Eating Patterns and Health Outcomes in Patients With Type 2 Diabetes

Insulinemic potential of diet and the risk of type 2 diabetes: a meta-analysis and systematic review

BACKGROUND

The possible role of the insulinemic potential of diet in the etiology of type 2 diabetes (T2D) has recently received significant attention in observational studies. This meta-analysis aimed to synthesize available evidence and quantify the potential association between the empirical dietary index for hyperinsulinemia (EDIH) score and T2D risk.

METHODS

Various electronic databases, including Scopus, PubMed, and Web of Science, were comprehensively searched up to January 2024 using related keywords to identify relevant studies. The hazard ratios (HR) or odds ratios were extracted from eligible cohort studies, and a random-effects model with an inverse variance weighting method was used to calculate the pooled effect size, which was expressed as HR.

RESULTS

The analysis included six cohort studies (four publications), with sample sizes ranging from 3,732 to 90,786 individuals aged 20 to 79 years. During follow-up periods of 5 to over 20 years, 31,284 T2D incidents were identified. The pooled results showed that a higher EDIH score was associated with an increased risk of T2D incidence (HR: 1.47; 95%CI 1.21-1.77; I2 = 91.3%). Significant publication bias was observed in the present meta-analysis (P = 0.020). Geographical region and follow-up period can be as sources of heterogeneity (Pheterogeneity <0.001).

CONCLUSION

Our meta-analysis of observational studies suggested that a diet with a higher EDIH score may be associated with an increased risk of incidence of T2D.

Magnesium Status and Dietary Patterns Associated with Glycemic Control in Individuals with Type 2 Diabetes Mellitus

Hypomagnesemia and unhealthy eating patterns are associated with poor glycemic control in individuals with type 2 diabetes mellitus (T2DM). This study aimed to associate magnesium status and dietary patterns with glycemic control in T2DM individuals. This cross-sectional study included 147 individuals with T2DM, aged between 19 and 59 years, of both sexes, residents in Sergipe/Brazil. The BMI, waist circumference, %body fat, plasma magnesium, serum glucose, insulin, %HbA1c, triacylglycerol, total cholesterol, LDL-c, and HDL-c were analyzed. Eating patterns were identified using a 24-h recall method. Logistic regression models were used to verify the association of magnesium status and dietary patterns with markers of glycemic control by adjusting for sex, age, time of T2DM diagnosis, and BMI. A P value < 0.05 was considered significant. Magnesium deficiency increased the chance of elevated %HbA1c by 5.893-fold (P = 0.041). Three main dietary patterns were identified: mixed (MDP), unhealthy (UDP), and healthy (HDP). UDP also increased the chance of elevated %HbA1c levels (P = 0.034). T2DM individuals' who presented magnesium deficiency had a higher chance of elevated %HbA1c levels (8.312-fold) and those in the lowest quartile (Q) of the UDP (Q1: P = 0.007; Q2: P = 0.043) had a lower chance of elevated %HbA1c levels. However, the lower quartiles of the HDP were associated with a greater chance of alterations in the %HbA1c level (Q1: P = 0.050; Q2: P = 0.044). No association was observed between MDP and the variables studied. Magnesium deficiency and UDP were associated with a higher chance of inadequate glycemic control in T2DM individuals.

Consumption of Ultra-Processed Food and Cognitive Decline among Older Adults With Type-2 Diabetes

BACKGROUND

Ultra-processed food (UPF) consumption is related to increased morbidity and mortality. However, knowledge on its association with cognitive function is lacking. In this longitudinal study, we examined the associations between UPF intake and cognitive decline in older adults with type-2 diabetes (T2D).

METHODS

The sample included initially nondemented T2D older adults (≥65 years), from the Israel Diabetes and Cognitive Decline study, who had complete information on nutrition at baseline and at least 3 cognitive assessments (mean follow-up 5.3 ± 1.5 years). Nutritional intake was evaluated by a validated Food-Frequency Questionnaire, and foods were categorized as UPF based on NOVA classification. Percent of calories from UPF were calculated from total caloric consumption in total and specific food groups. Mixed effect models were used to examine the link between UPF intake (top vs bottom quartiles) and change in cognitive function overall and in specific domains, adjusting for potential confounders.

RESULTS

Of the total sample (N = 568; mean age 71.3 ± 4.5 years, 60% men), 141 consumed >31% kcal from UPF (top quartile). Greater intake of ultra-processed meat was associated with a faster decline in executive functions and global cognition (β = -0.041 ± 0.013; p = .002 and β = -0.026 ± 0.010; p = .011, respectively). Additionally, consumption of ultra-processed oils/spreads was associated with faster decline in executive functions and global cognition (β = -0.037 ± 0.014; p = .006 and β = -0.028 ± 0.010; p = .009, respectively). Total UPF consumption and UPF-derived from dairy products and bread/pastries/starch were not associated with cognitive change.

CONCLUSION

This study suggests that a high intake of ultra-processed meat and oils/spreads may be associated with accelerated cognitive decline in older individuals with T2D.

Effects of different diets on glycemic control among patients with type 2 diabetes: A literature review

Background: Globally, type 2 diabetes mellitus (T2DM) is one of the most common diseases, and the incidence is gradually increasing. Diet management could improve the elevated HbA1c levels. Aim: This review aims to examine the effects of different types of diets on glycemic control in patients with T2DM. Methods: PubMed and Google scholar databases were searched. Reports published from the years 1991 to 2021 that focused on the effect of different diets on diabetes control were selected. Results: All the studies reported that the type of diet can affect insulin secretion and glycemic control in patients with diabetes. The recommended macronutrient distribution for patients with diabetes is 30% of fat, 45-60% of carbohydrates, and 15-35% of protein. Consuming more or less of these macronutrients may lead to changes in glucose metabolism and may affect insulin secretion. In fact, following alow-fat diet improves glycemic control and decreases HbA1c levels. Studies reported that a low-carbohydrate diet had the greatest effect on improving glycemic control and insulin parameters. A low-calorie diet reduced fasting plasma glucose, while a very low-calorie diet resulted in a long-term decrease in HbA1c level. A healthy diet free of processed foods and sugar, and rich in nutrients such as fiber, vitamins, and minerals contributed to maintaining controlled blood sugar and lipid plasma levels. Although studies show a low-salt diet improves blood pressure, which is common inT2DM, other findings show that restricting salt intake is associated with increased sugar consumption. Conclusion: Healthy diet with adequate intake of energy and low-fat and low-sugar foods can enhance the glycemic control and reduce T2DM complications.

Relationship between Ultra-Processed Food Consumption and Risk of Diabetes Mellitus: A Mini-Review

Studying the factors that cause diabetes and conducting clinical trials has become a priority, particularly raising awareness of the dangers of the disease and how to overcome it. Diet habits are one of the most important risks that must be understood and carefully applied to reduce the risk of diabetes. Nowadays, consuming enough home-cooked food has become a challenge, particularly with modern life performance, pushing people to use processed foods. Ultra-processed food (UPF) consumption has grown dramatically over the last few decades worldwide. This growth is accompanied by the increasing prevalence of non-communicable diseases (NCDs) such as cardiovascular diseases, hypertension, and type 2 diabetes. UPFs represent three main health concerns: (i) they are generally high in non-nutritive compounds such as sugars, sodium, and trans fat and low in nutritional compounds such as proteins and fibers, (ii) they contain different types of additives that may cause severe health issues, and (iii) they are presented in packages made of synthetic materials that may also cause undesirable health side-effects. The association between the consumption of UPF and the risk of developing diabetes was discussed in this review. The high consumption of UPF, almost more than 10% of the diet proportion, could increase the risk of developing type 2 diabetes in adult individuals. In addition, UPF may slightly increase the risk of developing gestational diabetes. Further efforts are needed to confirm this association; studies such as randomized clinical trials and prospective cohorts in different populations and settings are highly recommended. Moreover, massive improvement in foods' dietary guidelines to increase the awareness of UPF and their health concerns is highly recommended.

The healthy/unhealthy dietary pattern is associated with resting metabolic rate status among women with overweight/obesity

BACKGROUND

Although various dietary patterns have been indicated to be associated with the resting metabolic rate [RMR], limited data are available in this field. This study was therefore focused on the association between dietary patterns and resting metabolic rate among participants with overweight and obesity.

METHODS

This cross-sectional study was conducted on 304 women with overweight or obesity (BMI ≥ 25 kg/m²), aged 18-50. Anthropometric assessments, physical activity and biochemical measurements were assessed. RMR was also measured by means of indirect calorimetry. Dietary intake of participants was evaluated by 147-item semi-quantitative food frequency questionnaire [FFQ].

RESULTS

There was a significant association between higher adherence to the healthy dietary pattern [HDP] and RMR (P = 0.05), intakes of protein (P = 0.003), minerals (P = 0.001) as well as fat free mass [FFM] (P = 0.002), bone mineral content (P = 0.001), skeletal muscle mass (P = 0.001), soft lean mass (P = 0.002) and visceral fat area (P = 0.05). Also, there was a considerable association between higher adherence to the unhealthy dietary pattern [UHDP] and fasting blood sugar [FBS] (P = 0.05). Using multinomial logistic regression has been shown that the medium adherence to the HDP was marginally significant with decreased resting metabolic rate [Dec. RMR] group in crude model (OR: 0.54; 95% CI: 0.28-1.05, P = 0.07). After controlling for various confounders such as age, FFM, physical activity, and energy intake, the association between Dec. RMR group and the lowest quartile of the HDP (OR: 0.36; 95% CI: 0.14-0.91, P = 0.03) became significant as well as the association between Dec. RMR group and medium adherence to the HDP (OR: 0.42; 95% CI: 0.18-0.97, P = 0.04). The medium adherence to the UHDP in crude model was also significant with increased resting metabolic rate [Inc. RMR] group (OR: 2.59; 95% CI: 1.01-6.65, P = 0.04).

CONCLUSIONS

Our study showed that there are significant associations between dietary patterns and RMR status.

Association between dietary patterns and glycaemic control in a middle-aged Chinese population

OBJECTIVE

The present work was performed to analyse the association of dietary patterns with glycaemic control (Hb A1c < 7 %) in a large group of Chinese adults aged between 45 and 59 years.

DESIGN

Habitual dietary intakes in the preceding 12 months were assessed by well-trained interviewers using a validated semi-quantitative FFQ. Factor analysis with principal component method was used to obtain the dietary patterns, and the associations between dietary patterns and glycaemic control were determined using multivariable logistic regression models. Poor glycaemic control was defined as HbA1c ≥ 7·0.

SETTING

Despite decades of research, data on the relationship between dietary patterns and glycaemic control (HbA1c < 7 %) in China are sparse.

PARTICIPANTS

A total of 1739 participants aged 45-59 years from Hangzhou were included in the final analysis.

RESULTS

Three dietary patterns were ascertained and labelled as traditional southern Chinese, Western and grains-vegetables patterns. After controlling of the possible confounders, participants in the highest quartile of Western pattern scores had greater OR for HbA1c ≥ 7·0 (OR = 1·05; (95 % CI 1·000, 1·095); P = 0·048) than did those in the lowest quartile. Compared with those in the lowest quartile of grains-vegetables pattern, participants in the highest quartile had lower OR for HbA1c ≥ 7·0 (OR = 0·82; (95 % CI 0·720, 0·949); P = 0·038). Besides, no significant relationship between the traditional southern Chinese pattern and HbA1c ≥ 7·0 was observed (P > 0·05).

CONCLUSIONS

This study indicated that the Western pattern was associated with a higher risk, and the grains-vegetables pattern was associated with a lower risk for HbA1c ≥ 7·0. Future prospective studies are needed to confirm our findings.

Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review

Background

Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients.

Methods

The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed.

Results

Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies.

Conclusions

Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01209-w.

Dietary Patterns and Pediatric Bone

PURPOSE OF REVIEW

Much of what we know about dietary patterns (DPs) and bone is derived from cross-sectional studies in adults. Given, establishing healthy bones during childhood serves as a blueprint for adult bone, it is important to better understand the role of DPs on pediatric bone. The purpose of this review is to determine if DPs influence bone strength in children.

RECENT FINDINGS

The majority of studies investigating the role of DPs on pediatric bone are cross-sectional in design and examine data-derived "a posterori" DPs. Overall, the DPs characterized by high intakes of fruits and vegetables demonstrated positive effects on pediatric bone. Results from both "a posteriori" and "a priori" DPs approaches in children suggests that DPs dominated by the intake of fruits and vegetables might be beneficial for pediatric bone. Future studies may consider "a priori" DPs interventions to better understand relationship between DPs and pediatric bone.

Dietary patterns and glycaemic control among Qatari adults with type 2 diabetes

OBJECTIVE

To assess the association between dietary patterns and glycaemic control among Qatari adults with type 2 diabetes (T2DM).

DESIGN

Cross-sectional analysis using data from the Qatar Biobank Study. Poor glycaemic control was defined as HbA1c ≥7·0 %. Dietary patterns were constructed using factor analysis based on habitual food intake assessed by a FFQ. Medication use was based on self-report. Multivariable logistic regression was used to assess the association.

SETTING

Qatar.

PARTICIPANTS

Adults aged ≥18 years (n 1000) with known diabetes.

RESULT

The mean age of the participants was 52·3 (sd 11·5) years. Overall, the prevalence of poor glycaemic control was 57·6 %, and 27·7 % of the participants were insulin users. Three dietary patterns were identified. The modern dietary pattern (high intake of fast food, croissants, white bread and cheese) was inversely associated with poor glycaemic control. The sd increments of the modern pattern had OR for poor glycaemic control of 0·86 (95 % CI 0·68, 1·08) in men and 0·76 (95 % CI 0·61, 0·95) in women. There was a significant interaction between the modern pattern and diabetes medication in men but not in women. In men without diabetes medication, the modern pattern was positively associated with poor glycaemic control with an OR of 2·35 (95 % CI 1·13, 4·87).

CONCLUSIONS

Male diabetes patients took medication to control diabetes but ate more unhealthy food. In men who were not taking diabetes medication, modern dietary pattern was associated with poor glycaemic control. Promoting healthy eating should be encouraged especially among those under diabetes medication.

Emirates Diabetes Society Consensus Guidelines for the Management of Type 2 Diabetes Mellitus – 2020

Rapid urbanisation and socioeconomic development in the United Arab Emirates (UAE) have led to the widespread adoption of a sedentary lifestyle and Westernised diet in the local population and consequently a high prevalence of obesity and diabetes. In 2019, International Diabetes Federation statistics reported a diabetes prevalence rate of 16.3% for the adult population in the UAE. In view of the wealth of recent literature on diabetes care and new pharmacotherapeutics, the Emirates Diabetes Society convened a panel of experts to update existing local guidelines with international management recommendations. The goal is to improve the standard of care for people with diabetes through increased awareness of these management practices among healthcare providers licensed by national health authorities. These consensus guidelines address the screening, diagnosis and management of type 2 diabetes mellitus in adults including individuals at risk of developing the disease.

Diabetes-Related Health Care Utilization and Dietary Intake Among Food Pantry Clients

Purpose: Consuming a diet appropriate for management of diabetes mellitus (DM) is challenging, particularly for adults with food insecurity (FI). DM-related health care services are thought to support better dietary intake. In this study, we explored associations between DM-related health care utilization and dietary intake among FI adults with DM. Methods: We used cross-sectional, baseline data (collected 2015-2016) from a trial designed to improve glycemic control among adult food pantry clients with DM. We examined intake of vegetables, fruit, sugar-sweetened beverages (SSBs), and desserts using the California Health Interview Survey dietary screener. We then examined adjusted associations between dietary intake and two components of DM-related health care utilization (<12 months vs. ≥12 months ago): self-reported visit to a health care provider for DM management and DM self-management education. Results: Among 523 participants (mean hemoglobin A1c 9.8%; body mass index 34.6 kg/m2; 17.0% uninsured), vegetable intake was more frequent in those reporting recent utilization of health care providers for DM management and DSME-related services (p<0.01), compared with those with less recent use. There was no association between intake frequency of fruit or SSBs and utilization of either DM-related service. Participants more recently utilizing DSME-related services consumed desserts more frequently (p=0.02). Relationships persisted after controlling for DM duration, race/ethnicity, education, health insurance, location, medication adherence, and depression. Conclusions: Among FI patients, DM-related services offered in clinical settings may more effectively increase vegetable consumption than decrease consumption of food and beverage items that can worsen glycemic control. Food pantry settings may provide an opportunity to reinforce dietary messaging.