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Santos BC, Alves LF, Rocha VS, Hernandez-Ruiz Á, Silva AMO, Pires LV. Effectiveness of Health Action Interventions in Enhancing Diet Quality and Glycemic Control Among Individuals With Type 2 Diabetes Mellitus: A Systematic Review of Randomized Clinical Trials. Nutr Rev 2024:nuae071. [PMID: 38894637 DOI: 10.1093/nutrit/nuae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
CONTEXT Diet quality is directly related to glycemic control in individuals with type 2 diabetes mellitus (T2DM). The use of dietary indices can provide a comprehensive understanding of the relationship between diet quality and clinical outcomes. OBJECTIVE The aim was to evaluate the relationship between diet quality, measured using dietary indices, and its impact on improving glycemic control in individuals with T2DM through health interventions. DATA SOURCE This study was conducted using 6 databases, including Web of Science, MEDLINE (via PubMed), Embase, Bireme, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as the gray literature (Google Academic). DATA EXTRACTION Randomized clinical trials that evaluated the effectiveness of health interventions in adult and older adult individuals with T2DM and presented data on diet quality evaluated using dietary indices and the percentage of glycated hemoglobin (%HbA1c) were included. DATA ANALYSIS A total of 3735 articles were retrieved, 4 of which were included in the study selection stages. The quality indices assessed in the studies were the Alternate Healthy Eating Index (AHEI), Healthy Eating Index-2010 (HEI-2010), Diet Quality Index-International (DQI-I), and Diet Quality Index-Revised (DQI-R). A reduction in %HbA1c was observed in 2 studies, which correlated with the AHEI and DQI-I scores in the intervention groups. The approach of using food labels to improve diet quality reduced %HbA1c by 0.08% in the intervention group compared with the control group. Only 1 study found no significant association between the DQI-R index and %HbA1c. Additionally, negative correlations were observed between body weight and the AHEI and DQI-I scores. CONCLUSION Health interventions improved diet quality, glycemic control, and weight loss in individuals with T2DM. SYSTEMATIC REVIEW REGISTRATION PROSPERO no. CRD42023430036.
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Affiliation(s)
- Beatriz C Santos
- Postgraduate Program in Nutrition Sciences, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
| | - Luana F Alves
- Postgraduate Program in Nutrition Sciences, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
| | - Vivianne S Rocha
- Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe 49400-000, Brazil
| | - Ángela Hernandez-Ruiz
- Iberoamerican Nutrition Foundation (FINUT), Armilla, Granada 18016, Spain
- Department of Nursing, Faculty of Nursing, University of Valladolid, Valladolid 47005, Spain
| | - Ana Mara O Silva
- Postgraduate Program in Nutrition Sciences, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe 49060-100, Brazil
| | - Liliane V Pires
- Postgraduate Program in Nutrition Sciences, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
- Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe 49107-230, Brazil
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Barrea L, Vetrani C, Verde L, Frias-Toral E, Ceriani F, Cernea S, Docimo A, Graziadio C, Tripathy D, Savastano S, Colao A, Muscogiuri G. Comprehensive Approach to Medical Nutrition Therapy in Patients with Type 2 Diabetes Mellitus: From Diet to Bioactive Compounds. Antioxidants (Basel) 2023; 12:904. [PMID: 37107279 PMCID: PMC10135374 DOI: 10.3390/antiox12040904] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
In the pathogenesis of type 2 diabetes mellitus (T2DM), diet plays a key role. Individualized medical nutritional therapy, as part of lifestyle optimization, is one of the cornerstones for the management of T2DM and has been shown to improve metabolic outcomes. This paper discusses major aspects of the nutritional intervention (including macro- and micronutrients, nutraceuticals, and supplements), with key practical advice. Various eating patterns, such as the Mediterranean-style, low-carbohydrate, vegetarian or plant-based diets, as well as healthy eating plans with caloric deficits have been proven to have beneficial effects for patients with T2DM. So far, the evidence does not support a specific macronutrient distribution and meal plans should be individualized. Reducing the overall carbohydrate intake and replacing high glycemic index (GI) foods with low GI foods have been shown as valid options for patients with T2DM to improve glycemic control. Additionally, evidence supports the current recommendation to reduce the intake of free sugars to less than 10% of total energy intake, since their excessive intake promotes weight gain. The quality of fats seems to be rather important and the substitution of saturated and trans fatty acids with foods rich in monounsaturated and polyunsaturated fats lowers cardiovascular risk and improves glucose metabolism. There is no benefit of supplementation with antioxidants, such as carotene, vitamins E and C, or other micronutrients, due to the lack of consistent evidence showing efficacy and long-term safety. Some studies suggest possible beneficial metabolic effects of nutraceuticals in patients with T2DM, but more evidence about their efficacy and safety is still needed.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Isola F2, 80143 Napoli, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudia Vetrani
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Isola F2, 80143 Napoli, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
| | - Florencia Ceriani
- Nutrition School, Universidad de la Republica (UdelaR), Montevideo 11100, Uruguay
| | - Simona Cernea
- Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mures, 540146 Târgu Mureş, Romania
- Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, 540146 Târgu Mureş, Romania
| | - Annamaria Docimo
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Chiara Graziadio
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Devjit Tripathy
- Division of Diabetes UT Health and ALM VA Hospital, San Antonio, TX 78229, USA
| | - Silvia Savastano
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Annamaria Colao
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco “Educazione Alla Salute e Allo Sviluppo Sostenibile”, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco “Educazione Alla Salute e Allo Sviluppo Sostenibile”, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
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Whiteley C, Benton F, Matwiejczyk L, Luscombe-Marsh N. Determining Dietary Patterns to Recommend for Type 2 Diabetes: An Umbrella Review. Nutrients 2023; 15:nu15040861. [PMID: 36839218 PMCID: PMC9958769 DOI: 10.3390/nu15040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Some specific dietary patterns improve glycaemic levels and cardiovascular risk factors better than others. We aimed to identify the most effective dietary patterns using a food-focused approach to improve blood glucose management (primary outcome) and cardiovascular risk factors (secondary outcome) in people with type 2 diabetes. An umbrella review was conducted comparing dietary patterns for the management of these outcomes. Studies published between 2012 and 2022 were identified using PubMed Central, ProQuest, Web of Science, and the Cochrane Database of Systematic Reviews. Thirty systematic reviews met the inclusion criteria. Twenty-two of thirty reviews quantitated (via meta-analyses of over 212 randomised control trials) the effect size of different dietary patterns. Twelve reviews found Low-carbohydrate (LC), Mediterranean (M), Plant-based (PB), and/or Low-glycaemic Index (LGI) diets reduced HbA1c moderately more than control diets (typically a high-carbohydrate, low-fat diet) (i.e., LC: -0.1 to -0.5%; M: -0.3 to -0.5%; PB: -0.2 to -0.4%; LGI -0.2 to -0.5%; all p-value < 0.01). We conclude that Low-carbohydrate, Mediterranean, Plant-based, and Low-glycaemic Index dietary patterns are all clinically effective for people with type 2 diabetes as alternatives to high-carbohydrate, low-fat diets typically used for managing glycaemic levels and CVD risk. However, quality evidence about the sustainability of effects and safety remains limited, warranting future research.
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Affiliation(s)
- Cathryn Whiteley
- Research and Program Development, Diabetes SA, Hilton, SA 5033, Australia
| | - Fiona Benton
- Research and Program Development, Diabetes SA, Hilton, SA 5033, Australia
| | - Louisa Matwiejczyk
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Natalie Luscombe-Marsh
- Research and Program Development, Diabetes SA, Hilton, SA 5033, Australia
- Correspondence: ; Tel.: +61-08-8354-5803
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Young-Hyman D, Gabbay RA, on behalf of the American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S68-S96. [PMID: 36507648 PMCID: PMC9810478 DOI: 10.2337/dc23-s005] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Muscogiuri G, Verde L, Sulu C, Katsiki N, Hassapidou M, Frias-Toral E, Cucalón G, Pazderska A, Yumuk VD, Colao A, Barrea L. Mediterranean Diet and Obesity-related Disorders: What is the Evidence? Curr Obes Rep 2022; 11:287-304. [PMID: 36178601 PMCID: PMC9729142 DOI: 10.1007/s13679-022-00481-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Obesity is a chronic disease, a major public health problem due to its association with non-communicable diseases and all-cause mortality. Indeed, people with obesity are at increased risk for a variety of obesity-related disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease, and several cancers. Many popular diets with very different macronutrient composition, including the Mediterranean diet (MD), have been used, proposed, and studied for prevention and management of obesity. In particular, MD has been the subject of countless studies over the years and now boasts a large body of scientific literature. In this review, we aimed to update current knowledge by summarizing the most recent evidence on the effect of MD on obesity and obesity-related disorders. RECENT FINDINGS The negative effects of obesity are partly reversed by substantial weight loss that can be achieved with MD, especially when low-calorie and in combination with adequate physical activity. In addition, the composition of MD has been correlated with an excellent effect on reducing dyslipidemia. It also positively modulates the gut microbiota and immune system, significantly decreasing inflammatory mediators, a common ground for many obesity-related disorders. People with obesity are at increased risk for a variety of medical disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. Therefore, there is an inevitable need for measures to manage obesity and its related disorders. At this point, MD has been proposed as a valuable nutritional intervention. It is characterized by a high consumption of vegetables, fruit, nuts, cereals, whole grains, and extra virgin olive oil, as well as a moderate consumption of fish and poultry, and a limited intake of sweets, red meat, and dairy products. MD proves to be the healthiest dietary pattern available to tackle obesity and prevent several non-communicable diseases, including cardiovascular disease and type 2 diabetes.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Federico II, Naples, Italy.
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy.
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Cem Sulu
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil, 090615, Ecuador
| | - Gabriela Cucalón
- Escuela Superior Politécnica del Litoral, ESPOL, Lifescience Faculty, ESPOL Polytechnic University, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil, Ecuador
| | - Agnieszka Pazderska
- Division of Endocrinology, Metabolism, and Diabetes-Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Volkan Demirhan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Federico II, Naples, Italy
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Naples, 80143, Italy.
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Zhang R, Zhao Q, Li R. Predictors of acarbose therapeutic efficacy in newly diagnosed type 2 diabetes mellitus patients in China. BMC Pharmacol Toxicol 2022; 23:79. [PMID: 36258236 PMCID: PMC9580108 DOI: 10.1186/s40360-022-00621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Acarbose is one of the optimal drugs for patients with the first diagnosis of type 2 diabetes mellitus (T2DM). But what kind of emerging patients has the best therapeutic response to acarbose therapy has never been reported. To this end, we investigated predictors of acarbose therapeutic efficacy in newly diagnosed T2DM patients in China. Methods A total of 346 T2DM patients received acarbose monotherapy for 48 weeks as part of participating in the Study of Acarbose in Newly Diagnosed Patients with T2DM in China (MARCH study) from November 2008 to June 2011. Change in glycated hemoglobin (ΔHbA1c) served as a dependent variable while different baseline variables including sex, age, disease duration, weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1c, fasting plasma glucose (FPG), 2-h postprandial blood glucose (2 h PG), fasting insulin (FINS), 2-h postprandial insulin (2 h INS), early insulin secretion index (IGI), homeostasis model assessment of insulin resistance index (HOMA-IR), homeostasis model assessment of beta cell function (HOMA-B), area under the curve (AUC) of glucagon, insulin and GLP-1 were assessed as independent predictors. Step-wise multiple linear regression was employed for statistical analysis. Results The results suggested that independent predictors of ΔHbA1c at 12 weeks included baseline body weight (β = − 0.012, P = 0.006), DBP (β = 0.010, P = 0.047), FPG (β = 0.111, P = 0.005) and 2 h PG (β = 0.042, P = 0.043). Independent predictors of ΔHbA1c at 24 weeks included disease duration (β = 0.040, P = 0.019) and FPG (β = 0.117, P = 0.001). Finally, independent predictor of ΔHbA1c at 48 weeks was disease duration (β = 0.038, P = 0.046). Conclusions Acarbose may be more effective in newly diagnosed T2DM patients with low FPG, low 2 h PG and obesity. The earlier T2DM is diagnosed and continuously treated with acarbose, the better the response to therapy.
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Affiliation(s)
- Rong Zhang
- Department of Geriatrics, Xijing Hospital of Air Force Medical University, No.127 West Changle Road, Xi'an, 710032, China
| | - Quanxi Zhao
- Department of Pharmacy, Second People's Hospital of Shaanxi Province, No.3 Shangqin Road, Xi'an, 710068, China
| | - Rong Li
- Department of Geriatrics, Xijing Hospital of Air Force Medical University, No.127 West Changle Road, Xi'an, 710032, China.
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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: 139] [Impact Index Per Article: 69.5] [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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Nicholls J. Perspective: The Glycemic Index Falls Short as a Carbohydrate Food Quality Indicator to Improve Diet Quality. Front Nutr 2022; 9:896333. [PMID: 35529459 PMCID: PMC9067577 DOI: 10.3389/fnut.2022.896333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
This perspective examines the utility of the glycemic index (GI) as a carbohydrate quality indicator to improve Dietary Guidelines for Americans (DGA) adherence and diet quality. Achieving affordable, high-quality dietary patterns can address multiple nutrition and health priorities. Carbohydrate-containing foods make important energy, macronutrient, micronutrient, phytochemical, and bioactive contributions to dietary patterns, thus improving carbohydrate food quality may improve diet quality. Following DGA guidance helps meet nutrient needs, achieve good health, and reduce risk for diet-related non-communicable diseases in healthy people, yet adherence by Americans is low. A simple indicator that identifies high-quality carbohydrate foods and improves food choice may improve DGA adherence, but there is no consensus on a definition. The GI is a measure of the ability of the available carbohydrate in a food to increase blood glucose. The GI is well established in research literature and popular resources, and some have called for including the GI on food labels and in food-based dietary guidelines. The GI has increased understanding about physiological responses to carbohydrate-containing foods, yet its role in food-based dietary guidance and diet quality is unresolved. A one-dimensional indicator like the GI runs the risk of being interpreted to mean foods are "good" or "bad," and it does not characterize the multiple contributions of carbohydrate-containing foods to diet quality, including nutrient density, a core concept in the DGA. New ways to define and communicate carbohydrate food quality shown to help improve adherence to high-quality dietary patterns such as described in the DGA would benefit public health.
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S60-S82. [PMID: 34964866 DOI: 10.2337/dc22-s005] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Craig WJ, Mangels AR, Fresán U, Marsh K, Miles FL, Saunders AV, Haddad EH, Heskey CE, Johnston P, Larson-Meyer E, Orlich M. The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients 2021; 13:4144. [PMID: 34836399 PMCID: PMC8623061 DOI: 10.3390/nu13114144] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 12/13/2022] Open
Abstract
Plant-based diets, defined here as including both vegan and lacto-ovo-vegetarian diets, are growing in popularity throughout the Western world for various reasons, including concerns for human health and the health of the planet. Plant-based diets are more environmentally sustainable than meat-based diets and have a reduced environmental impact, including producing lower levels of greenhouse gas emissions. Dietary guidelines are normally formulated to enhance the health of society, reduce the risk of chronic diseases, and prevent nutritional deficiencies. We reviewed the scientific data on plant-based diets to summarize their preventative and therapeutic role in cardiovascular disease, cancer, diabetes, obesity, and osteoporosis. Consuming plant-based diets is safe and effective for all stages of the life cycle, from pregnancy and lactation, to childhood, to old age. Plant-based diets, which are high in fiber and polyphenolics, are also associated with a diverse gut microbiota, producing metabolites that have anti-inflammatory functions that may help manage disease processes. Concerns about the adequate intake of a number of nutrients, including vitamin B12, calcium, vitamin D, iron, zinc, and omega-3 fats, are discussed. The use of fortified foods and/or supplements as well as appropriate food choices are outlined for each nutrient. Finally, guidelines are suggested for health professionals working with clients consuming plant-based diets.
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Affiliation(s)
- Winston J. Craig
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (F.L.M.); (E.H.H.); (C.E.H.); (P.J.)
| | | | - Ujué Fresán
- eHealth Group, Instituto de Salud Global Barcelona (ISGlobal), 08036 Barcelona, Spain;
| | - Kate Marsh
- Private Practice, Chatswood, NSW 2067, Australia;
| | - Fayth L. Miles
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (F.L.M.); (E.H.H.); (C.E.H.); (P.J.)
- School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA;
| | - Angela V. Saunders
- Nutrition Insights, Sanitarium Health Food Company, Berkeley Vale, NSW 2261, Australia;
| | - Ella H. Haddad
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (F.L.M.); (E.H.H.); (C.E.H.); (P.J.)
| | - Celine E. Heskey
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (F.L.M.); (E.H.H.); (C.E.H.); (P.J.)
| | - Patricia Johnston
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA; (F.L.M.); (E.H.H.); (C.E.H.); (P.J.)
| | - Enette Larson-Meyer
- Human Nutrition, Foods, and Exercise Virginia Tech, Blacksburg, VA 24061, USA;
| | - Michael Orlich
- School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA;
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A dietary pattern high in full-fat dairy and sweetened beverages is associated with glycated hemoglobin and weight in Mexican patients with type-2 diabetes. NUTR HOSP 2021; 39:53-62. [PMID: 34743525 DOI: 10.20960/nh.03651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE the aim of this study was to identify dietary patterns in a sample of patients with type-2 diabetes, and to evaluate their association with markers of metabolic control. METHODS a cross-sectional study in 395 patients with type-2 diabetes in primary care was conducted. Fasting blood levels of glycated hemoglobin (A1c), glucose, total cholesterol, low- (LDL-c) and high-density lipoprotein cholesterol (HDL-c), and triglycerides were measured. Waist circumference, body mass index (BMI), and blood pressure were evaluated. Dietary intake was assessed by a food frequency questionnaire, and dietary patterns were derived by cluster analysis. Three dietary patterns were identified: 'fruits and vegetables', 'dairy and sweetened beverages', and 'diverse with alcohol'. RESULTS an association between the 'dairy and sweetened beverages' dietary pattern and A1c levels was identified (ß = 0.61; 95 % CI: 0.09, 1.12, p = 0.021), considering the 'fruits and vegetables' dietary pattern as the reference group. We also observed a trend towards an adjusted increased risk of A1c ≥ 7 % (odds ratio [OR]: 1.56; 95 % CI: 0.92, 2.64; p = 0.099) and an increased risk of BMI ≥ 25 kg/m2 (OR: 2.62, 95 % CI: 1.20, 5.71, p = 0.015) among patients in the 'dairy and sweetened beverages' dietary pattern as compared to the reference group. CONCLUSIONS a dietary pattern characterized by a high intake of full-fat dairy and sweetened beverages was associated with higher A1c levels and increased risk of high glucose and BMI when compared to a dietary pattern with a higher consumption of fruits and vegetables.
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Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence. Nutrients 2021; 13:nu13041060. [PMID: 33805161 PMCID: PMC8064070 DOI: 10.3390/nu13041060] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022] Open
Abstract
The alarmingly rising trend of type 2 diabetes constitutes a major global public health challenge particularly in the Middle Eastern and North African (MENA) region where the prevalence is among the highest in the world with a projection to increase by 96% by 2045. The economic boom in the MENA region over the past decades has brought exceptionally rapid shifts in eating habits characterized by divergence from the traditional Mediterranean diet towards a more westernized unhealthy dietary pattern, thought to be leading to the dramatic rises in obesity and non-communicable diseases. Research efforts have brought a greater understanding of the different pathways through which diet and obesity may affect diabetes clinical outcomes, emphasizing the crucial role of dietary interventions and weight loss in the prevention and management of diabetes. The purpose of this review is to explore the mechanistic pathways linking obesity with diabetes and to summarize the most recent evidence on the association of the intake of different macronutrients and food groups with the risk of type 2 diabetes. We also summarize the most recent evidence on the effectiveness of different macronutrient manipulations in the prevention and management of diabetes while highlighting the possible underlying mechanisms of action and latest evidence-based recommendations. We finally discuss the need to adequately integrate dietetic services in diabetes care specific to the MENA region and conclude with recommendations to improve dietetic care for diabetes in the region.
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S53-S72. [PMID: 33298416 DOI: 10.2337/dc21-s005] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Benson G, Hayes J. An Update on the Mediterranean, Vegetarian, and DASH Eating Patterns in People With Type 2 Diabetes. Diabetes Spectr 2020; 33:125-132. [PMID: 32425449 PMCID: PMC7228822 DOI: 10.2337/ds19-0073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
When it comes to eating, there is no "one-size-fits-all" solution. This article provides an overview of recommendations and research for three evidence-based eating patterns-Mediterranean, DASH (Dietary Approaches to Stop Hypertension), and vegetarian/vegan-that can be individualized for people with type 2 diabetes. In an effort to improve adherence and health outcomes, practical considerations for improving nutrition are highlighted with the aim of helping patients successfully adopt an eating pattern that meets their individual needs and sociocultural and personal preferences.
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Affiliation(s)
| | - Joy Hayes
- Minneapolis Heart Institute Foundation, Minneapolis, MN
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Adjuvant Therapies in Diabetic Retinopathy as an Early Approach to Delay Its Progression: The Importance of Oxidative Stress and Inflammation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:3096470. [PMID: 32256949 PMCID: PMC7086452 DOI: 10.1155/2020/3096470] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/16/2020] [Accepted: 02/08/2020] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM) is a progressive disease induced by a sustained state of chronic hyperglycemia that can lead to several complications targeting highly metabolic cells. Diabetic retinopathy (DR) is a multifactorial microvascular complication of DM, with high prevalence, which can ultimately lead to visual impairment. The genesis of DR involves a complex variety of pathways such as oxidative stress, inflammation, apoptosis, neurodegeneration, angiogenesis, lipid peroxidation, and endoplasmic reticulum (ER) stress, each possessing potential therapeutic biomarkers. A specific treatment has yet to be developed for early stages of DR since no management is given other than glycemic control until the proliferative stage develops, offering a poor visual prognosis to the patient. In this narrative review article, we evaluate different dietary regimens, such as the Mediterranean diet, Dietary Pattern to Stop Hypertension (DASH) and their functional foods, and low-calorie diets (LCDs). Nutraceuticals have also been assessed in DR on account of their antioxidant, anti-inflammatory, and antiangiogenic properties, which may have an important impact on the physiopathology of DR. These nutraceuticals have shown to lower reactive oxygen species (ROS), important inflammatory factors, cytokines, and endothelial damage biomarkers either as monotherapies or combined therapies or concomitantly with established diabetes management or nonconventional adjuvant drugs like topical nonsteroidal anti-inflammatory drugs (NSAIDs).
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Mambiya M, Shang M, Wang Y, Li Q, Liu S, Yang L, Zhang Q, Zhang K, Liu M, Nie F, Zeng F, Liu W. The Play of Genes and Non-genetic Factors on Type 2 Diabetes. Front Public Health 2019; 7:349. [PMID: 31803711 PMCID: PMC6877736 DOI: 10.3389/fpubh.2019.00349] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Diabetes has been a disease of public health concern for a number of decades. It was in the 1930s when scientists made an interesting discovery that the disease is actually divided into two types as some patients were insensitive to insulin treatment then. Type 2 Diabetes which happens to be the non-insulin dependent one is the most common form of the disease and is caused by the interaction between genetic and non-genetic factors. Despite conflicting results, numerous studies have identified genetic and non-genetic factors associated with this common type of diabetes. This review has summarized literature on some genes and non-genetic factors which have been identified to be associated with Type 2 diabetes. It has sourced literature from PubMed, Web of Science and Medline without any limitation to regions, publication types, or languages. The paper has started with the introduction, the play of non-genetic factors, the impact of genes in general, and ended with the interaction between some genes and environmental factors.
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Affiliation(s)
- Michael Mambiya
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Mengke Shang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Yue Wang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Qian Li
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Shan Liu
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Luping Yang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Qian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Kaili Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Mengwei Liu
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Fangfang Nie
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Fanxin Zeng
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
| | - Wanyang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, China
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Jiang ZL, Jin H, Liu ZS, Liu MY, Cao XF, Jiang YY, Bai HD, Zhang B, Li Y. Lentiviral‑mediated Shh reverses the adverse effects of high glucose on osteoblast function and promotes bone formation via Sonic hedgehog signaling. Mol Med Rep 2019; 20:3265-3275. [PMID: 31432117 PMCID: PMC6755203 DOI: 10.3892/mmr.2019.10540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/11/2019] [Indexed: 12/25/2022] Open
Abstract
Patients with diabetes tend to have an increased incidence of osteoporosis, which may be associated with hyperglycemia; however, the pathogenic mechanisms governing this interaction remain unknown. The present study sought to investigate whether elevated extracellular glucose levels of bone mesenchymal stem cells (BMSCs) could influence osteoblastic differentiation and whether the intracellular Sonic hedgehog (Shh) pathway could adjust the effects. Furthermore, to verify the results in vivo, a rat tooth extraction model was constructed. BMSCs were incubated in eight types of culture medium, including low glucose (LG), LG + lentivirus (Lenti), LG + Lenti-small interfering RNA (Lenti-siRNA), LG + Lenti-Shh, high glucose (HG), HG + Lenti, HG + Lenti-siRNA and HG + Lenti-Shh. The lentiviral transfection efficiency was observed using a fluorescence microscope; protein and mRNA expression was detected by western blotting and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The matrix mineralization and alkaline phosphatase (ALP) activity of BMSCs were examined by Alizarin red staining and ALP activity assays, respectively. The expression of osteogenesis-related genes in BMSCs were quantified by RT-qPCR. The alveolar ridge reduction was measured and histological sections were used to evaluate new bone formation in the tooth socket. With high concentrations of glucose, Shh expression, matrix mineralization nodules formation, ALP activity and the levels of bone morphogenic protein 4 (BMP4), bone sialoprotein (BSP) and osteopontin (OPN) expression were greatly reduced compared with LG and corresponding control groups. Whereas activated Shh signaling via Lenti-Shh could increase the number of matrix mineralization nodules, ALP activity, and the expression levels of BMP4, BSP and OPN in BMSCs. Additionally, in vivo assays demonstrated that Lenti-Shh induced additional bone formation. Collectively, the results of the present study indicated that HG inhibited the Shh pathway in osteoblasts and resulted in patterning defects during osteoblastic differentiation and bone formation, while the activation of Shh signaling could suppress these deleterious effects.
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Affiliation(s)
- Zhu-Ling Jiang
- Department of Implantology, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Han Jin
- Institute of Hard Tissue Development and Regeneration, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhong-Shuang Liu
- Institute of Hard Tissue Development and Regeneration, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Ming-Yue Liu
- Department of Dentistry, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Xiao-Fang Cao
- Department of Dentistry, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yang-Yang Jiang
- Department of Dentistry, The Affiliated Hospital, Harbin Institute of Technology, Harbin, Heilongjiang 150001, P.R. China
| | - Hong-Dan Bai
- Feiyang Dental Clinic, Heihe, Heilongjiang 164300, P.R. China
| | - Bin Zhang
- Institute of Hard Tissue Development and Regeneration, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Ying Li
- Institute of Hard Tissue Development and Regeneration, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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