Glycemic index-based nutritional education improves blood glucose control in Japanese adults: a randomized controlled trial

Patient-centered nutrition education improved the eating behavior of persons with uncontrolled type 2 diabetes mellitus in North Ethiopia: a quasi-experimental study

Background

Improving the clinical outcome of people with type 2 diabetes mellitus by modifying their eating behavior through nutrition education is an important element of diabetes self-management. Significant data from the literature supports this idea, however in the Ethiopian setting, there is a practice gap. Therefore, the purpose of this study was to assess how patient-centered nutrition education affected the eating behavior and clinical outcomes of people with uncontrolled type 2 diabetes mellitus.

Method

In this quasi-experimental trial, 178 people with uncontrolled type 2 diabetes were purposely assigned to the intervention (n = 89) or control (n = 89) arm. The intervention arm was given patient-centered nutrition education, whereas the control arm received the routine care. Eating behavior and clinical outcome indicators such as HbAc, lipid profile, anthropometric indices, and blood pressure were assessed in both groups at the start and completion of the intervention. All scale variables were tested for normality and log transformed when appropriate. The baseline characteristics of the intervention and control groups were compared using the t-test for continuous variables and the chi-square test for categorical variables. The effect of nutrition education was determined using a difference in differences (DID) approach. P < 0.05 was established as the criterion of significance.

Result

Food selection (DID = 15.84, P < 0.001), meal planning (DID = 31.11, P < 0.001), and calorie needs (DID = 37.65, P < 0.001) scores were statistically higher in the nutrition education arm. Furthermore, their overall eating behavior score (DID = 27.06, P < 0.001) was statistically greater than the controls. In terms of clinical outcomes, the overall picture reveals that the intervention did not outperform over the routine care. However, in comparison to the controls, the intervention arm showed clinically significant improvement in HbA1c (DID = -0.258, P = 0.485).

Conclusion

Patient-centered nutrition education has resulted in positive adjustments in the eating behavior of people with uncontrolled type 2 diabetes mellitus. Furthermore, it has shown a great potential for improving their glycemic control.

Utilising a Real-Time Continuous Glucose Monitor as Part of a Low Glycaemic Index and Load Diet and Determining Its Effect on Improving Dietary Intake, Body Composition and Metabolic Parameters of Overweight and Obese Young Adults: A Randomised Controlled Trial

A randomised controlled trial to measure the effects of integrating real-time continuous glucose monitor (rtCGM) into a low glycaemic index (GI) and glycaemic load (GL) dietary intervention on dietary intake, body composition and specific metabolic parameters was carried out. A total of 40 overweight young adults [(means ± SD) age: 26.4 ± 5.3 years, BMI: 29.4 ± 4.7 kg/m2] were randomised into an intervention and control groups for a period of eight weeks. Both groups received nutrition education on low GI and GL foods. The intervention group also received an rtCGM system to monitor their glucose levels 24 h a day. While controlling for physical activities and GI and GL nutrition knowledge, the results indicated that the rtCGM system further improved body weight, BMI, fat mass, fasting plasma glucose, HbA1c, total cholesterol, HDL cholesterol and LDL cholesterol in the intervention group (p < 0.05). This trial unveils the robustness of the rtCGM where non-diabetic overweight and obese young adults can benefit from this device and utilise it as a management tool for overweight and obesity and a primary prevention tool for type 2 diabetes, as it provides real-time and personalised information on physiological changes.

Effect of diabetes nutrition education on the dietary feeding practices and lifestyle of type 2 diabetic patients

BACKGROUND

Type 2 diabetes mellitus (T2DM) is one of the most common global diseases of public concern. In developing countries like Uganda, dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM. Therefore, awareness about diabetes dietary practices and life style are paramount in the control of the disease.

METHODOLOGY

One hundred type 2 diabetic patients were randomly selected and divided into two groups of intervention and control (50 patients in each group) to participate in the study. The intervention consisted of two educational sessions each for 30 min with various learning segments. A conversation map for type 2 diabetes, 24-h dietary recall and glycemic load tables were used. Data were collected using a pre-tested questionnaire before intervention and on monthly basis for a period of four months of intervention. Data were entered and analyzed using SPSS software version 21.

RESULTS

There was a significant (p < 0.001) increase in water, vegetables, fruits, and number of meals intake per day coupled with quitting alcohol, soda, and beer among the intervention group. On the other hand, it was revealed that meat and milk consumption significantly reduced by 81.6 and 82.4% respectively among the intervention group. At the end of study period, milk, meat, vegetable, beer, soda, cigarettes intake, and duration of physical activity increased among the control group.

CONCLUSIONS

Nutrition education improves dietary feeding practices and lifestyle among type 2 diabetes patients within four months of intervention.

Cultural Adaptation, Validation, and Primary Application of a Questionnaire to Assess Intentions to Eat Low-Glycemic Index Foods among Rural Chinese Women

Different lines of evidence indicate that knowledge of low-glycemic index (GI) foods and the practice of eating them play important roles in blood glucose management and preventing T2DM in women with prior gestational diabetes mellitus (GDM). According to the theory of planned behavior (TPB), intention is a critical factor in complying with health-related behaviors. However, an instrument for assessing the intention to eat low-GI foods is lacking in China. We aimed to (1) adapt and validate a Chinese version of the intentions to eat low-GI foods questionnaire (CIELQ) and (2) apply the CIELQ among rural Chinese women to explore the associations between CIELQ scores and glycemic status. A cross-sectional study was conducted on 417 nondiabetic, nonpregnant participants with a history of GDM in Hunan, China. After cultural adaptation and validation, the CIELQ was applied in a target population. Glycemic status, anthropometric variables, dietary intake, and physical activity were measured; a self-developed, standard questionnaire was applied to collect relevant information. The CIELQ showed good internal consistency; model fitness was acceptable based on the confirmatory factor analysis results. Awareness of the glycemic index was low among the study population. TPB factors were found to be associated with each other; education level and parents’ diabetes history were associated with specific factors. The score for instrumental attitude showed a positive association with the risk for a high level of the 2-h 75-g oral glucose tolerance test (odds ratio, OR = 1.330), while the score for perceived behavior control (PBC) showed a negative association with the risk for a high level (OR = 0.793). The CIELQ was determined to be a valid instrument for assessing the intention to eat a low-GI diet among the study population. The awareness of the GI was poor among the study population. The score for instrumental attitude showed a positive association with the risk of a high level on the 2-h 75-g oral glucose tolerance test (OGTT), and the score for PBC showed a negative association with the risk for a high level on OGTT.

Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis

BACKGROUND

Low-glycemic index (GI) diets are thought to reduce postprandial glycemia, resulting in more stable blood glucose concentrations.

OBJECTIVE

We hypothesized that low-GI diets would be superior to other diet types in lowering measures of blood glucose control in people with type 1 or type 2 diabetes, or impaired glucose tolerance.

METHODS

We searched PubMed, the Cochrane Library, EMBASE, and clinical trials registries for published and unpublished studies up until 1 March, 2019. We included 54 randomized controlled trials in adults or children with impaired glucose tolerance, type 1 diabetes, or type 2 diabetes. Continuous data were synthesized using a random effects, inverse variance model, and presented as standardized mean differences with 95% CIs.

RESULTS

Low-GI diets were effective at reducing glycated hemoglobin (HbA1c), fasting glucose, BMI, total cholesterol, and LDL, but had no effect on fasting insulin, HOMA-IR, HDL, triglycerides, or insulin requirements. The reduction in fasting glucose and HbA1c was inversely correlated with body weight. The greatest reduction in fasting blood glucose was seen in the studies of the longest duration.

CONCLUSIONS

Low-GI diets may be useful for glycemic control and may reduce body weight in people with prediabetes or diabetes.

Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): Protocol for a Pragmatic Randomized Controlled Trial

BACKGROUND

Rigorous evidence is needed regarding the best approach for increasing the uptake of Diabetes Canada's evidence-based recommendations to include low-glycemic index (GI) foods in daily meal planning as an effective dietary self-care strategy for glycemic control among people with type 2 diabetes (T2D).

OBJECTIVE

This study aims to present the study design and baseline data from the Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI) trial, which was designed to evaluate the effectiveness of an enhanced GI-targeted nutrition education on GI-related knowledge and mean daily GI among adults with T2D in Edmonton, Alberta.

METHODS

We used a pragmatic randomized controlled trial design and allocated 67 adults (aged ≥18 years) with T2D living in Edmonton, Alberta, Canada, to a control group that received standard printed copies of Canada's Food Guide and Diabetes Canada's GI resources or to an intervention group that received the same materials, plus a customized Web-based platform with 6 self-directed learning modules and print material. Each module included videos, links to reliable websites, chat rooms, and quizzes. Evidence-based GI concept information included GI values of foods and low-GI shopping, recipes, and cooking tips by a registered dietitian. In addition, support through email, text messaging (short message service), phone calls, or postal mail was provided to reinforce participants' learning. The primary outcome, average dietary GI, was assessed using 3-day food records. Additional measures including GI knowledge and self-efficacy, glycated hemoglobin (HbA_1c), lipids, systolic blood pressure, body mass index (BMI; weight, height), waist circumference, and computer proficiency were assessed at baseline and at 3-month postintervention.

RESULTS

Between November 2017 and February 2018, we contacted adults (aged ≥18 years) with T2D living in Edmonton, Alberta, screened and recruited eligible participants into the study. All data collection ended in June 2018. Overall, 64% (43/67) participants were males; mean age was 69.5 (SD 9.3) years, with a mean diabetes duration of 19.0 (SD 13.7) years. Mean BMI was 30.1 (SD 5.7) kg/m², and mean HbA_1c value was 7.1% (SD 1.2%). Data analysis was completed in December 2018.

CONCLUSIONS

The GI concept is often difficult to teach. The HEALD-GI study aims to provide evidence in support of an alternative approach to translating the GI concept to adults with T2D. Findings from this study may help registered dietitians to better disseminate low-GI dietary recommendations using efficient and cost-effective, patient-centered approaches. Furthermore, evidence generated will contribute to addressing some of the controversies regarding the clinical usefulness of the GI concept.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/11707.

Examining sex differences in glycemic index knowledge and intake among individuals with type 2 diabetes

AIM

We examined self-reported dietary behaviours and actual food intakes among adult men and women with type 2 diabetes participating in Alberta's Caring for Diabetes (ABCD) Study.

METHODS

Participants completed 3-day food records and questions about glycemic index (GI) concept knowledge and dietary behaviours. Daily average GI and glycemic load (GL) were calculated for all carbohydrates consumed. Dietary intake was analyzed using ESHA FoodPro (version 10.13.1). Sex differences in nutrient intakes were explored across categories of GI knowledge and dietary practices.

RESULTS

Participants (N=170) mean (SD) age 65.8 (9.6) years were 46.5% women, 90.6% Caucasian with a mean BMI of 31.3 (7.0)kg/m² and diabetes duration of 13.4 (8.6) years. Overall, 60% of men versus 40% of women consumed carbohydrates in quantities below Acceptable Macronutrient Distribution Ranges (AMDR). About 80% of men versus 90% of women consumed proteins above AMDR whereas 60% versus 65% of women consumed fats above AMDR. Fibre intake among men was lower than recommended (p<0.01). Men who reported having knowledge of the GI-concept also reported lower GI intake versus men who did not (p=0.03).

CONCLUSION

Sex differences exist in low-GI diabetes self-care dietary behaviours among adults with type 2 diabetes participating in this study. Gender-sensitive approaches for enhancing diabetes self-care low-GI dietary behaviour should be explored.

Low glycaemic index diets for the prevention of cardiovascular disease

BACKGROUND

The glycaemic index (GI) is a physiological measure of the ability of a carbohydrate to affect blood glucose. Interest is growing in this area for the clinical management of people at risk of, or with, established cardiovascular disease. There is a need to review the current evidence from randomised controlled trials (RCTs) in this area. This is an update of the original review published in 2008.

OBJECTIVES

To assess the effect of the dietary GI on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible randomised controlled trials.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and CINAHL in July 2016. We also checked reference lists of relevant articles. No language restrictions were applied.

SELECTION CRITERIA

We selected RCTs that assessed the effects of low GI diets compared to diets with a similar composition but a higher GI on cardiovascular disease and related risk factors. Minimum trial duration was 12 weeks. Participants included were healthy adults or those at increased risk of cardiovascular disease, or previously diagnosed with cardiovascular disease. Studies in people with diabetes mellitus were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently screened and selected studies. Two review authors independently assessed risk of bias, evaluated the overall quality of the evidence using GRADE, and extracted data following the Cochrane Handbook for Systematic Reviews of Interventions. We contacted trial authors for additional information. Analyses were checked by a second reviewer. Continuous outcomes were synthesized using mean differences and adverse events were synthesized narratively.

MAIN RESULTS

Twenty-one RCTs were included, with a total of 2538 participants randomised to low GI intervention (1288) or high GI (1250). All 21 included studies reported the effect of low GI diets on risk factors for cardiovascular disease, including blood lipids and blood pressure.Twenty RCTs (18 of which were newly included in this version of the review) included primary prevention populations (healthy individuals or those at high risk of CVD, with mean age range from 19 to 69 years) and one RCT was in those diagnosed with pre-existing CVD (a secondary prevention population, with mean age 26.9 years). Most of the studies did not have an intervention duration of longer than six months. Difference in GI intake between comparison groups varied widely from 0.6 to 42.None of the included studies reported the effect of low GI dietary intake on cardiovascular mortality and cardiovascular events such as fatal and nonfatal myocardial infarction, unstable angina, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, and stroke. The unclear risk of bias of most of the included studies makes overall interpretation of the data difficult. Only two of the included studies (38 participants) reported on adverse effects and did not observe any harms (low-quality evidence).

AUTHORS' CONCLUSIONS

There is currently no evidence available regarding the effect of low GI diets on cardiovascular disease events. Moreover, there is currently no convincing evidence that low GI diets have a clear beneficial effect on blood lipids or blood pressure parameters.

WITHDRAWN: Group based diabetes self-management education compared to routine treatment, waiting list control or no intervention for people with type 2 diabetes mellitus

The review authors of this review update are unable to continue with their work. The Cochrane Metabolic and Endocrine Disorders Review Group is seeking very experienced new authors to perform an update on this complex intervention review.

At June 2015, this review has been withdrawn. This review is out of date although it is correct as the date of publication. The latest version is available in the 'Other versions' tab on the Cochrane Library, and may still be useful to readers.

The editorial group responsible for this previously published document have withdrawn it from publication.

Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus

BACKGROUND

Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population.

OBJECTIVES

To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus.

SEARCH METHODS

A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification.

MAIN RESULTS

A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment.

AUTHORS' CONCLUSIONS

Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.

The influence of fasting insulin level in post-gestational diabetes mellitus women receiving low-glycaemic-index diets

Post-gestational diabetes mellitus (GDM) women are recommended weight loss to manage increased cardio-metabolic risks. We investigated the effects of lowering diet glycaemic index (GI) on fasting blood glucose (FBG), serum lipids, body weight and composition of post-GDM women with varying fasting insulin levels (INS). Seventy-seven Asian, non-diabetic women with previous GDM (aged 20–40 years, mean BMI: 26.4±4.6 kg m⁻²) were recruited. At baseline, 20 subjects with INS <2 μIU ml⁻¹ and 18 with INS ⩾2 μIU ml⁻¹ received conventional dietary recommendations (CHDR) only. CHDR emphasised energy and fat intake restriction and encouraged increase in dietary fibre intakes. Twenty-four subjects with INS <2 μIU ml⁻¹ and 15 with INS ⩾2 μIU ml⁻¹, in addition to CHDR, received low-GI education (LGI). Changes in FBG, serum lipids, body weight and body composition were evaluated. Subjects with INS <2 μIU ml⁻¹ had similar outcomes with both diets. After 1 year, subjects with INS ⩾2 μIU ml⁻¹ who received LGI education had reductions in FBG and triglycerides. Subjects who received CHDR observed increase in both FBG and triglycerides (P<0.05). Among all subjects, diet GI was lower and dietary fibre intakes were higher in LGI compared with CHDR subjects (all P<0.05). Thus, in Asian post-GDM women with normal/higher INS, adding low-GI education to CHDR improved management of FBG and triglycerides.

The transcultural diabetes nutrition algorithm: a canadian perspective

The Transcultural Diabetes Nutrition Algorithm (tDNA) is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG) recommendations is essential to address varied patient populations within and among diverse regions worldwide. The Canadian version of tDNA supports and targets behavioural changes to improve nutritional quality and to promote regular daily physical activity consistent with Canadian Diabetes Association CPG, as well as channelling the concomitant management of obesity, hypertension, dyslipidemia, and dysglycaemia in primary care. Assessing glycaemic index (GI) (the ranking of foods by effects on postprandial blood glucose levels) and glycaemic load (GL) (the product of mean GI and the total carbohydrate content of a meal) will be a central part of the Canadian tDNA and complement nutrition therapy by facilitating glycaemic control using specific food selections. This component can also enhance other metabolic interventions, such as reducing the need for antihyperglycaemic medication and improving the effectiveness of weight loss programs. This tDNA strategy will be adapted to the cultural specificities of the Canadian population and incorporated into the tDNA validation methodology.

Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial

BACKGROUND

Gestational Diabetes Mellitus (GDM) increases risks for type 2 diabetes and weight management is recommended to reduce the risk. Conventional dietary recommendations (energy-restricted, low fat) have limited success in women with previous GDM. The effect of lowering Glycaemic Index (GI) in managing glycaemic variables and body weight in women post-GDM is unknown.

OBJECTIVE

To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education, in the management of glucose tolerance and body weight in Asian women with previous GDM.

METHOD

Seventy seven Asian, non-diabetic women with previous GDM, between 20- 40y were randomised into Conventional healthy dietary recommendation (CHDR) and low GI (LGI) groups. CHDR received conventional dietary recommendations only (energy restricted, low in fat and refined sugars, high-fibre). LGI group received advice on lowering GI in addition. Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test (2HPP) were measured at baseline and 6 months after intervention. Anthropometry and dietary intake were assessed at baseline, three and six months after intervention. The study is registered at the Malaysian National Medical Research Register (NMRR) with Research ID: 5183.

RESULTS

After 6 months, significant reductions in body weight, BMI and waist-to-hip ratio were observed only in LGI group (P<0.05). Mean BMI changes were significantly different between groups (LGI vs. CHDR: -0.6 vs. 0 kg/m2, P= 0.03). More subjects achieved weight loss ≥5% in LGI compared to CHDR group (33% vs. 8%, P=0.01). Changes in 2HPP were significantly different between groups (LGI vs. CHDR: median (IQR): -0.2(2.8) vs. +0.8 (2.0) mmol/L, P=0.025). Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group (-1.9±0.42 vs. +1.31±1.4 mmol/L, P<0.001). After 6 months, LGI group diets showed significantly lower GI (57±5 vs. 64±6, P<0.001), GL (122±33 vs. 142±35, P=0.04) and higher fibre content (17±4 vs.13±4 g, P<0.001). Caloric intakes were comparable between groups.

CONCLUSION

In women post-GDM, lowering GI of healthy diets resulted in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription.

Diabetes self-management education: miles to go

This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts.

Optimizing HgA1C and glucose monitoring frequency in patients with Type 2 diabetes

BACKGROUND

The primary objective of our study is to compare HgA1C to self monitoring frequency in diabetes subjects. A secondary objective is to evaluate the influence of family support and gender on glucose monitoring frequency and HgA1C.

MATERIAL/METHODS

We studied the glucose monitoring frequency and HgA1c outcome of 67 subjects treated with diet alone, 350 subjects treated with tablets, 155 subjects treated with insulin, and 228 subjects treated with both tablets and insulin.

RESULTS

Eleven percent of the subjects monitoring 4-7 times per week produced a positive significant coefficient (p<.05). Self monitoring less than 4 times per week showed no statistical significance and self monitoring more than 8 times per week showed no statistical significance. Forty-eight percent of subjects treating with insulin alone and tablet plus insulin produced positive significant coefficients (p<.05). The percentage lowering of HgA1C of tablet plus insulin is 15.64% as the mean HgA1C at the first visit was 9.35 compared to 7.89. The percentage lowering of HgA1C for insulin alone was 12.24% as the mean HgA1C at the first visit was 9.37 compared to 8.23 at the later visit.

CONCLUSIONS

We conclude that (1) frequency of self monitoring should be based on individualized goals and willingness to participate, (2) both insulin alone and tablet plus insulin levels of medication are effective at lowering HgA1C levels; however, using the tablet and insulin combined produced lower HgA1C levels than using insulin alone; (3) family support and gender have no effect on glucose monitoring frequency and lowering HgA1C levels.

A behavioural intervention incorporating specific glycaemic index goals improves dietary quality, weight control and glycaemic control in adults with type 2 diabetes

OBJECTIVE

A lower glycaemic index (GI) diet is associated with a reduction in glycosylated Hb (HbA(1c)) in people with diabetes. Yet, little research has been conducted to determine the effects of specific goals regarding consumption of low GI (LGI) foods on diabetes outcomes. The present study evaluated a behavioural intervention on dietary intake, weight status and HbA(1c), which included a goal to consume either six or eight servings of LGI foods daily.

DESIGN

A parallel two-group design was used. Following the 5-week intervention, participants were randomly assigned to the group of six (n 15) or eight (n 20) servings of LGI foods daily and followed up for 8 weeks. Dietary intake was assessed using the mean of 4 d food records.

SETTING

A metropolitan community in the USA.

SUBJECTS

Individuals aged 40-65 years with type 2 diabetes of ≥1 year and HbA(1c) ≥ 7·0 % were eligible.

RESULTS

There was no significant difference between goal difficulty groups with regard to GI servings at the end of the study. However, mean consumption of LGI foods increased by 2·05 (SE 0·47) and 1·65 (SE 0·40) servings per 4184 kJ in the six (P < 0·001) and eight (P < 0·001) LGI serving groups, respectively. For all participants combined, there were significant decreases in mean HbA(1c) (-0·58 (SE 0·21) %; P = 0·01), weight (-2·30 (SE 0·78) kg; P = 0·01), BMI (-0·80 (SE 0·29) kg/m(2); P = 0·01) and waist circumference (-2·36 (SE 0·81) cm; P = 0·01).

CONCLUSIONS

An intervention including a specific goal to consume six to eight servings of LGI foods daily can improve diabetes outcomes. Clinicians should help patients set specific targets for dietary change and identify ways of achieving those goals.

The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults

This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.

Rice intake and type 2 diabetes in Japanese men and women: the Japan Public Health Center-based Prospective Study

BACKGROUND

Refined carbohydrates have been suggested to deteriorate glucose metabolism; however, whether persons with elevated intakes of white rice, which is a major staple food for the Japanese, experience increased risk of developing type 2 diabetes remains unclear.

OBJECTIVE

We prospectively investigated the association between white rice intake and risk of type 2 diabetes.

DESIGN

Participants were 25,666 men and 33,622 women aged 45-75 y who participated in the second survey of the Japan Public Health Center-based Prospective Study and who had no prior history of diabetes. We ascertained food intake by using a validated 147-item food-frequency questionnaire. Odds ratios of self-reported, physician-diagnosed type 2 diabetes over 5 y were estimated by using logistic regressions.

RESULTS

A total of 1103 new cases of type 2 diabetes were self-reported. There was a significant association between rice intake and an increased risk of type 2 diabetes in women; the multivariate-adjusted odds ratio for the highest compared with lowest quartiles of rice intake was 1.65 (95% CI: 1.06, 2.57; P for trend = 0.005). In men, the association was unclear, although there was a suggestion of a positive association in persons who were not engaged in strenuous physical activity (P for trend = 0.08).

CONCLUSIONS

Elevated intake of white rice is associated with an increased risk of type 2 diabetes in Japanese women. The finding that is suggestive of a positive association of rice intake in physically inactive men deserves further investigation.

Use of the glycemic index for weight loss and glycemic control: a review of recent evidence

This article summarizes current findings regarding the use of low-glycemic index (GI) diets for weight loss and type 2 diabetes control. Results from cross-sectional studies evaluating the association between dietary GI and body mass index had equivocal results, especially when dietary fiber was included in the model. Of five prospective cohort studies, two reported increased risk of type 2 diabetes diagnosis with higher dietary GI or glycemic load (GL). Risk of type 2 diabetes appeared to have a stronger association with carbohydrate intake or GL than with GI. Evidence from intervention studies using a low-GI approach for weight loss produced inconsistent results, especially for longer-term studies. In intervention studies with type 2 diabetes patients, consumption of a low-GI diet resulted in lower hemoglobin A1c concentrations in participants of shorter-term studies. Recent evidence adds to the controversy regarding the effectiveness of consuming low-GI diets for glycemic control and weight reduction.

A randomized behavioural trial targeting glycaemic index improves dietary, weight and metabolic outcomes in patients with type 2 diabetes

Objective

Glycaemic index (GI) reflects the postprandial glucose response of carbohydrate-containing foods. A diet with lower GI may improve glycaemic control in people with diabetes. The purpose of the present study was to evaluate the change in outcomes following a behavioural intervention which promoted lower-GI foods among adults with diabetes.

Design

A pre-test–post-test control group design was used with participants randomly assigned to an immediate (experimental) or delayed (control) treatment group. The intervention included a 9-week, group-based intervention about carbohydrate and the glycaemic index. Dietary, anthropometric and metabolic measures were obtained pre/post-intervention in both groups and at 18-week follow-up for the immediate group.

Setting

The study was conducted in a rural community in the north-eastern USA.

Subjects

Adults having type 2 diabetes mellitus for ≥1 year, aged 40–70 years and not requiring insulin therapy (n 109) were recruited.

Results

Following the intervention, mean dietary GI (P < 0·001), percentage of energy from total fat (P < 0·01) and total dietary fibre (P < 0·01) improved in the immediate compared with the delayed group. Mean BMI (P < 0·0001), fasting plasma glucose (P = 0·03), postprandial glucose (P = 0·02), fructosamine (P = 0·02) and insulin sensitivity factor (P = 0·04) also improved in the immediate group compared with the delayed group. Mean waist circumference among males (P < 0·01) and body weight among males and females (P < 0·01) were significantly different between treatment groups.

Conclusions

Educating clients about carbohydrate and the glycaemic index can improve dietary intake and health outcomes among adults with type 2 diabetes.

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

O controle glicêmico intensificado pode prevenir e/ou retardar o aparecimento das complicações crônicas do diabetes melito (DM). O carboidrato da dieta é o principal determinante da glicemia pós-prandial, sendo o índice glicêmico (IG) e a carga glicêmica úteis para prever a resposta glicêmica aos alimentos. O objetivo deste manuscrito foi revisar criticamente o papel das dietas de baixo IG na prevenção e controle metabólico do diabetes melito tipo 2 (DMT2). O risco para desenvolvimento de DMT2 com dietas de alto IG variou de 1,21 a 1,59. A redução de 12 a 32 unidades no IG da dieta diminuiu em 0,39 a 0,50 pontos percentuais a HbA1c. Os efeitos dessas dietas no perfil lipídico e peso corporal no DMT2 permanecem controversos. Em conclusão, as evidências atuais indicam que a incorporação do IG no planejamento dietético de pacientes com DMT2 contribui para a melhora do controle glicêmico.