Functional insulin therapy in type 1 diabetics: Short-term effects on weight and nutritional intake.

INTRODUCTION-AIM: Flexible insulin therapy is currently considered the gold standard therapy of type 1 diabetes. We aimed to study the evolution of glycemic control, weight and nutritional intake of a group of patients with type 1 diabetes, three months after the initiation of functional insulin therapy (FIT). METHODS: This was a prospective longitudinal study having included 30 type 1 diabetic patients hospitalized for education to FIT. Each patient underwent an assessment of glycemic control (glycated hemoglobin (A1C) and number of hypoglycemia), weight and nutritional intake before FIT and 3 months after the initiation of this educative approach. RESULTS: The mean age of patients was 21,8 ± 7,9 years and the sex ratio was 0,5. The mean duration of diabetes was 7,2 ± 6 years. Three months after initiation of FIT, we observed a significant lowering of A1C, which went from 9,2 ± 1,6% to 8,3 ± 1,4% (p<0,001) of the number of minor hypoglycemia (p=0,001) and that of severe hypoglycemia (p= 0,021). the average weight went from 64,6 ± 13,1 kg to 65,5 ± 13,5 kg (p = 0,040) with a significant increase in BMI (p = 0,041). Weight gain was observed in 67% of patients. This weight gain contrasted with a significant decrease in caloric (p = 0,040) and in carbohydrates intakes (p = 0,027). CONCLUSION: Weight gain, associated with better glycemic control, should encourage the healthcare team to strengthen therapeutic education of patients undergoing FIT in order to limit weight gain.

Impacts of nutritional education before Ramadan fasting on dietary intake, weight and body composition in diabetic patients.

BACKGROUND: The fasting period of Ramadan requires special attention for diabetic patients in particular. AIM: To determine the impacts of a nutritional education program before Ramadan fasting (RF) on dietary intake, anthropometry and body composition. METHODS: This was an interventional and comparative study including 54 type 2 diabetic patients, recruited at the National Institute of Nutrition. The patients were divided into two groups: an educated group who received a nutritional education session before Ramadan (n=26), and an uneducated group who did not receive any education (n=28). Food survey, anthropometry and body composition measurements were conducted before and after the month of Ramadan. RESULTS: During RF, a significantly decrease in carbohydrate intake was observed in both educated and uneducated patients (∆=-4.1 vs. ∆=-6.25). Lipid intake was increased significantly during RF for all patients. This increase was lower in patients receiving education compared to the other group (3.4±7.43 vs. 5.25±5.7). During RF, a significant increase in protein, saturated and monounsaturated fatty acids intake was shown in the uneducated group compared to educated group (respectively, ∆=1.19±2.30 vs. ∆ =1.06±7.10, ∆=3.40±7.43 vs. ∆=5.25±5.70 and ∆=2.23±5.60 vs. ∆=2.31±5.10). The weight loss was similar between the two groups of educated (-1.05 kg) and uneducated (-0.58 kg) patients. There was no significant change in body composition during Ramadan in both groups of diabetics. CONCLUSIONS: Nutritional education programs positively impact diabetic patients who prefer RF or insist to fast during Ramadan. These programs must be provided to diabetics before Ramadan.

Prevalence of vitamin D deficiency in mothers and their newborns in a Tunisian population.

OBJECTIVE: To assess vitamin D status in mothers and their newborns and identify predictive factors of vitamin D deficiency. METHODS: A cross-sectional study was undertaken of healthy women and their full-term newborns delivered at the Charles Nicolle Hospital, Tunis, Tunisia, between October and November 2012. Maternal and neonatal serum 25-hydroxy vitamin D (25(OH)D) concentrations were measured. Correlations were tested. RESULTS: Overall, 87 mothers and their newborns were enrolled. No mother or neonate had an adequate vitamin D status. Mean maternal and neonatal serum 25(OH)D concentrations were 6.82±5.14ng/mL (range 3.60-23.77) and 5.92±4.15ng/mL (range 3.60-22.28), respectively. Vitamin D deficiency (serum 25(OH)D<20ng/mL) was found in 84 (97%) mothers and 85 (98%) neonates, of whom 76 (87%) and 78 (90%), respectively, had severe deficiency (serum 25(OH)D<12ng/mL). Maternal serum 25(OH)D showed a strong positive correlation with neonatal serum 25(OH)D (r=0.69, P<0.001). Maternal dietary vitamin D intake was the only factor shown to be associated with serum 25(OH)D concentrations (P<0.05). CONCLUSION: Vitamin D deficiency is prevalent among Tunisian mothers and their neonates.