4 ± 5.1 years, BMI 29.2 ± 4.8 kg.m-2) were allocated to low GI (LGI) (n = 10) or high GI (HGI) (n = 10) groups. Body composition, inflammatory and metabolic markers were assessed at baseline and after 30 days of intervention. Food intake was monitored during the study using three-day food records completed on two non-consecutive weekdays and on a weekend day. Results Body fat reduced after the LGI intervention compared with baseline (P = 0.043) and with the HGI group (P = 0.036). Serum fructosamine concentration (P = 0.031) and TNF-α mRNA expression (P = 0.05) increased in the HGI group. Serum non-esterified fatty acids were greater in the HGI than in the LGI group (P = 0.032). IL-6 mRNA expression tended to decrease after the consumption of the LGI diet compared to baseline (P = 0.06). Conclusion The LGI diet reduced body fat and prevented the negative metabolic and inflammatory responses induced by the HGI diet.

Influência da hipomagnesemia sobre a homeostase do ferro e estresse oxidativo no diabetes mellitus tipo 2 / Influence of hypomagnesemia on iron homeostasis and oxidative stress in type 2 diabetes mellitus

OBJECTIVE: This review aims to bring updated information about the influence of magnesium deficiency on iron homeostasis and oxidative stress in type 2 diabetics. Data source: A bibliographic search was conducted in the databases Bireme, SciELO, Science Direct, PubMed and Portal.periodicos.Capes using the following descriptors: "diabetes mellitus", "magnesium", "iron", "oxidative stress" and "malondialdehyde". Fifty articles related to this literature were selected. Data synthesis: Several studies have shown the influence of hypomagnesemia on oxidative stress in type 2 diabetics. Deficiency of this mineral seems to be related to the induction of hemolysis, which favors the release of iron with overload of this mineral in the body, allowing an increase of the hydroxyl radical through the Fenton reaction and, consequently, oxidative stress. The increase in free iron contributes significantly to the manifestation of lipid peroxidation, which triggers a sequence of lesions in the cell with loss of selectivity in ion exchange and release of the contents of organelles, such as the hydrolytic enzymes of lysosomes, and the formation of cytotoxic products, such as malondialdehyde. CONCLUSIONS: There is scientific evidence that magnesium deficiency alters iron compartmentalization in the body; however, new studies are needed to bring information that would enable the biochemical understanding of the importance of the balance of magnesium and iron concentrations in protecting against the oxidative stress present in type 2 diabetes

OBJETIVO: Esta revisão visa trazer informações atualizadas sobre a influência da deficiência de magnésio na homeostase do ferro e estresse oxidativo em diabéticos tipo 2. Fonte de dados: O levantamento bibliográfico foi realizado nas bases de dados Bireme, Scielo, Science Direct, periódicos Capes e Pubmed com os seguintes descritores: "diabetes mellitus", "magnésio", "ferro", "estresse oxidativo" e "malondialdeído". Foram selecionados 50 artigos entre os relacionados por essa pesquisa bibliográfica. Síntese dos dados: Diversos estudos têm mostrado a influência da hipomagnesemia sobre o estresse oxidativo em diabéticos tipo 2, sendo que a deficiência desse mineral parece estar relacionada à indução da hemólise dos eritrócitos, que favorece a liberação do ferro com sobrecarga desse mineral no organismo, o que possibilita aumento do radical hidroxila por meio da reação de Fenton e, consequentemente, o estresse oxidativo. O aumento de ferro livre contribui de forma relevante para a manifestação da peroxidação lipídica, que desencadeia sequência de lesões na célula, com perda da seletividade na troca iônica e liberação do conteúdo de organelas, como as enzimas hidrolíticas dos lisossomas e a formação de produtos citotóxicos, como o malondialdeído. CONCLUSÕES: Há evidências científicas de que a deficiência de magnésio altera a compartimentalização do ferro no organismo, entretanto a realização de novos estudos é necessária para trazer informações que permitam o entendimento bioquímico da importância do equilíbrio das concentrações de magnésio e ferro na proteção contra o estresse oxidativo presente no diabetes tipo 2

Curcumin restores mitochondrial functions and decreases lipid peroxidation in liver and kidneys of diabetic db/db mice

BACKGROUND: Nitrosative and oxidative stress play a key role in obesity and diabetes-related mitochondrial dysfunction. The objective was to investigate the effect of curcumin treatment on state 3 and 4 oxygen consumption, nitric oxide (NO) synthesis, ATPase activity and lipid oxidation in mitochondria isolated from liver and kidneys of diabetic db/db mice. RESULTS: Hyperglycaemia increased oxygen consumption and decreased NO synthesis in liver mitochondria isolated from diabetic mice relative to the control mice. In kidney mitochondria, hyperglycaemia increased state 3 oxygen consumption and thiobarbituric acid-reactive substances (TBARS) levels in diabetic mice relative to control mice. Interestingly, treating db/db mice with curcumin improved or restored these parameters to normal levels; also curcumin increased liver mitochondrial ATPase activity in db/db mice relative to untreated db/db mice. CONCLUSIONS: These findings suggest that hyperglycaemia modifies oxygen consumption rate, NO synthesis and increases TBARS levels in mitochondria from the liver and kidneys of diabetic mice, whereas curcumin may have a protective role against these alterations.

Reduced Food Intake is the Major Contributor to the Protective Effect of Rimonabant on Islet in Established Obesity-Associated Type 2 Diabetes

PURPOSE: Although the presence of cannabinoid type 1 (CB1) receptor in islets has been reported, the major contributor to the protective effect of rimonabant on islet morphology is unknown. We determined whether the protective effect of rimonabant on pancreatic islet morphology is valid in established diabetes and also whether any effect was independent of decreased food intake. MATERIALS AND METHODS: After diabetes was confirmed, Otsuka Long-Evans Tokushima Fatty rats, aged 32 weeks, were treated with rimonabant (30 mg/kg/d, rimonabant group) for 6 weeks. Metabolic profiles and islet morphology of rats treated with rimonabant were compared with those of controls without treatment (control group), a pair-fed control group, and rats treated with rosiglitazone (4 mg/kg/d, rosiglitazone group). RESULTS: Compared to the control group, rats treated with rimonabant exhibited reduced glycated albumin levels (p<0.001), islet fibrosis (p<0.01), and improved glucose tolerance (p<0.05), with no differences from the pair-fed control group. The retroperitoneal adipose tissue mass was lower in the rimonabant group than those of the pair-fed control and rosiglitazone groups (p<0.05). Rimonabant, pair-fed control, and rosiglitazone groups showed decreased insulin resistance and increased adiponectin, with no differences between the rimonabant and pair-fed control groups. CONCLUSION: Rimonabant had a protective effect on islet morphology in vivo even in established diabetes. However, the protective effect was also reproduced by pair-feeding. Thus, the results of this study did not support the significance of islet CB1 receptors in islet protection with rimonabant in established obesity-associated type 2 diabetes.

Evaluation of risk for type 2 diabetes mellitus in medical students using Indian diabetes risk score.

Background: According to World Health Organisation, type 2 diabetes mellitus [type 2 D. M] has recently escalated in all age groups and is now being identified in younger age groups. This underscores the need for mass awareness and screening programs to detect diabetes at an early stage. For this purpose we have used a simplified Indian Diabetes Risk Score (IDRS) for prediction of diabetes in undergraduate medical students. Objectives: To screen and to identify 1st MBBS students at risk for developing type 2 D. M using IDRS. Materials and Methods : 261 undergraduates (1st MBBS students) were scored using IDRS which includes age, family history of diabetes, exercise status, and waist circumference. After scoring them, we assessed random capillary blood glucose (RCBG) in students with high IDRS score. Students with RCBG ≥ 113 mg/dl are followed for definitive tests for diagnosis of prediabetes and diabetes. Results and Conclusion: We have assessed 261 students till now. It was observed that 5%, 55%, and 38% students in High, Moderate, and Low risk group, respectively, for developing type 2 D. M. The mean abdominal obesity in high risk students was 101.95 ± 5.76 as compared to 79.17 ± 11.08 in moderate and low risk students (P < 0.0001). 63% students were having sedentary lifestyle. Family history of diabetes in either or both parents was present in 25% students. Mean RCBG in students having score more than 50 was 97.33 ± 9.68 mg/dl. Also, two students were having RCBG > 113 mg/dl in which one student found to have prediabetic. Conclusion: This underscores the need for further investigations to detect diabetes at an early stage and to overcome the disease burden of diabetes in future. Prevention of obesity and promotion of physical activity have to be the future plan of action which can be suggested in the form of regular exercise and diet planning for the students as part of an integrated approach.

[ effects of green tea extract on serum adiponectin concentration and insulin resistance in patients with type 2 diabetes mellitus]

Adiponectin is a novel adipose tissue-specific adipokine that can increase insulin sensitivity. Many studies have shown anti obesity and anti diabetic effects of green tea consumption. In this study we examined the effects of green tea extract on circulating adiponectin levels and insulin resistance status in patients with type 2 diabetes mellitus [T2DM]. In this double blind randomized clinical trial 58 type 2 diabetic patients with BMI >/= 25 were recruited from an unselected population from the outpatient clinic of Shariati hospital, Tehran, Iran. Patients were randomly divided into two groups; green tea extract and placebo. All the patients received the capsules for 8 weeks. Laboratory measurements including fasting serum adiponectin, insulin, HOMA-IR, FPG, OGTT, HbA1c and lipid profile and anthropometric were performed before and after the intervention. Nutrient intakes were obtained via 24-hour recall from each patient in three successive days. The data were analyzed using appropriate software. We found a significant effect of green tea extract on increasing the logarithm of serum adiponectin in diabetic patients [0.15 +/- 0.10 micro g/ ml, P<0.05]. A significant independent correlation between the logarithm of serum adiponectin and WHR [Waist to Hip Ratio] was found [P=0.009, t=-2.7]. The consumption of green tea extract had a significant effect in control the levels of HbA1C, weigh and also BMI in green tea group [P<0.05]. The results showed that consumption of green tea extract can be useful in the control of T2DM by increasing the levels of serum adiponectin and controlling the weight, BMI and HbA1C levels in patients with T2DM

Effects of dietary omeg-3 fatty acid supplementation on HbA1c, total antioxidant capacity and superoxide dismutase and catalase activities in type-2 diabetic patients: a randomized clinical trial

Essential fatty acid deficiency has been found in diabetic patients. Omega-3 fatty acid supplementation could be beneficial in alleviating diabetes complications and glycemic control. However, it may increase oxidative stress. In this study the effects of omega-3 fatty acid supplements on glycemic control, total antioxidant capacity and antioxidant enzymes [superoxide dismutase and catalase] activities were investigated. In a double-blind, randomized, controlled clinical trial, 81 type-2 diabetic patients were divided into 2 groups. The experimental group took 2714 mg/day omega-3 fatty acids [1548 mg EPA, 828 mg DHA, and 338 mg other omega-3 fatty acids], and the control group took sunflower oil as a placebo, for 8 weeks. Dietary intakes were assessed by a 24h dietary recall, before and after intervention, and analyzed using food processor II. In addition, fasting blood samples were collected for analysis and height and weight were measured, initially and at the end of the trial. At the start of the study there were no statistically significant differences between the two groups with regard to mean weight, height, body mass index [BMI], daily intakes of energy, carbohydrate, protein, total fat, polyunsaturated fatty acids, fiber, vitamins A, B, C, E, folate, cobalamine, zinc, or biochemical parameters. Neither were there any difference in weight, BMI and dietary intakes before and after intervention in either group. The supplementation brought about a significant decrease [P < 0.00] in HbA1c% in the experimental group, while in the control group the HbA1c level actually increased [p < 0.02]. Furthermore, the magnitudes of HbA1c changes were significantly deferent between the two groups [P < 0.00]. Changes in the fasting blood sugar [163.88 +/- 10 vs. 165.6 +/- 7.9 mg/dl], total antioxidant capacity [3.79 +/- 0.07 vs. 3.62 +/- 0.7 mg/dl], and activities of super oxide dismutase [449.22 +/- 14.14 vs. 417.16 +/- 11.9 U/gHb] and catalase [150.72 +/- 9.6 vs. 151.86 +/- 12.6 k/gHb] were not statistically significant. Omega-3 fatty acid supplementation may be helpful in glycemic control in type-2 diabetes, but it has no significant effect on the antioxidant enzyme activities

effects of oligofructose and polydextrose on metabolic control parameters in type-2 diabetes

This study investigated the effects of oligofructose and polydextrose on metabolic control in Type-2 diabetes. Twenty voluntary, postmenopausal, total cholesterol [TC]/HDL-cholesterol [HDL-C] ratios >4.5, female, Type-2 diabetes patients were included. The study was performed in four periods, with the baseline as the period one. In periods two and four, the patients consumed individual diabetic diets for eight weeks. In period three, they consumed 20g of oligofructose and polydextrose mixture in 40g sweetener [in powdered form], added to their diets for six weeks. Prebiotic soluble fiber sources [oligofructose and polydextrose] significantly decreased fasting and postprandial [2-hour] blood glucose, glycosylated hemoglobin, TC, LDL-cholesterol [LDL-C], TC/HDL-C and LDL-C/HDL-C ratios, triglyceride, VLDL-cholesterol, lipoprotein [a], systolic and diastolic blood pressures [p<0.001], apolipoprotein B [p<0.05], and increased HDL-C, insulin [p<0.05], and C-peptide levels [p>0.05] compared to the initial values, respectively. Individual diabetic diets supplemented with prebiotics improved metabolic control in Type-2 diabetes

Barriers to changing dietary behavior.

Dietary change requires giving up long established patterns of eating behavior and acquiring new habits. 'Non-compliance' to diet advice may be a result of inability to provide diet self-management training and getting the right messages across to change eating behavior. Using a pre-tested questionnaire based interview, we carried out a study amongst 350 adults (> 20 years) with type 2 diabetes from two metro cities in South India, who had previously received diet advice with the objective to understand perceptions, attitudes and practices, as well as study factors that enhance or reduce compliance to diet advice. Ninety six patients (28%) followed diet for the full duration of diabetes (Group1), 131 (38%) followed diet for a partial duration varying between more than a quarter to three quarters of the total diabetes duration (Group 2) and 115 (34%) did not follow diet advice (Group 3) - followed for a duration less than a quarter of their diabetes duration. Study results show that many factors both patient and health care provider related influence outcomes of dietary advice. Factors that have a positive impact on compliance are - older age, shorter duration, nuclear family, good family support, less busy work life, higher health consciousness, advice given by dietician, more frequent visits to dietician, advice that includes elements to promote overall health not merely control of blood sugar, diet counseling that is easy to understand and use and includes healthy food options, cooking methods, practical guidance to deal with lifestyle issues. We conclude that patient barriers related to life circumstance are mostly non-modifiable, most modifiable barriers are related to behavioural aspect and the inability of the health care provider to provide individualized diet advice and self management training. Efforts must be made to improve counseling skills.

Soy and cardio-metabolic abnormalities: an update

Soy protein contains beneficial components like complex carbohydrates, unsaturated fatty acids, vegetable protein, soluble fiber, oligosaccharides, vitamins, minerals, inositol-derived substances and phytoestrogens, particularly the isoflavones genistein, diadzein, and glycitein, which might affect different cardio-metabolic abnormalities. Soy consumption has been reported to beneficially affect features of the metabolic syndrome in animal models and also in humans to some extent. There are inconsistent reports regarding the hypothesis of the effectiveness of soy protein on obesity. While some studies have shown that soy consumption can improve the features of the metabolic syndrome without affecting body weight, others showed that soy consumption has beneficial role in weight management and might improve the metabolic syndrome by affecting body weight control. Several studies have consistently reported the effects of soy on cardiovascular risks. Beneficial role of soy intake on diabetes is another aspect of soy inclusion in the diet. The present study discusses the effects of soy consumption on different cardio-metabolic abnormalities and provides information regarding the possible mechanisms by which soy protein might exert its beneficial roles

Does adding garlic [Allium sativum] with antidiabetic therapy help achieving better glycemic control in type 2 diabetic patients

With high incidence of diabetes and a wide spread belief among the general public that garlic has beneficial effects on cardiovascular risk factors., we designed a study to evaluate the blood glucose lowering effects and potential adverse effects of garlic in patients with type 2 diabetes mellitus. The study was a 12 weeks randomized, single-blind placebo controlled study, comparing the additional blood glucose lowering effects of dried garlic powder tablet 300 mg [standardized to provide 1.3% allicin equivalent to 0.6% allicin] twice daily combined with standard anti diabetic therapy [which the patient is already taking] with that of standard antidiabetic therapy alone in type 2 diabetic patients. At the end of 12 weeks it was found that changes in blood glucose [P <0.01] and cholesterol [P <0.001] were significantly different between the garlic and placebo groups. Adding garlic to an anti diabetic regimen could be a good and safe method to achieve a good glycemic control in type 2 diabetic patients. Long term clinical trials at different doses of garlic is needed to further strengthen the current findings

Effect of nurse-led telephone follow ups [Tele-Nursing] on diet adherence among type 2 diabetic patients

Diabetes education does not assure adherence to diabetic regimen. The aim of this study was to investigate the effect of nurse-led telephone follow ups [Tele-Nursing] program on adherence to diabetic diet among type 2 diabetic patients. This was a quasi experimental study. Sixty patients who were registered at Iranian Diabetes Society were selected using convenience sampling method. Data gathering instruments included a data sheet to record glycosylated hemoglobin and a questionnaire. Data were gathered at baseline and 12 weeks after the intervention. First, all participants attended in a three-day self-care education and dietary consultation program at Iranian Diabetes Society. Then, they were randomly assigned to the experiment and control groups. Telephone follow ups were applied in experiment group for 3 months, twice a week for the first month and then weekly for the second and third months. Data were analyzed using SPSS version 13. Results showed that there were significant statistical differences between control and experiment groups in adherence to diabetic diet [P=0.035]. There were significant differences in glycosylated hemoglobin between control and experiment groups after the intervention [P<0.000]. According to the results of the study, it is concluded that the nurse-led telephone follow ups can improve HbA[1c] and diet adherence in type 2 diabetic patients