Self-Rated Health and Associated Factors in Older Turkish Adults With Type 2 Diabetes: A Pilot Study.

PURPOSE: To evaluate self-rated health (SRH) and determine its associations with participant characteristics, glycemic control, family support, and health-related quality of life in older Turkish adults with type 2 diabetes. METHOD: This cross-sectional study included 113 adults aged 60 years or older with type 2 diabetes. Data were collected by using an information form, the Perceived Social Support From Family Scale, and the Nottingham Health Profile. SRH was assessed by a single-item question. Glycemic control was measured by glycosylated hemoglobin levels. RESULTS: Ninety-seven patients (85.8%) evaluated their health as fair or poor. The glycemic target level (glycosylated hemoglobin <7.5%) was achieved in 47.8% of the patients. Female gender, a low or moderate family income, and lower levels of family support were associated with poorer SRH. CONCLUSIONS/IMPLICATIONS: The majority of the participants considered their health to be fair or poor. Better understanding of risk factors associated with SRH may provide more effective interventions to improve health outcomes.

Dietary magnesium intake and the risk of diabetes in the Japanese community: results from the Takayama study.

PURPOSE: Several experimental studies showed that magnesium intake improved insulin resistance and glucose uptake in diabetes patients. However, epidemiological studies on the association between magnesium intake and diabetes risk have yielded inconsistent results. We investigated whether magnesium intake is related to the risk of developing diabetes in a population-based cohort study in Japan. METHODS: Study subjects were participants in the Takayama study. A total of 13,525 residents in Takayama City, Japan, responded to a self-administered questionnaire in 1992 and to a follow-up questionnaire seeking information about diabetes in 2002. Magnesium and other nutrient intakes were estimated from a validated food frequency questionnaire administered at the baseline. RESULTS: During a follow-up of 10 years, 438 subjects reported diabetes newly diagnosed by physician. Compared with women in the low quartile of magnesium intake, women in the high quartile were at a significantly reduced risk of diabetes (HR 0.50; 95 % CI 0.30-0.84; P-trend 0.005) after adjustments for covariates. In men, there was no association between magnesium intake and the risk of diabetes. CONCLUSION: These results suggest that diets with a high intake of magnesium may decrease the risk of diabetes in women.

Dietary carbohydrate intake, glycaemic load, glycaemic index and ovarian cancer risk in African-American women.

Epidemiological evidence regarding the association between carbohydrate intake, glycaemic load (GL) and glycaemic index (GI) and risk of ovarian cancer has been mixed. Little is known about their impact on ovarian cancer risk in African-American women. Associations between carbohydrate quantity and quality and ovarian cancer risk were investigated among 406 cases and 609 controls using data from the African American Cancer Epidemiology Study (AACES). AACES is an ongoing population-based case-control study of ovarian cancer in African-Americans in the USA. Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by random-digit dialling. Dietary information over the year preceding diagnosis or the reference date was obtained using a FFQ. Multivariable logistic regression models were used to estimate odds ratios and 95% CI adjusted for covariates. The OR comparing the highest quartile of total carbohydrate intake and total sugar intake v. the lowest quartile were 1·57 (95% CI 1·08, 2·28; P trend=0·03) and 1·61 (95% CI 1·12, 2·30; P trend<0·01), respectively. A suggestion of an inverse association was found for fibre intake. Higher GL was positively associated with the risk of ovarian cancer (OR 1·18 for each 10 units/4184 kJ (1000 kcal); 95% CI 1·04, 1·33). No associations were observed for starch or GI. Our findings suggest that high intake of total sugars and GL are associated with greater risk of ovarian cancer in African-American women.

Control glucémico y complicaciones crónicas a 20 años del comienzo de la diabetes tipo 1. Resultados de una unidad especializada / Blood glucose control and complications at 20 years from onset of type 1 diabetes. Results from a specialist unit

OBJETIVOS: Conocer en un grupo de pacientes con diabetes tipo 1 (DM1) de larga evolución la prevalencia de complicaciones tardías y su relación con el control glucémico desde el diagnóstico, así como la prevalencia y control de los factores de riesgo cardiovascular (FRCV). MATERIAL Y MÉTODOS: Pacientes con comienzo de DM1 entre 1985 y 1994, seguidos en nuestro centro. Se recogieron datos antropométricos, de control glucémico, complicaciones crónicas y FRCV al comienzo y anualmente, mediante revisión de la historia clínica. Se realizó además una visita con examen físico y extracción de muestra de sangre. RESULTADOS: Participaron 77 pacientes (46 varones, edad 47 ± 8,5 años, tiempo de evolución 22,4 ± 2,2 años). Dieciséis pacientes (20,4%) desarrollaron retinopatía, 8 (10,4%) nefropatía, 12 (15,6%) polineuropatía y 3 (3,9%) macroangiopatía. Presentaban hipertensión arterial, dislipidemia y obesidad un 28,6, un 46,8 y un 20,8%, respectivamente. El 22,1% de ellos eran sedentarios y el 35,1%, fumadores. La hemoglobina glucosilada (HbA1c) media durante todo el período de seguimiento fue 7,2 ± 0,8%, en los primeros 5 años 6,4 ± 1,2% y en la visita del estudio 7,6 ± 1,1%. El 70% de los pacientes se mantuvieron dentro de objetivos en los primeros 5 años, el 45% en los 5 años siguientes y alrededor del 25% a partir de los 10 años de evolución. Los pacientes sin complicaciones tenían mejor control glucémico global (HbA1c7,0 ± 0,7% vs. 7,6 ± 0,9%; p = 0,003) y en los primeros 5 años (HbA1c 6,1 ± 0,9 vs. 7,0 ± 1,4%; p = 0,001). CONCLUSIÓN: La prevalencia de complicaciones a los 20 años en pacientes con DM1 bien controlados desde el diagnóstico es baja y está relacionada con el control glucémico global durante el seguimiento y los primeros años de la enfermedad. La prevalencia de fumadores es elevada. OBJECTIVES: To determine the prevalence of chronic complications in a group of patients with long duration type 1 diabetes (DM1), and their relationship with glycemic control since diagnosis of disease, as well as control and prevalence of cardiovascular risk factors (CVRF)

OBJECTIVES: To determine the prevalence of chronic complications in a group of patients with long duration type 1 diabetes (DM1), and their relationship with glycemic control since diagnosis of disease, as well as control and prevalence of cardiovascular risk factors (CVRF). MATERIAL AND METHODS: The study included patients diagnosed in our center between 1985 and 1994 and followed-up until the present. Anthropometric data, glycemic control, chronic complications, and CVRF were collected from medical records at baseline and annually. A visit was made that included a physical examination and complete blood analysis. RESULTS: A total of 77 patients were studied (46 males, and mean age 47 ± 8.5 years, duration of follow-up, 22.4 ± 2.2 years). Sixteen patients (20.4%) developed retinopathy, 8 (10.4%) nephropathy, 12 (15.6%) polyneuropathy, and 3 (3.9%) macroangiopathy. Hypertension, dyslipidemia and obesity were found in 28.6%, 46.8% and 20.8%, respectively, and 22.1% were sedentary, and 35.1% were smokers. Mean glycosylated hemoglobin (HbA1c) during the entire follow-up was 7.2 ± 0.8%. In the first five years it was 6.4 ± 1.2% and at the study visit, it was 7.6 ± 1.1%. More than two-thirds (70%) of patients remained on target in the first five years, with 45% in the next five years, and about 25% from years 10 to 22. Patients with no complications showed better glycemic control during the entire follow-up (HbA1c 7.0 ± 0.7% vs. 7.6 ± 0.9%; P=.003), and also in the first five years (HbA1c 6.1 ± 0.9 vs. 7.0 ± 1.4%; P=.001). CONCLUSION: Prevalence of complications after 20 years of follow-up in well controlled DM1 since diagnosis is low, and is related to the overall glycemic control during follow-up and in the early years of the disease. The prevalence of smoking is high

Low-glycemic load decreases postprandial insulin and glucose and increases postprandial ghrelin in white but not black women.

Alterations in appetite hormones favoring increased postprandial satiety have been implicated in both the glycemic control and potential weight-loss benefits of a low-glycemic diet. Racial differences exist in dietary glycemic load and appetite hormone concentrations. This study examined the impact of glycemic load on appetite hormones in 20 black women [10 normal weight, BMI = 22.8 ± 1.42 (mean ± SD); 10 obese, BMI = 35.1 ± 2.77] and 20 white women (10 normal weight, BMI = 22.9 ± 1.45; 10 obese, BMI = 34.3 ± 2.77). Each woman completed two 4.5-d weight-maintenance, mixed-macronutrient, high-glycemic vs. low-glycemic load diets that concluded with a test meal of identical composition. Blood samples collected before and serially for 3 h after each test meal were assayed for plasma ghrelin and serum insulin and glucose concentrations. Compared with the high-glycemic load meal, the low-glycemic load meal was associated with lower insulin(AUC) (P = 0.02), glucose(AUC) (P = 0.01), and urge to eat ratings (P = 0.05) but with higher ghrelin(AUC) (P = 0.008). These results suggest the satiating effect of a low-glycemic load meal is not directly linked to enhanced postprandial suppression of ghrelin. Notably, these effects were significant among white but not black women, suggesting that black women may be less sensitive than white women to the glucoregulatory effects of a low-glycemic load. These findings add to a growing literature demonstrating racial differences in postprandial appetite hormone responses. If reproducible, these findings have implications for individualized diet prescription for the purposes of glucose or weight control in women.

Comparison of postprandial glycaemia in Asians and Caucasians.

OBJECTIVE: To compare postprandial glycaemic responses between Asian and Caucasian subjects. RESEARCH DESIGN AND METHODS: Postprandial capillary blood glucose concentrations were measured as 2-h incremental areas-under-the-curve (iAUCs) following consumption of a glucose beverage and a breakfast cereal in 27 Asians and 73 Caucasians. RESULTS: The mean difference in iAUC was 29%(95%CI 10, 51) and 63%(95%CI 32, 102) higher in the Asian compared with the Caucasian group following the glucose beverage and cereal, respectively.The glycaemic index (GI) of the cereal was 77(95%CI 66, 90) in the Asian group and 61 (95% CI 55, 67) in the Caucasian group; the values were different (P = 0.01). CONCLUSIONS: The findings suggest that dietary recommendations for people with diabetes and those at risk of Type 2 diabetes may be more appropriate if based on research in the ethnic group for which they are intended.

Association of glycemic index and glycemic load with risk of incident coronary heart disease among Whites and African Americans with and without type 2 diabetes: the Atherosclerosis Risk in Communities study.

PURPOSE: In this study we examined whether high glycemic index (GI) and glycemic load (GL) diets are associated with increased risk of developing coronary heart disease (CHD) in Whites and African Americans with and without type 2 diabetes. METHODS: Data on 13,051 patients ages 45 to 64 years from the Atherosclerosis Risk in Communities study were analyzed. The ARIC food frequency questionnaire baseline data provided GI and GL indices. A propensity score was created to estimate the effect of a patient's covariates on energy-adjusted GI or GL. During a maximum of 17 years of follow-up, 1683 cases of CHD (371 with diabetes and 1312 without diabetes) were recorded. RESULTS: For every 5-units increase in GI, there was a 1.16-fold (95% confidence interval [95% CI], 1.01-1.33) increased risk of incident CHD in African Americans. For every 30-units increase in GL, there was a 1.11-fold (95% CI, 1.01-1.21) increased risk of incident CHD in Whites. High GL was an especially important CHD risk factor for Whites without diabetes (per 30-units increase; hazard ratio, 1.14; 95% CI, 1.02-1.26). However, these relationships were not seen in individuals with diabetes. CONCLUSIONS: Nutritional advice to reduce the GI and GL in diets of African Americans and Whites subjects (without diabetes) may play a role in reducing CHD risk.

Ethnic variation in adiponectin and leptin levels and their association with adiposity and insulin resistance.

OBJECTIVE: To investigate ethnic differences in adiponectin and leptin concentration and to determine whether these adipokines and a high-glycemic index diet account for ethnic variation in insulin resistance. RESEARCH DESIGN AND METHODS: In 1,176 South Asian, Chinese, Aboriginal, and European Canadians, fasting blood samples were drawn, and clinical history and dietary habits including glycemic index/glycemic load were recorded using standardized questionnaires. Insulin resistance was defined using homeostasis model assessment-insulin resistance (HOMA-IR). RESULTS: Adiponectin concentrations were significantly higher in Europeans (adjusted mean 12.94 [95% CI 2.27-13.64]) and Aboriginal people (11.87 [11.19-12.59]) than in South Asians (9.35 [8.82-9.92]) and Chinese (8.52 [8.03-9.03]) (overall P < 0.001). Serum leptin was significantly higher in South Asians (11.82 [10.72-13.04]) and Aboriginal people (11.13 [10.13-12.23]) than in Europeans (9.21 [8.38-10.12]) and Chinese (8.25 [7.48-9.10]). BMI and waist circumference were inversely associated with adiponectin in every group except the South Asians (P < 0.001 for interaction). Adiponectin was inversely and leptin was positively associated with HOMA-IR (P < 0.001). The increase in HOMA-IR for each given decrease in adiponectin was larger among South Asians (P = 0.01) and Aboriginal people (P < 0.001) than among Europeans. A high glycemic index was associated with a larger decrease in adiponectin among South Asians (P = 0.03) and Aboriginal people (P < 0.001) and a larger increase in HOMA-IR among South Asians (P < 0.05) relative to that in other groups. CONCLUSIONS: South Asians have the least favorable adipokine profile and, like the Aboriginal people, display a greater increase in insulin resistance with decreasing levels of adiponectin. Differences in adipokines and responses to glycemic foods parallel the ethnic differences in insulin resistance.

The glycaemic index values of foods containing fructose are affected by metabolic differences between subjects.

BACKGROUND/OBJECTIVES: Glycaemic responses are influenced by carbohydrate absorption rate, type of monosaccharide absorbed and the presence of fat; the effect of some of these factors may be modulated by metabolic differences between subjects. We hypothesized that glycaemic index (GI) values are affected by the metabolic differences between subjects for foods containing fructose or fat, but not for starchy foods. SUBJECTS/METHODS: The GI values of white bread (WB), fruit leather (FL) and chocolate-chip cookies (CCC) (representing starch, fructose and fat, respectively) were determined in subjects (n=77) recruited to represent all 16 possible combinations of age (< or =40, >40 years), sex (male, female), ethnicity (Caucasian, non-Caucasian) and body mass index (BMI) (< or =25, >25 kg/m2) using glucose as the reference. At screening, fasting insulin, lipids, c-reactive protein (CRP), aspartate transaminase (AST) and waist circumference (WC) were measured. RESULTS: There were no significant main effects of age, sex, BMI or ethnicity on GI, but there were several food x subject-factor interactions. Different factors affected each food's area under the curve (AUC) and GI. The AUC after oral glucose was related to ethnicity, age and triglycerides (r 2=0.27); after WB to ethnicity, age, triglycerides, sex and CRP (r 2=0.43); after CCC to age and weight (r 2=0.18); and after FL to age and CRP (r 2=0.12). GI of WB was related to ethnicity (r 2=0.12) and of FL to AST, insulin and WC (r 2=0.23); but there were no significant correlations for CCC. CONCLUSIONS: The GI values of foods containing fructose might be influenced by metabolic differences between -subjects, whereas the GI of starchy foods might be affected by ethnicity. However, the proportion of variation explained by subject factors is small.

Dietary glycemic load, glycemic index, and associated factors in a multiethnic cohort of midlife women.

BACKGROUND: Dietary glycemic load (GL) and glycemic index (GI), indicators of the postprandial glucose and insulin response to carbohydrate composition of diet, have been suggested as independent risk factors for cardiovascular disease and diabetes. However, current knowledge about the distribution, correlates, and major contributors of these measures in human populations is limited. OBJECTIVE: To describe the intakes and correlates of GL and GI in African American, Caucasian, Chinese, and Japanese women in the Study of Women's Health Across the Nation (SWAN). DESIGN: Data are from 2025 women participating in SWAN, a multi-ethnic, community-based cohort study of women transitioning into menopause. GL and GI were estimated from dietary information obtained in the fifth year of the study using a modified Block food frequency questionnaire. The relationship of GL and GI to dietary factors and selected demographic measures, including race/ethnicity and lifestyle factors, was examined using bivariate and multivariate analyses. RESULTS: GI and GL were consistently lower in Caucasian women than in African American, Japanese, or Chinese women. Education was inversely associated with GL and alcohol consumption was inversely associated with GI among all ethnic groups. The association between family income and glycemic measures varied across ethnic groups. GI was positively associated with consumption of grains and potatoes and inversely associated with consumption of fruits, juices, dairy foods, protein sources, and sweets among all ethnic groups. CONCLUSIONS: It is important for researchers to consider factors such as ethnicity, family income, and alcohol intake as potential confounders when investigating the associations of GL and GI with disease.

Glycaemic index of common foods tested in the UK and India.

The aim of this study was to ascertain whether international glycaemic index (GI) values, predominantly developed using peoples living in Europe, North America or Australia, are applicable to Asian Indians resident in their own country. Thirty-four Caucasian subjects were recruited in Oxford, UK and thirteen Asian Indian subjects in Chennai, India. Two types of sweet biscuits and three breakfast cereals were tested for glycaemic response in each group. Subjects were served equivalent available carbohydrate amounts (50 g) of test foods and a reference food (glucose), on separate occasions. Capillary blood glucose was measured from finger-prick samples in fasted subjects ( - 5 and 0 min) and at 15, 30, 45, 60, 90 and 120 min after starting to eat. For each test food, the incremental area under the curve (IAUC) and GI values were determined. Although the glycaemic response to the reference food was higher in Asian Indian subjects compared with UK Caucasian subjects (IAUC 219 mmol/min per litre v. 157 mmol/min per litre, respectively; P < 0.01), there was no significant difference in GI values of the five test foods between the two groups. This is the first study known to the authors to examine the role of ethnicity on GI when the subjects are resident in their own countries. The findings from this study have important implications for the use of the GI concept worldwide and support the application of international values to different ethnic groups. The higher glycaemic response to all foods in Asian Indians may represent another mechanism for increased diabetes susceptibility among Asian Indians.