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Sunuwar DR, Nayaju S, Dhungana RR, Karki K, Singh Pradhan PM, Poudel P, Nepal C, Thapa M, Shakya NS, Sayami M, Shrestha PK, Yadav R, Singh DR. Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with type 2 diabetes in Nepal: a single centre, open-label, randomised controlled trial. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 18:100285. [PMID: 38028163 PMCID: PMC10667281 DOI: 10.1016/j.lansea.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/01/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023]
Abstract
Background Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D. Methods An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24-64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367. Findings Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: -0.80 to -0.16), while it increased in the control group by 0.22 (95% CI: -0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: -1.04 to -0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: -36.12 to -1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group. Interpretation The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs. Funding The research was funded by the University Grants Commission (UGC), Nepal.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Nepal
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Suvash Nayaju
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Nepal
| | - Raja Ram Dhungana
- Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Kshitij Karki
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Nepal
- Department of Food, Agriculture, and Bioresources, School of Environment Resources and Development, Asian Institute of Technology, Thailand
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
| | - Pramod Poudel
- Central Department of Biotechnology, Tribhuvan University, Kathmandu, Nepal
| | - Chitrakala Nepal
- Department of Nutrition and Dietetics, College of Applied Food and Dairy Technology, Lalitpur, Nepal
| | - Madhu Thapa
- Department of Nutrition and Dietetics, College of Applied Food and Dairy Technology, Lalitpur, Nepal
| | - Nani Shobha Shakya
- Department of Nutrition and Dietetics, College of Applied Food and Dairy Technology, Lalitpur, Nepal
| | - Matina Sayami
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Renu Yadav
- Department of Nutrition and Dietetics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Nepal
- Department of Public Health, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
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2
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Nakahata M, Tanaka-Mizuno S, Yamaguchi F, Takeuchi M, Kawakami K. Does nutritional guidance reduce cardiovascular events in patients with type 2 diabetes mellitus? A retrospective cohort study using a nationwide claims database. Acta Diabetol 2023; 60:1541-1549. [PMID: 37421440 DOI: 10.1007/s00592-023-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
AIM To examine the effect of nutritional guidance (NG) provided by a registered dietitian under the direction of a physician on the development of subsequent cardiovascular events in patients with early-stage type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This retrospective cohort study used the JMDC claims database to explore patients aged 18 years or older who first met the diagnostic criteria for T2DM at a health checkup between January 2011 and January 2019. The last day of the observation period was set for 28 February, 2021. Exposure was defined as receiving NG within 180 days of diagnosis of T2DM. The primary outcome was a composite endpoint of coronary artery disease (CAD) and cerebrovascular disease, and the secondary outcomes were each event, and time to event was compared. The propensity score weighting method was used for adjusting the distribution of confounding variables. Cox regression was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Overall, 31,378 patients met the eligibility criteria at an annual health checkup. 9.6% received NG (n = 3013). Patients who attended ≥ 1 NG after diagnosis had significantly reduced risk of cardiovascular composite (adjusted HR 0.75, 95% CI 0.58-0.97) and cerebrovascular disease (adjusted HR 0.65, 95% CI 0.47-0.90) during approximately 3.3 years of follow-up. In contrast, no difference was observed for CAD. CONCLUSIONS Receiving NG in early-stage diabetes may reduce the incidence of cardiovascular events, especially cerebrovascular events.
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Affiliation(s)
- Misaki Nakahata
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
- Department of Digital Health and Epidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
| | - Fumitaka Yamaguchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
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3
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Li L, Yang HY, Ma Y, Liang XH, Xu M, Zhang J, Huang ZX, Meng LH, Zhou J, Xian J, Suo YJ, Huang S, Cai JW, Meng BH, Zhao ZY, Lu JL, Xu Y, Wang TG, Li M, Chen YH, Wang WQ, Bi YF, Ning G, Shen FX, Hu RY, Chen G, Chen L, Chen LL, Deng HC, Gao ZN, Huo YN, Li Q, Liu C, Mu YM, Qin GJ, Shi LX, Su Q, Wan Q, Wang GX, Wang SY, Wang YM, Wu SL, Xu YP, Yan L, Yang T, Ye Z, Yu XF, Zhang YF, Zhao JJ, Zeng TS, Tang XL, Qin YF, Luo ZJ. Whole fresh fruit intake and risk of incident diabetes in different glycemic stages: a nationwide prospective cohort investigation. Eur J Nutr 2023; 62:771-782. [PMID: 36261730 PMCID: PMC9941276 DOI: 10.1007/s00394-022-02998-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/31/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Fruit intake is beneficial to several chronic diseases, but controversial in diabetes. We aimed to investigate prospectively the associations of whole fresh fruit intake with risk of incident type 2 diabetes (T2D) in subjects with different glucose regulation capacities. METHODS The present study included 79,922 non-diabetic participants aged ≥ 40 years from an ongoing nationwide prospective cohort in China. Baseline fruit intake information was collected by a validated food frequency questionnaire. Plasma HbA1c, fasting and 2 h post-loading glucose levels were measured at both baseline and follow-up examinations. Cox proportional hazards models were used to calculate hazard ratio (HR) and 95% confidence intervals (CI) for incident diabetes among participants with normal glucose tolerance (NGT) and prediabetes, after adjusted for multiple confounders. Restricted cubic spline analysis was applied for dose-response relation. RESULTS During a median 3.8-year follow-up, 5886 (7.36%) participants developed diabetes. Overall, we identified a linear and dose-dependent inverse association between dietary whole fresh fruit intake and risk of incident T2D. Each 100 g/d higher fruit intake was associated with 2.8% lower risk of diabetes (HR 0.972, 95%CI [0.949-0.996], P = 0.0217), majorly benefiting NGT subjects with 15.2% lower risk (HR 0.848, 95%CI [0.766-0.940], P = 0.0017), while not significant in prediabetes (HR 0.981, 95%CI 0.957-4.005, P = 0.1268). Similarly, the inverse association was present in normoglycemia individuals with a 48.6% lower risk of diabetes when consuming fruits > 7 times/week comparing to those < 1 time/week (HR 0.514, 95% CI [0.368-0.948]), but not in prediabetes (HR 0.883, 95% CI [0.762-1.023]). CONCLUSION These findings suggest that higher frequency and amount of fresh fruit intake may protect against incident T2D, especially in NGT, but not in prediabetes, highlighting the dietary recommendation of higher fresh fruit consumption to prevent T2D in normoglycemia population.
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Affiliation(s)
- Li Li
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Hai-Yan Yang
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Yan Ma
- grid.412594.f0000 0004 1757 2961Department of Ultrasonography, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xing-Huan Liang
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Min Xu
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Jie Zhang
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Zhen-Xing Huang
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Li-Heng Meng
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Jia Zhou
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Jing Xian
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Ying-Jun Suo
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Song Huang
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Jin-Wei Cai
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Bi-Hui Meng
- grid.412594.f0000 0004 1757 2961Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021 Guangxi China
| | - Zhi-Yun Zhao
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Jie-Li Lu
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Yu Xu
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Tian-Ge Wang
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Mian Li
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Yu-Hong Chen
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Wei-Qing Wang
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Yu-Fang Bi
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Guang Ning
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Fei-Xia Shen
- grid.414906.e0000 0004 1808 0918The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ru-Ying Hu
- grid.433871.aZhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Gang Chen
- grid.256112.30000 0004 1797 9307Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Li Chen
- grid.452402.50000 0004 1808 3430Qilu Hospital of Shandong University, Jinan, China
| | - Lu-Lu Chen
- grid.33199.310000 0004 0368 7223Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Cong Deng
- grid.452206.70000 0004 1758 417XThe First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Nan Gao
- grid.452337.40000 0004 0644 5246Dalian Municipal Central Hospital, Dalian, China
| | - Ya-Nan Huo
- grid.415002.20000 0004 1757 8108Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
| | - Qiang Li
- grid.412463.60000 0004 1762 6325The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chao Liu
- grid.412676.00000 0004 1799 0784Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Yi-Ming Mu
- grid.414252.40000 0004 1761 8894Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Gui-Jun Qin
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li-Xin Shi
- grid.452244.1Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Qing Su
- grid.412987.10000 0004 0630 1330Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Wan
- grid.488387.8The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gui-Xia Wang
- grid.430605.40000 0004 1758 4110The First Hospital of Jilin University, Changchun, China
| | - Shuang-Yuan Wang
- grid.16821.3c0000 0004 0368 8293Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - You-Min Wang
- grid.412679.f0000 0004 1771 3402The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sheng-Li Wu
- Karamay Municipal People’s Hospital, Xinjiang, China
| | - Yi-Ping Xu
- grid.16821.3c0000 0004 0368 8293Clinical Trials Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Yan
- grid.12981.330000 0001 2360 039XSun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tao Yang
- grid.412676.00000 0004 1799 0784The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen Ye
- grid.433871.aZhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Xue-Feng Yu
- grid.33199.310000 0004 0368 7223Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin-Fei Zhang
- grid.459667.fCentral Hospital of Shanghai Jiading District, Shanghai, China
| | - Jia-Jun Zhao
- grid.460018.b0000 0004 1769 9639Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Tian-Shu Zeng
- grid.33199.310000 0004 0368 7223Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu-Lei Tang
- grid.412643.60000 0004 1757 2902The First Hospital of Lanzhou University, Lanzhou, China
| | - Ying-Fen Qin
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Zuo-Jie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, No. 6 of Shuangyong Road, Nanning, 530021, Guangxi, China.
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4
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Zhang PX, Zeng L, Meng L, Li HL, Zhao HX, Liu DL. Observation on clinical effect of Huoxue-Jiangtang decoction formula granules in treating prediabetes: a randomized prospective placebo-controlled double-blind trial protocol. BMC Complement Med Ther 2022; 22:274. [PMID: 36261813 PMCID: PMC9580157 DOI: 10.1186/s12906-022-03755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Prediabetes is a hypermetabolic syndrome with blood sugar levels falling between the normal and diabetes. People with prediabetes have a significantly increased chances of developing diabetes, cardiovascular and cerebrovascular diseases, tumors, dementia, and other diseases in the future when compared to the healthy population. However, prediabetes is mainly treated based on lifestyle intervention, currently without targeted drug treatment plan. Traditional Chinese medicine (TCM), which has a longstanding experience, has been shown in clinical studies to be effective for the treatment of diabetes and its related complications. Furthermore, different dosage forms such as decoction and granule have developed gradually in clinical application. Preliminary studies have found that Huoxue-Jangtang Decoction (HJD), with good hypoglycemic and lipid-regulating effects, is potentially one of the complementary and alternative treatments for prediabetes. Therefore, this project intends to perform a prospective clinical study to observe the clinical effectiveness of HJD on prediabetes and the consistency of the efficacy of formula granules and the elixation. Methods This is a prospective, randomized, double-blind, and placebo-controlled clinical trial. A total of 183 participants are randomly assigned to HJD Formula Granules plus lifestyle intervention, HJD Elixation plus lifestyle intervention, and placebo plus lifestyle intervention. All subjects undergo 1 day of screening before participating in the study, followed by 84 days of drug intervention and observation. During and after treatment, the main outcome measures include fasting blood glucose and 2-hour postprandial blood glucose. Discussion This research attempts to verify the clinical efficacy and possible mechanism of HJD in the treatment of prediabetes, and prove the consistency of HJD Formula Granules with HJD Elixation. This study also aims to provide a treatment that is both effective and safe for prediabetic patients. Trial registration ClinicalTrials.gov Identifier: ChiCTR2200060813, Registered 12 June 2022.
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Affiliation(s)
- Peng-Xiang Zhang
- grid.411866.c0000 0000 8848 7685The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong People’s Republic of China
| | - Lin Zeng
- grid.411866.c0000 0000 8848 7685The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong People’s Republic of China
| | - Lu Meng
- grid.411866.c0000 0000 8848 7685The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong People’s Republic of China
| | - Hui-Lin Li
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong People’s Republic of China
| | - Heng-Xia Zhao
- Endocrinology Department of Shenzhen Traditional Chinese Medicine Hospital, No. 1 Fuhua Road, Shenzhen, 518033 Guangdong Province People’s Republic of China
| | - De-Liang Liu
- Endocrinology Department of Shenzhen Traditional Chinese Medicine Hospital, No. 1 Fuhua Road, Shenzhen, 518033 Guangdong Province People’s Republic of China
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5
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Liu Y, Guo H, Wang Q, Chen J, Xuan Y, Xu J, Liu Y, Sun K, Gao Q, Sun Z, Wang B. Short-term effects of lifestyle intervention in the reversion to normoglycemia in people with prediabetes. Prim Care Diabetes 2022; 16:168-172. [PMID: 34930688 DOI: 10.1016/j.pcd.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 01/13/2023]
Abstract
AIMS To evaluate the short-term effect of lifestyle intervention in people with prediabetes. METHODS A stratified multistage sampling method was used in the recruitment of residents of the Jiangsu Province, China in 2017, who had no previous diagnosis of diabetes. Physical examination and laboratory tests were performed, and questionnaires were completed. Those with a prediabetes diagnosis at baseline were included in the cohort and participants were randomized to the intervention group or the control group. The intervention group received a lifestyle intervention strategy, which included exercise, diet and peer educations. The control group received general health education. Participants were followed up in 2018. RESULTS A total of 2005 individuals were included in the analysis. At follow-up, there were 516 (36.7%) individuals in the intervention group and 207 (34.5%) individuals in the control group with normal blood glucose levels. The decline in waist circumference and fasting plasma glucose levels was significantly higher in the intervention group than in the control group. This was still observed after adjusting for variables (odds ratio 1.32, P = 0.02). Females or younger individuals who had lower body mass index and plasma glucose levels at baseline were more likely to reverse to normoglycemia at follow-up. CONCLUSIONS Compared with a strategy of general health education, a lifestyle intervention strategy could reverse glucose levels to normoglycemia in individuals with prediabetes.
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Affiliation(s)
- Yuxiang Liu
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China
| | - Haijian Guo
- Integrated Business Management Office, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
| | - Qing Wang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jianshuang Chen
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China
| | - Yan Xuan
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jinshui Xu
- Integrated Business Management Office, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
| | - Yu Liu
- Center for Disease Control and Prevention of Jurong, Jurong, Jiangsu 212400, China
| | - Kaicheng Sun
- Center for Disease Control and Prevention of Yandu, Yandu, Jiangsu 224006, China
| | - Qian Gao
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China
| | - Zilin Sun
- Department of Endocrinology, Institute of Diabetes, Medical School, Southeast University, Nanjing, Jiangsu 210009, China
| | - Bei Wang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China.
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Weber MB, Gujral UP, Jagannathan R, Shah M. Lifestyle Interventions for Diabetes Prevention in South Asians: Current Evidence and Opportunities. Curr Diab Rep 2021; 21:23. [PMID: 34097137 DOI: 10.1007/s11892-021-01393-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the burden of diabetes in South Asian populations and reviews recent evidence for diabetes prevention through lifestyle modification among South Asians worldwide. We indicate important gaps in the current literature and point to opportunities for additional research in this area. RECENT FINDINGS Randomized, controlled, efficacy studies and implementation research show that lifestyle intervention can be an effective, cost-effective, and feasible method for reducing diabetes risk, improving cardiometabolic health, and improving lifestyle behaviors in South Asian populations, a population at high diabetes risk and elevated rates of diabetes risk factors. Additional research is needed to address diabetes risk reduction in normal-weight South Asians and individuals with impaired fasting glucose; improve community-level implementation, individual uptake, and dissemination of proven programs; and assess long-term outcomes of interventions.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Ram Jagannathan
- Division of Hospital Medicine, School of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Dietary Patterns and the Risk of Prediabetes in Taiwan: A Cross-Sectional Study. Nutrients 2020; 12:nu12113322. [PMID: 33138050 PMCID: PMC7694012 DOI: 10.3390/nu12113322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background: prediabetes prevention and management are the main methods used to combat the prevalence of diabetes. Exploratory factor analysis is an upcoming method that is successful in identifying dietary patterns that correlate with healthy or unhealthy outcomes. Aim: this study aims to identify dietary patterns in Taiwan that are associated with the risk of prediabetes. Methods: anthropometric, blood glucose, 3 d/24 h dietary records, and food frequency questionnaire data were collected from subjects recruited at Taipei Tzu-Chi Hospital. The following five dietary patterns were identified using factor analysis: Western, prudent, convenience, Asian traditional, and continental. This cross-sectional study compares tertiles of dietary patterns and analyzes the significance of the characteristics. Results: the Western and the prudent patterns are the major dietary patterns found in other studies. A higher factor loading in the Western pattern is significantly related to a higher risk of prediabetes. A higher factor loading in the continental pattern is significantly related to a lower risk of prediabetes. Conclusion: decreasing meat and seafood consumption while increasing egg, coffee, and milk consumption may be associated with a decreased risk for prediabetes.
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Chen X, Su H, Kunii D, Kudou K, Zhang Y, Zhao Y, Zhang D, Xing Y, Teng J, Nie Z, Liu X, Niu K, Zhao Y, Guo Q. The Effects of Mobile-App-Based Low-Carbohydrate Dietary Guidance on Postprandial Hyperglycemia in Adults with Prediabetes. Diabetes Ther 2020; 11:2341-2355. [PMID: 32870466 PMCID: PMC7509028 DOI: 10.1007/s13300-020-00906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Postprandial hyperglycemia is independently associated with many adverse complications, while diets with a low glycemic load are beneficial in improving post-meal glucose levels. This study aims to determine if mobile-app-based low-carbohydrate dietary guidance will reduce exposure to postprandial hyperglycemia in adults with prediabetes. METHODS This single-blind, randomized controlled pilot study included 100 participants (39 men; mean age 53.6 ± 11.9 years) and was performed in the PKU Care CNOOC Hospital, China. The intervention group (n = 57) received low-carbohydrate dietary guidance through a moblie app (CAReNA) for 3 months, while the control group (n = 43) only received health education on a diabetic diet. The primary outcome was change in time of postprandial hyperglycemia between baseline and 3 months. RESULTS The study revealed that the mean time in postprandial hyperglycemia (> 7.8 mmol/l [140 mg/dl]) monitored by flash glucose monitoring changed from 3.27 h/day at baseline to 2.34 h/day at 3 months in the intervention group and from 3.08 h/day to 2.96 h/day in the control group, with a between-group difference of - 0.81 h/day (P < 0.05). Fasting plasma glucose and glycated hemoglobin (HbA1c) in the intervention group decreased significantly, although no significant difference was seen between the two groups. Compared with the control group, the intervention group had a significant decrease in anthropometric and body composition measurements as well as triglycerides. CONCLUSION The mobile-app-based low-carbohydrate dietary guidance effectively reduced the time spent in postprandial hyperglycemia in adults with prediabetes. This new type of nutritional management has beneficial effects on people with prediabetes and needs further research. CLINICAL TRIAL REGISTRATION ChiCTR1900024880.
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Affiliation(s)
- Xiaoyu Chen
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Haihua Su
- Department of Endocrinology and Nephrology, PKU Care CNOOC Hospital, Tianjin, China
| | - Daisuke Kunii
- Department of Food and Nutritional Sciences, Jumonji University, Tokyo, Japan
| | - Kousuke Kudou
- Japan Nutrition Care Service Association, Tokyo, Japan
| | - Yiyan Zhang
- Department of Food and Nutritional Sciences, Jumonji University, Tokyo, Japan
| | - Ying Zhao
- Department of Rehabilitation Medicine, PKU Care CNOOC Hospital, Tianjin, China
| | - Dan Zhang
- Department of Endocrinology and Nephrology, PKU Care CNOOC Hospital, Tianjin, China
| | - Yuanyuan Xing
- Department of Endocrinology and Nephrology, PKU Care CNOOC Hospital, Tianjin, China
| | - Jiaqi Teng
- Department of Endocrinology and Nephrology, PKU Care CNOOC Hospital, Tianjin, China
| | - Zhiqiang Nie
- Department of Rehabilitation Medicine, PKU Care CNOOC Hospital, Tianjin, China
| | - Xinxin Liu
- Department of Rehabilitation Medicine, PKU Care CNOOC Hospital, Tianjin, China
| | - Kaijun Niu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yong Zhao
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
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Yau JW, Thor SM, Ramadas A. Nutritional Strategies in Prediabetes: A Scoping Review of Recent Evidence. Nutrients 2020; 12:E2990. [PMID: 33003593 PMCID: PMC7650618 DOI: 10.3390/nu12102990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes. However, recommended nutritional strategies evolve over time. Hence, we performed a scoping review on recently reported nutritional interventions for individuals with prediabetes. Ovid MEDLINE, PubMed, Embase, Scopus, CINAHL and PsycINFO databases were searched to identify relevant research articles published within the past 10 years. Ninety-five articles involving a total of 11,211 participants were included in this review. Nutritional strategies were broadly classified into four groups: low calorie diet, low glycemic index diet, specific foods, and a combination of diet and exercise. The most frequently assessed outcomes were plasma glucose, serum insulin, serum lipid profile, body mass index and body weight. More than 50% of reported interventions resulted in significant improvements in these parameters. Nutritional interventions have demonstrated feasibility and practicality as an effective option for prediabetes management. However, the intervention variability demonstrates the challenges of a 'one-size-fits-all' approach. Investigations in genetically diverse populations and objective assessment of progression rate to diabetes are necessary to better comprehend the impact of these nutritional strategies in prediabetes.
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Affiliation(s)
| | | | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (J.W.Y.); (S.M.T.)
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