Recent Advances in Nutrition and Diabetes.

The prevalence of diabetes is on the increase worldwide, being one of the fastest growing international health emergencies in the 21st century [...].

Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done?

Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin-associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch-up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co-morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.

[The evolution of insulin therapy and new insight into nutrition recommendations for individuals with diabetes]. / Postep w insulinoterapii i nowe spojrzenie na zywienie w cukrzycy.

The dietary guideline has undergone change during the last decades. It has been done by the introduction of new insulin therapy methods, also by the numerous epidemiological studies which have documented the influence of eating habits on macro-vascular diseases, obesity and type 2 diabetes. The Glycemic Index (GI) and Glycemic Load (GL) play a pivotal role in carbohydrate classification and for food choice by diabetic patients. Post-prandial glycemia response and insulinemia strongly relate to value of GI and GL. Intensive insulin therapy as a multiple daily injection or pump therapy has brought a liberalization in diabetic regime and diet. It gives possibility to introduce modern dietary guidelines including healthy eating advice with respect for traditional eating habits.

Diet and tobacco use: analysis of data from the diabetic control and complications trial, a randomized study.

CONTEXT: The Diabetic Control and Complications Trial (DCCT) researchers kept careful records of the food consumption and tobacco using habits of type 1 diabetic subjects. However, they did not report the relationship of tobacco using habits with dietary intake. OBJECTIVE: Analyze the relationship between tobacco smoking and intake of macro and micronutrients. DESIGN: Randomized controlled trial. SETTING: Referral clinics in 27 academic centers. PATIENTS: Type 1 diabetics. INTERVENTION: Using the data sets of the DCCT, this study analyzed the strengths of the associations between smoking and macronutrient consumption, hemoglobin A1c (HbA1c), body mass index (BMI), and serum lipid levels at the study baseline, 2 years, and 4 years. MAIN OUTCOME MEASURES: Statistically significant correlations between smoking and nutrient intake, HbA1c, and serum lipid levels. RESULTS: Cigarette, cigar, or pipe use at each time interval correlated with significantly increased caloric intake in males but not in females. In both males and females, tobacco users consumed more fat, cholesterol, and alcohol. Female smokers had higher serum low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratios and triglycerides. Serum cholesterols, LDL/HDL ratios, LDL cholesterols, and triglyceride determinations in male tobacco users significantly exceeded those in nonsmoking males. HDL cholesterols were lower in both female and male tobacco users. Nutrient intake of former tobacco users resembled that of nonusers rather than current users. CONCLUSIONS: A significant association exists between smoking and a diet with higher risks of atherosclerosis, cancer, and other degenerative diseases. The strong association of tobacco with heart disease, stroke, vasculopathies, and various malignancies may be in part due to its association with a higher fat diet. The higher fat diet of tobacco users probably accounts in part for their higher risk of developing type 2 diabetes and hyperlipidemia. Tobacco users should be informed about the diet and tobacco use association.

[The diabetic at the table: pariah or model?]. / Le diabétique à table: paria ou modèle?

Diet has long been part of the treatment. In fact modern dieting in diabetes comes only back 130 years ago with the description given by Apollinaire Bouchardat. He described how excessive glycosuria was observed in the postprandial periods and recommended a low carbohydrate diet. Along with the exclusion of simple sugars introduced 50 years later, the diabetic diet became a very restrictive one partly excluding the patients from normal social life event at home. Recent findings that carbohydrates should better represent 45 to 60% of the total daily caloric intake, that not all refined sugar are that "quick" nor particularly hyperglycaemic, along with the right use of mono-, poly- and saturated fat are now making the diabetic diet more flexible, more attractive, more eclectic. Nowadays we can say that the diet of a diabetic person (type 1 or 2) should follow is very comparable to that a non-diabetic person of the same age, sex, body weight and activity should also follow.

Medical nutrition therapy: an individualized approach to treating diabetes.

Making healthy food choices can be challenging for individuals with diabetes. However, nutrition education and counseling can help people understand how food affects their blood glucose level. Education also helps them to understand how the diet for diabetes has changed to include more carbohydrate-based foods than in the past. We now know that no single diet works to treat all people with diabetes; instead, diets should be individualized to meet the unique needs of each person. A variety of meal-planning approaches can be used to fit the lifestyle, food preferences, and learning needs of different individuals. Health professionals and dietitians need to strive to encourage people with diabetes to use tailored meal plans as an effective part of their diabetes self-management plan.

Recommended dietary allowances (RDA) in the dietary management of children and adolescents with IDDM: an unfeasible target or an achievable cornerstone?

A diet in line with RDAs is seldom achieved by IDDM patients. High post-prandial glucose levels are often attributed to food excess rather than to inadequate insulin doses. Lower dietary CHO with greater fat (in particular SFA) and protein are progressively scheduled instead of increasing insulin units. We studied 194 IDDM patients (1-23 yr) on a diet conforming to RDAs with a restriction of sucrose and without a quantitative approach and exchange lists of food for one year. The diet consisted of a high intake of starchy foods and vegetables and a restricted amount of animal products. HbA1c mean values of the year were used as an indicator of metabolic control. The mean daily insulin dose was 0.53 U/kg in patients with diabetes duration (DD) < 2 yr and 0.81 U/kg in those with DD > 2 yr. Mean annual HbA1c was 7.1 +/- 0.9%. The prevalence of obesity was low (5.7%). Adolescent females were more obese than males. A dietary approach in line with RDA requirements, that may help prevent any complications related to an inappropriate diet pattern, coupled with a dynamic insulin adjustment, is the first-line intervention to prevent complications in IDDM patients.

New recommendations and principles for diabetes management.

Table 1 presents a historical overview of nutrition recommendations for diabetes from pre-1921 to the present. The 1994 recommendations obliterate the concept of only one "ADA diabetic diet," preferring instead to define the recommended diet as a dietary prescription based on nutrition assessment and treatment goals. The new recommendations require a comprehensive, multiclinician approach that must be both ongoing and integrated.

New possibilities in the diabetic diet.

Recent changes in diabetic diet have been reviewed with special regard to the role of obesity, eating habits, carbohydrate content, and the ratio of simple and complex carbohydrates in meals, glycaemic index and fibre content of diet. The lack of standard conditions for comparing the results of different examinations as well as the need for the decisive results of long-term studies have been pointed out. The recommended carbohydrate content of diabetic diet is 60%, fat content 30-35%. The previous complete elimination of simple naturally occurring carbohydrates from the diet is not recommended anymore, these may be consumed in a wider field. The observance of glycaemic index and the use of high-fibre diet are of high importance--even if not primary--especially in type II diabetic patient. In general it is recommended to maintain/obtain an ideal body weight and to introduce a simple diet--planned not only for diabetics.

[Diet treatment of the diabetic patient: yesterday and today. What has changed? What can be learned from it?]. / De dieetbehandeling van de diabeticus: vroeger en nu. Wat is er veranderd? Wat is eruit geleerd?

The initial treatment in the past of diabetes was one "of trial and error" as easily understandable. Carbohydrate restriction and their replacement by fats was followed, happily, last century already, by global caloric restriction. Around the fourties, after the introduction of insulin in 1922, the principle of the carbohydrate tolerance was introduced as an objective+ measure, followed by the proposal of "bread equivalencies" in the dietetic practice, assuring in this manner a figured evaluation. Around the seventies years the diet fiber came into its own and seemed very important for the evolution of the postprandial glycemia and insulinemia. Next to this, complex polysaccharides looked also of prime impact on this two biochemical parameters. The nature of this complex character is due to their liaison with other diet components (lectins, phytins, tannins etc.). So the concept of the glycemic index was born which explains why next to the presence of a given carbohydrate quantity the evolution of the glycemia is different from what is expected, just because the absorption is accelerated or retarded by the structure or the manipulation of these polysaccharides. This novel data are so much the more important because actually the hyperglycemia on the long run seems so important for the development of micro-angiopathy, at the base of the famous diabetic triad (nephropathy, retinopathy, neuropathy). The hyperlipemia is also beneficially influenced by the diet fiber and at the same level by the complex polysaccharides. All this statements are at the base of novel ways for the dietetic treatment of diabetes, as well on the quantitative as on the qualitative level and equally so for the diabetes of type I as of type II.