Recent Advances in Nutrition and Diabetes.

The prevalence of diabetes is on the increase worldwide, being one of the fastest growing international health emergencies in the 21st century [...].

Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done?

Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin-associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch-up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co-morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.

Dieta proteinada en la diabetes de tipo 2. No / Protein diet in type 2 diabetes. No

Las proteínas representan un constituyente fundamental de los organismos vivos y su equilibrio depende inevitablemente del contenido proteico de los alimentos. Las recomendaciones de los diferentes Comités sugieren que, en dietas isoenergéticas, las proteínas deben aportar entre un 10 y un 20% del consumo calórico diario. Las necesidades para las personas con diabetes no difieren de las recomendadas para la población general. Sin embargo, se ha sugerido que dietas con alto contenido en proteínas y bajas en calorías podrían desempeñar un papel en el tratamiento de la obesidad asociada a la diabetes tipo 2. El objetivo del tratamiento de la obesidad es capacitar al paciente para que mantenga a largo plazo la pérdida de peso que sea capaz de alcanzar induciendo cambios en el estilo de vida, que consisten en incrementar la actividad física y en una alimentación saludable, es decir, variada y con adecuado balance calórico. Las dietas proteinadas carecen de estas características y no están exentas de efectos secundarios severos

Proteins are a fundamental constituent of living organisms, in which the balance depends inevitably on the protein content of food. The recommendations of various Committees suggest that, in isocaloric diets, proteins should provide between 10 and 20% of daily energy intake. The needs of people with diabetes do not differ from those of the general population. However, it has been suggested that high protein and low energy diets may have a role in the treatment of obesity associated with type 2 diabetes. The aim of the treatment of obesity is to enable the patient to maintain long-term weight loss. Changes in lifestyle are essential, and are based on increased physical activity and healthy eating habits, that include variety in foods and adequate calorie balance. Protein diets lack these features and can be accompanied by severe side effects

Diet and diabetes in the Caribbean

The problem is that in many Caribbean countries, especially Trinidad and Tobago, Barbados and the Bahamas, an incipient scourge has developed. Referred to sometimes as "sugar" or "sweet blood", diabetes is our most expensive disease and the one responsible for the most deaths. Diabetes has everything to do with the way we eat and live. Statistics for Trinidad, which are most up to date, show that we need not look far to find someone with diabetes. One- but possibly as many as two- out of every ten people have it. These days it's a cultural problem. Sadly, even the very cuisine on which we pride ourselves has become a source of health problems. That together with two much 'liming', social drinking, and smoking are now all on a national bad list. So, now it is time we weigh the benifits of our lifestyle against its consequences.

[The evolution of insulin therapy and new insight into nutrition recommendations for individuals with diabetes]. / Postep w insulinoterapii i nowe spojrzenie na zywienie w cukrzycy.

The dietary guideline has undergone change during the last decades. It has been done by the introduction of new insulin therapy methods, also by the numerous epidemiological studies which have documented the influence of eating habits on macro-vascular diseases, obesity and type 2 diabetes. The Glycemic Index (GI) and Glycemic Load (GL) play a pivotal role in carbohydrate classification and for food choice by diabetic patients. Post-prandial glycemia response and insulinemia strongly relate to value of GI and GL. Intensive insulin therapy as a multiple daily injection or pump therapy has brought a liberalization in diabetic regime and diet. It gives possibility to introduce modern dietary guidelines including healthy eating advice with respect for traditional eating habits.

Carbohidratos. Consideraciones nutricionales en el tratamiento de la diabetes mellitus. Estado actual del conocimiento / No disponible

No disponible

Diet and tobacco use: analysis of data from the diabetic control and complications trial, a randomized study.

CONTEXT: The Diabetic Control and Complications Trial (DCCT) researchers kept careful records of the food consumption and tobacco using habits of type 1 diabetic subjects. However, they did not report the relationship of tobacco using habits with dietary intake. OBJECTIVE: Analyze the relationship between tobacco smoking and intake of macro and micronutrients. DESIGN: Randomized controlled trial. SETTING: Referral clinics in 27 academic centers. PATIENTS: Type 1 diabetics. INTERVENTION: Using the data sets of the DCCT, this study analyzed the strengths of the associations between smoking and macronutrient consumption, hemoglobin A1c (HbA1c), body mass index (BMI), and serum lipid levels at the study baseline, 2 years, and 4 years. MAIN OUTCOME MEASURES: Statistically significant correlations between smoking and nutrient intake, HbA1c, and serum lipid levels. RESULTS: Cigarette, cigar, or pipe use at each time interval correlated with significantly increased caloric intake in males but not in females. In both males and females, tobacco users consumed more fat, cholesterol, and alcohol. Female smokers had higher serum low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratios and triglycerides. Serum cholesterols, LDL/HDL ratios, LDL cholesterols, and triglyceride determinations in male tobacco users significantly exceeded those in nonsmoking males. HDL cholesterols were lower in both female and male tobacco users. Nutrient intake of former tobacco users resembled that of nonusers rather than current users. CONCLUSIONS: A significant association exists between smoking and a diet with higher risks of atherosclerosis, cancer, and other degenerative diseases. The strong association of tobacco with heart disease, stroke, vasculopathies, and various malignancies may be in part due to its association with a higher fat diet. The higher fat diet of tobacco users probably accounts in part for their higher risk of developing type 2 diabetes and hyperlipidemia. Tobacco users should be informed about the diet and tobacco use association.

[The diabetic at the table: pariah or model?]. / Le diabétique à table: paria ou modèle?

Diet has long been part of the treatment. In fact modern dieting in diabetes comes only back 130 years ago with the description given by Apollinaire Bouchardat. He described how excessive glycosuria was observed in the postprandial periods and recommended a low carbohydrate diet. Along with the exclusion of simple sugars introduced 50 years later, the diabetic diet became a very restrictive one partly excluding the patients from normal social life event at home. Recent findings that carbohydrates should better represent 45 to 60% of the total daily caloric intake, that not all refined sugar are that "quick" nor particularly hyperglycaemic, along with the right use of mono-, poly- and saturated fat are now making the diabetic diet more flexible, more attractive, more eclectic. Nowadays we can say that the diet of a diabetic person (type 1 or 2) should follow is very comparable to that a non-diabetic person of the same age, sex, body weight and activity should also follow.

Medical nutrition therapy: an individualized approach to treating diabetes.

Making healthy food choices can be challenging for individuals with diabetes. However, nutrition education and counseling can help people understand how food affects their blood glucose level. Education also helps them to understand how the diet for diabetes has changed to include more carbohydrate-based foods than in the past. We now know that no single diet works to treat all people with diabetes; instead, diets should be individualized to meet the unique needs of each person. A variety of meal-planning approaches can be used to fit the lifestyle, food preferences, and learning needs of different individuals. Health professionals and dietitians need to strive to encourage people with diabetes to use tailored meal plans as an effective part of their diabetes self-management plan.

Nutrición y diabetes / Nutrition and diabetes

La dieta constituye un elemento fundamental en el tratamiento de la Diabetes Mellitus Insulinodependiente. Una nutrición adecuada va a tener un papel fundamental en la prevención de las complicaciones agudas y crónicas. El tratamiento dietético de la diabetes ha sufrido grandes cambios. La Asociación Americana de Diabetes y la Asociación Europea de Diabetes recomiendan actualmente una alimentación más flexible y equilibrada. La dieta ideal debe contener la energía necesaria para asegurar un crecimiento y desarrollo normales, con un mayor contenido de carbohidratos (50-60 por ciento) y menor de grasas (30 por ciento) y proteínas (10-20 por ciento). También debe asegurarse un aporte adecuado de fibra (30-40 gr/día), vitaminas y oligoelementos. No se conoce aún el papel del sodio pero se recomienda una ingesta moderada (3-6 gr/día). La distribución de calorías y alimentos a lo largo del día debe realizarse de forma regular y fija para evitar fluctuaciones importantes de la glucemia. En general, el cumplimiento de estas recomendaciones dietéticas es muy escaso (30 por ciento), por ello es necesario individualizar el plan de comidas diario y realizar una buena educación nutricional, transmitiendo al paciente diabético y a su familia que la alimentación ha de ser saludable, equilibrada y variada (AU)

Recommended dietary allowances (RDA) in the dietary management of children and adolescents with IDDM: an unfeasible target or an achievable cornerstone?

A diet in line with RDAs is seldom achieved by IDDM patients. High post-prandial glucose levels are often attributed to food excess rather than to inadequate insulin doses. Lower dietary CHO with greater fat (in particular SFA) and protein are progressively scheduled instead of increasing insulin units. We studied 194 IDDM patients (1-23 yr) on a diet conforming to RDAs with a restriction of sucrose and without a quantitative approach and exchange lists of food for one year. The diet consisted of a high intake of starchy foods and vegetables and a restricted amount of animal products. HbA1c mean values of the year were used as an indicator of metabolic control. The mean daily insulin dose was 0.53 U/kg in patients with diabetes duration (DD) < 2 yr and 0.81 U/kg in those with DD > 2 yr. Mean annual HbA1c was 7.1 +/- 0.9%. The prevalence of obesity was low (5.7%). Adolescent females were more obese than males. A dietary approach in line with RDA requirements, that may help prevent any complications related to an inappropriate diet pattern, coupled with a dynamic insulin adjustment, is the first-line intervention to prevent complications in IDDM patients.

New recommendations and principles for diabetes management.

Table 1 presents a historical overview of nutrition recommendations for diabetes from pre-1921 to the present. The 1994 recommendations obliterate the concept of only one "ADA diabetic diet," preferring instead to define the recommended diet as a dietary prescription based on nutrition assessment and treatment goals. The new recommendations require a comprehensive, multiclinician approach that must be both ongoing and integrated.

New possibilities in the diabetic diet.

Recent changes in diabetic diet have been reviewed with special regard to the role of obesity, eating habits, carbohydrate content, and the ratio of simple and complex carbohydrates in meals, glycaemic index and fibre content of diet. The lack of standard conditions for comparing the results of different examinations as well as the need for the decisive results of long-term studies have been pointed out. The recommended carbohydrate content of diabetic diet is 60%, fat content 30-35%. The previous complete elimination of simple naturally occurring carbohydrates from the diet is not recommended anymore, these may be consumed in a wider field. The observance of glycaemic index and the use of high-fibre diet are of high importance--even if not primary--especially in type II diabetic patient. In general it is recommended to maintain/obtain an ideal body weight and to introduce a simple diet--planned not only for diabetics.