Papel do índice glicêmico e da carga glicêmica na prevenção e no controle metabólico de pacientes com diabetes melito tipo 2

The Role of the Mediterranean Dietary Pattern on Metabolic Control of Patients with Diabetes Mellitus: A Narrative Review

Diabetes mellitus (DM) is a metabolic disorder characterised by hyperglycemia and abnormalities in carbohydrate, fat and protein metabolism. Several studies demonstrated that foods typical of the Mediterranean diet (MedDiet), including vegetables, fruits, oilseeds, extra virgin olive oil and fish, can promote health benefits for individuals at risk of or with type 2 diabetes (T2DM). In this review, we summarised randomised clinical trials, cohort studies, meta-analyses and systematic reviews that evaluated the effects of the MedDiet on metabolic control of T2DM. The data suggest that the MedDiet influences cardiovascular risk factors, including blood pressure, lipid profile, insulin resistance, inflammation and glucose metabolism, in T2DM patients. In conclusion, the MedDiet appears to protect patients from macro- and microangiopathy and should be considering in the management of diabetic patients.

Determination of glycemic index of enteral formulas used in clinical practice

Glycemic Index (GI) is a measure of carbohydrate quality and is recognised as a valid and reproducible method of classifying carbohydrate foods according to its effects on postprandial glycaemia. In this randomised crossover trial (RBR-7rjx3k) we determined the GI of nine enteral formulas, following the Food and Agriculture Organisation/World Health Organisation method. Forty healthy participants were included in the study (85% female mean age 27.1 ± 6.7 years). GI of the enteral formulas ranged from 40.5 to 85.2; four formulas had high GI (Nutrienteral 1.5^®, Novasource GI Control^®, Diamax^®, Isosource Soya^®), two intermediate GI (Fresubin 1.2 HP Fibre^®, Nutrison Energy Multifiber 1.5^®) and three low GI (Trophic 1.5^®, Glucerna^®, Novasource GC HP^®). The GI coefficient of variation ranged from 22.9% to 83.6%. The effect of the enteral formulas with low GI in glycemic control of patients with enteral nutrition prescription needs to be test in future studies.

Changes in glucose levels and fecal excretion of lipids due to consumption of yacon flour

Purpose

As studies investigating the effects of fructan sources, such as yacon, on glucose and lipid metabolism showed different results, additional research is required to establish a clear relationship between them. Thus, this paper aims to evaluate possible effects of the consumption of the yacon pulp flour (YPF) on biological and metabolic parameters such as food consumption, weight gain, serum glucose levels and fecal lipid excretion of rats, as well as determine the role of glycemic index (GI) of the diets added of this ingredient on those parameters.

Design/methodology/approach

For this purpose, 24 male albino Wistar rats were divided into four groups, which received the following treatments for 17 days: Group 1 (G1) (Control) – American Institute of Nutrition (AIN)-M; Group 2 (G2) – AIN-M added 5 per cent YPF; Group 3 (G3) – AIN-M added 10 per cent YPF and Group 4 (G4) – AIN-M added 15 per cent YPF. Analysis of fasting and postprandial glycemia was conducted for elaboration of the glycemic curve and calculation of the GI of the diets. Lipids loss was measured by quantification of crude fat in feces after consumption of the diet.

Findings

YPF, regarding the concentration in the diets, did not elevate the fasting glucose among the groups. The postprandial glucose of the animals declined in different postprandial glucose peaks of the groups ingesting YPF in relation to the control one, especially in group treated with 15 per cent YPF, between 30 and 60 min (p <0,05), confirming the influence of the dietary fiber on the absorption of the glucose. The ingestion of YPF increased dragging of lipids to the animal feces, proportional to the amounts of YPF added to the diets. According to the regression analysis, followed by regression testing to 5 per cent, there was a significant difference between the experimental groups, being that the elevation of the percentage of YPF added to the diet caused a proportional increase in the lipid levels in the animal feces.

Originality/value

YPF could be an alimentary source of interest, mainly when the focus is on disease risk prevention such as diabetes, obesity and dyslipidemias.

Tight glycemic control and cardiovascular effects in type 2 diabetic patients

Diabetes Mellitus (DM) with poor glycemic control is one of the leading causes for cardiovascular mortality in diabetic patients. Tight glycemic control with glycosylated haemoglobin of <7 gms% is recommended as a routine and < 6.5 gms% is recommended for young and newly diagnosed diabetics. Treatment goal aims at achieving near normal blood glucose level, and directed at management of other co morbid conditions such as obesity, hypertension and dyslipidemia. Oral hypoglycemic agents are the preferred drugs, alone or in combination. Preference for glitazones is declining due to the increasing evidences of associated adverse events. Gliptins appear as promising agents with lesser tendency to cause hypoglycemia, but their long term safety and efficacy is yet to be established. We emphasize the role of preventive measures in prediabetics and in established DM, treatment should be individualized and customized to minimize hypoglycemic effects and to retain quality of life.