Role of dietary modifications in the management of type 2 diabetic complications.

Diabetes is a chronic metabolic disorder with a high rate of morbidity and mortality. Insufficient insulin secretion and insulin action are two major causes for the development of diabetes, which is characterized by a persistent increase in blood glucose level. Diet and sedentary life style play pivotal role in development of vascular complications in type 2 diabetes. Dietary modification is associated with a reprogramming of nutrient intake, which are proven to be effective for the management of diabetes and associated complications. Dietary modifications modulate various molecular key players linked with the functions of nutrient signalling, regulation of autophagy, and energy metabolism. It activates silent mating type information regulation 2 homolog1 (SIRT1) and AMP-activated protein kinase (AMPK). AMPK mainly acts as an energy sensor and inhibits autophagy repressor Mammalian target of rapamycin (mTOR) under nutritional deprivation. Under calorie restriction (CR), SIRT1 gets activated directly or indirectly and plays a central role in autophagy via the regulation of protein acetylation. Dietary modification is also effective in controlling inflammation and apoptosis by decreasing the level of pro-inflammatory cytokines like nuclear factor kappa- beta (NF-kß), tissue growth factor-beta (TGF-ß), tissue necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). It also improves glucose homeostasis and insulin secretion through beta cell regeneration. This indicates calorie intake plays a crucial role in the pathogenesis of type 2 diabetes-associated complications. The present review, emphasizes the role of dietary modifications in diabetes and associated complications.

The Effect of Lactobacillus fermentum ME-3 Treatment on Glycation and Diabetes Complications.

SCOPE: Type 2 diabetes (T2D) induces organ damage associated with glycation, among other metabolic pathways. While therapeutic strategies have been tested to reduce the formation and impact of glycation products, results remain equivocal. Anti-diabetic therapies using probiotics have been proposed, but their effect upon glycation has not been reported. Here, the effects of the bacterial strain Lactobacillus fermentum ME-3 on glycation and T2D-related complications in a mouse model of T2D are investigated. METHODS & RESULTS: Wild-type LepRdb/+ and diabetic LepRdb/db littermates receive a daily gavage of either water or the probiotic ME-3 strain (1010 CFU). Glycation markers, fructoselysine-derived furosine (FL-furosine) and carboxymethyllysine (CML), are quantified in four major organs and plasma using stable-isotope dilution LC-MS/MS. After 12 weeks of ME-3 treatment, diabetic mice gain less weight and exhibit an apparently improved glucose tolerance. The ME-3 treatment reduces median renal levels of FL-furosine in both genotypes by 12-15%, and renal and pulmonary free-CML in diabetic mice by 30% and 18%, respectively. Attenuated hepatic steatosis and an improved plasma lipid profile are also observed with treatment in both genotypes, while the gut microbiota profile is unchanged. CONCLUSION: L. fermentum ME-3 has therapeutic potential for reducing the formation/accumulation of some glycation products in kidneys and attenuating some common diabetes-related complications.

Nutritional Aspects in Diabetic CKD Patients on Tertiary Care.

Background and objectives: Diabetes is largely prevalent in the chronic kidney disease (CKD) population. Both conditions have metabolic and nutritional abnormalities that affect body composition and the presence of diabetes makes the dietary management of CKD patients more difficult. The aim of this study was to assess peculiar nutritional and functional aspects of diabetic patients in an adult/elderly CKD population, and their predictive significance. Materials and methods: This prospective cohort study included 144 out-patients aged >55 years, affected by stage 3b-4 CKD, on tertiary care clinic; 48 (40 males) were type 2 diabetics and 96 (80 males) were nondiabetics. The two groups have similar age, gender, and residual renal function (30 ± 9 vs. 31 ± 11 mL/min×1.73). All patients underwent a comprehensive nutritional and functional assessment and were followed for 31 ± 14 months. Results: Diabetic CKD patients showed higher waist circumference and fat body mass, lower muscle mass, and lower number of steps per day and average daily METs. Meanwhile, resting energy expenditure (REE), as assessed by indirect calorimetry, and dietary energy intake were similar as well as hand-grip and 6 min walking test. Diabetic patients did not show a greater risk for all-cause mortality and renal death with respect to nondiabetics. Middle arm muscle circumference, phase angle, serum cholesterol, and serum albumin were negatively related to the risk of mortality and renal death after adjustment for eGFR. Conclusions: CKD diabetic patients differed from nondiabetics for a greater fat mass, lower muscle mass, and lower physical activity levels. This occurred at the same REE and dietary energy intake. The outcome of diabetic or nondiabetic CKD patients on tertiary care management was similar in terms of risk for mortality or renal death. Given the same residual renal function, low levels of muscle mass, phase angle, serum albumin, and cholesterol were predictive of poor outcome. Overall, a malnutrition phenotype represents a major predictor of poor outcome in diabetic and nondiabetic CKD patients.

Obesity/Type II Diabetes Promotes Function-limiting Changes in Murine Tendons that are not reversed by Restoring Normal Metabolic Function.

Type II Diabetes (T2DM) negatively alters baseline tendon function, including decreased range of motion and mechanical properties; however, the biological mechanisms that promote diabetic tendinopathy are unknown. To facilitate identification of therapeutic targets we developed a novel murine model of diabetic tendinopathy. Mice fed a High Fat Diet (HFD) developed diet induced obesity and T2DM and demonstrated progressive impairments in tendon gliding function and mechanical properties, relative to mice fed a Low Fat Diet (LFD). We then determined if restoration of normal metabolic function, by switching mice from HFD to LFD, was sufficient to halt the pathological changes in tendon due to obesity/T2DM. However, switching from a HFD to LFD resulted in greater impairments in tendon gliding function than mice maintained on a HFD. Mechanistically, IRß signaling is decreased in obese/T2DM murine tendons, suggesting altered IRß signaling as a driver of diabetic tendinopathy. However, knock-down of IRß expression in S100a4-lineage cells (IRcKOS100a4) was not sufficient to induce diabetic tendinopathy as no impairments in tendon gliding function or mechanical properties were observed in IRcKOS100a4, relative to WT. Collectively, these data define a murine model of diabetic tendinopathy, and demonstrate that restoring normal metabolism does not slow the progression of diabetic tendinopathy.

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines.

Abordaje nutricional del paciente con diabetes mellitus e insuficiencia renal crónica, a propósito de un caso / Nutritional approach of the patient with diabetes mellitus and chronic kidney disease. A case report

La prevención y el tratamiento de la enfermedad renal crónica (ERC) en pacientes con diabetes ha sido un tema de gran interés a lo largo de los años. Para conseguir un adecuado control glucémico, una función renal estable y una reducción del riesgo cardiovascular, es fundamental un correcto aporte de hidratos de carbono, lípidos y proteínas. Las medidas dietéticas realizadas se irán modificando a lo largo de la evolución de la ERC. La malnutrición energético-proteica es muy frecuente en pacientes con ERC y diabetes y es un importante predictor de morbimortalidad. Revisamos el manejo nutricional de un paciente diabético a lo largo de la progresión de su ERC (AU)

The prevention and treatment of chronic kidney disease (CKD) in diabetes through diet and lifestyle have been a topic of much interest over the years. Consideration of the type and amount of carbohydrate, protein and fat is required for optimal blood glucose control, for clinical outcomes related to renal function and for consideration of risk reduction for cardiovascular disease. Depending on the CKD stage different dietary changes should be considered protein-calorie malnutrition is common in chronic kidney disease patients and is a powerful predictor of morbidity and mortality. We review the nutritional management of a diabetic patient throughout the progression of their CKD (AU)

Factors complicating the diabetes management of visitors to Japan: advices from a Japanese National Center for overseas medical staff.

Linguistic, cultural, and geographical differences might challenge the management of diabetes patients travelling in a culturally and linguistically homogeneous country. This article presents an instructive case and identifies various factors that can help in effective diabetes management of such cases. A Russian female patient aged 23 came to Japan and visited our hospital for a second opinion regarding glycemic control. She was diagnosed with type 1 diabetes at age three and started insulin injections and diet therapy with carbohydrate counting methods. Her HbA1c level was 11.0% with multiple daily insulin injections. She showed neuropathy, nephropathy, and blindness due to her progressed retinopathy. Because of the language barrier, suggestions for lifestyle modification were not effectively conveyed to the patient. We analyzed possible barriers to effective diabetes management in such foreign patients. In addition to language barriers and difficulties in diet therapy, dissimilar diabetes treatment guidelines, inadequate healthcare insurance, and stress-inducing conditions can be barriers to effective diabetes management. Foreign diabetes patients might face several barriers in effective management while travelling in Japan. Use of medical interpreters, adequate medical insurance, and trained medical staff will help in overcoming these barriers.

Pérdida de peso y diabetes / Loss of weight and diabetes

Introducción: Aunque los cambios en el estilo de vida han demostrado ser beneficiosos en la reducción de los eventos cardiovasculares, poco se sabe acerca de la efectividad de programas específicos en la práctica clínica diaria. MOVE! es un programa que promueve cambios en el estilo de vida auspiciado por la Veterans Health Administration («Administración de la Salud de los Veteranos») en los Estados Unidos. En este estudio se analizó si la participación en este programa se asociaba con una reducción en la incidencia de diabetes. Métodos: Para ello se realizó un análisis retrospectivo observacional de los pacientes con sobrepeso u obesidad y un trastorno relacionado con el peso incluidos en la base de datos de la Administración de la Salud de los Veteranos, con un seguimiento mínimo de 3 años entre 2005 y 2012. Resultados: De los cerca de 1,8 millones de posibles candidatos, solo el 13% participaron en el programa MOVE! El 8% de los sujetos que participaron cumplieron criterios para una intervención más intensa y mantenida, que incluía al menos 8 sesiones en 6 meses. Este programa intensivo se asoció con reducciones de peso a los 3 años que fueron superiores a las obtenidas por la participación en el programa de baja intensidad o la no participación en el mismo (−2,2 frente a −0,64 o +0,46%, respectivamente). En cuanto a la incidencia de diabetes, esta se redujo significativamente en un 33% al comparar el programa intensivo y sostenido frente a la no participación (HR 0,67; IC 95% 0,61-0,74), y en un 20% frente a la participación en el programa de baja intensidad (HR 0,80; IC 95% 0,77-0,83). Estos resultados fueron independientes del sexo, la raza o la edad. El efecto fue más beneficioso en aquellos sujetos con un índice de masa corporal más elevado o unas concentraciones de glucosa más altas al inicio del estudio. Conclusiones: La participación en el programa MOVE! se asoció con una reducción tanto del peso como de la incidencia de diabetes. Desafortunadamente, la participación en el programa fue muy baja (AU)

No disponible

Therapeutic Effect of Cereal Grains: A Review.

Over the last few decades, life style changes have resulted in drastic increase in the incidence of diabetes all over the world, especially in the developing countries. Oral hypoglycemic agents and insulin form the main stay in controlling diabetes but they have prominent side effects and fail to significantly alter the course of diabetic complications. Appropriate diet and exercise programs that form a part of lifestyle modifications have proven to be greatly effective in the management of this disease. Dietary therapy is showing a bright future in the prevention and treatment of diabetes. Cereal grains which form the staple diet for humans in most of the countries are increasingly being used to treat diabetes and other associated disorders in view of their anti-diabetic and anti-lipidemic potential. Given this background, this paper reviews the possible mechanisms of lowering blood sugar and cholesterol levels possessed by various commonly consumed cereal grains. It is concluded that cereal grains are not only the potential sources of energy but also possess the therapeutic role in preventing metabolic disorders and decreasing the risk factors for cardiovascular and renal diseases.

Efeito do treinamento de força e suplementação da dieta com leucina no tecido adiposo de ratos com diabetes mellitus tipo 1 / Effect of resistance training and diet supplementation with leucine in the adipose tissue of type 1 diabetic rats

A diabetes mellitus (DM) é considerada uma das principais epidemias mundiais deste século, sendo responsável direta ou indiretamente pelo óbito de 123 mil diabéticos no Brasil em 2010. Na diabetes mellitus do tipo 1 (DM1), que corresponde a 5-10% dos casos, há ausência ou um relativo déficit de insulina circulante, acarretando aumento na glicemia e em produtos glicosilados, que por sua vez, podem estar relacionados à perda de visão e doenças cardiovasculares. Além disso, a marcante perda de tecido adiposo verificada na DM1 também pode acarretar hipercolesterolemia e esteatose hepática, além de possivelmente contribuir para a inflamação crônica característica da doença. Neste contexto, o objetivo principal do presente estudo foi examinar o efeito do treinamento de força e suplementação da dieta com leucina no tecido adiposo de ratos portadores de diabetes mellitus tipo 1. Para a realização do estudo, ratos Wistar machos foram aleatoriamente distribuídos em quatros grupos: i) Grupo DA (controle) (n=8) - sem treinamento (sedentário) e suplementado com uma mistura de aminoácidos não-essenciais (água ad libitum); ii) Grupo DL (n=8) - sem treinamento (sedentário) e suplementado com leucina (água ad libitum); iii) Grupo DTA (n=8) - com treinamento de força e suplementado com uma mistura de aminoácidos não-essenciais (água ad libitum); iv) Grupo DTL (n = 8) - com treinamento de força e suplementado com leucina (água ad libitum). Após 12 semanas de intervenção, os animais foram eutanasiados. Foram avaliados os seguintes parâmetros: lactato, tolerância à glicose, sensibilidade à insulina, consumo semanal de ração e água, evolução semanal do peso total dos animais, peso total do tecido adiposo e dos diferentes coxins; no soro: triacilglicerol (TAG), lipoproteína de alta densidade (HDL), colesterol total, TNF-α, IL-6, IL-10, IL-1ß, leptina, adiponectina e insulina; no tecido adiposo retroperitoneal: expressão gênica de mTOR, Akt, 4E-BP, eif4E, p70s6k, PPARy, LPL, leptina, adiponectina e CEBP-α; concentração total de TNF-α, IL-6, IL-10, e IL-1ß. A tolerância à glicose, o consumo de ração e água, a concentração total do TAB e do TARP, assim como a expressão gênica de mTOR, 4E-BP1, eif4E, p70S6k, PPARγ e CEBP-α encontraram-se melhorados nos grupos DL, DTA e DTL em comparação ao grupo DA; e as concentrações de HDL, colesterol total, IL-10 e adiponectina no soro, bem como a expressão gênica de adiponectina e a concentração total de IL-10 no TARP apresentaram-se aumentadas somente nos grupos DTA e DTL quando comparados ao grupo DA. Como conclusão, ambas intervenções foram capazes de atenuar as alterações fisiológicas verificadas na DM1, dentre eles as perdas excessivas do TAB. No entanto, por servir de estímulo para uma maior síntese de citocinas e hormônios antiinflamatórios por parte TAB, o treinamento de força foi o principal responsável pela redução da inflamação sistêmica dos animais

Diabetes mellitus (DM) is considered one of the most important world epidemics of this century, being responsible directly or indirectly for the death of 123000 diabetics in Brazil in 2010. In type 1 diabetes (DM1), which corresponds to 5-10% of cases, there is absence or relative deficit of circulating insulin, leading to an increased glycemia and glycosilated products, which might be related to loss of vision and cardiovascular diseases. Furthermore, the marked loss of white adipose tissue (WAT) associated with DM1 might induce liver steatosis and hypercholesterolemia, besides possibly contributing to an increased chronic systemic inflammation. In this context, the main objective of the present study was examine the effect of resistance training and supplementation with leucine in the adipose tissue of type 1 diabetic rats. To conduct this study, Wistar male rats were randomly distributed in 4 groups: i) DA group (control of the experiment) (n=8) - without RT and supplemented with a mixture containing non-essential amino acids (water ad libitum); ii) DL group - without RT and supplemented with leucine (water ad libitum); iii) DTA group (n=8) - with RT and supplemented with a mixture containing non-essential amino acids (water ad libitum); iv) DTL group - with RT and supplemented with leucine (water ad libitum). After 12 weeks of intervention, animals were euthanized. The following parameters were analyzed: blood lactate, glucose tolerance, insulin sensitivity, weekly consumption of chow and water, evolution of total weight, WAT total weight and depots; concentration of triacylglycerol, high density lipoprotein, total cholesterol, TNF-α, IL-6, IL-10, IL-1ß, adiponectin, leptin and insulin in the serum; gene expression of mTOR, 4E-BP1, eif4E, p70S6k, PPARγ, CEBP-α, LPL, leptin and adiponectin; in addition to the concentration of TNF-α, IL-6, IL-10, and IL- 1ß in the retroperitoneal adipose tissue. Glucose tolerance, weekly consumption of chow and water, WAT and RPAT total weight, such as gene expression of mTOR, Akt, 4E-BP1, eif4E, p70S6k, PPARγ and CEBP-α were improved in DL, DTA and DTL groups in comparison with DA group; and the concentrations of HDL, total cholesterol, IL-10 and adiponectin in the serum, as well as gene expression of adiponectin and total concentration of IL-10 in the serum were increased only in DTA and DTL groups when compared to DA group. In conclusion, both interventions were capable of improving some DM1 physiological alterations, including the excessive loss of WAT. However, because resistance training stimulates an increased synthesis of antiinflammatory cytokines and hormones by WAT, this intervention might be the main responsible by the reduction of systemic inflammation of the animals

White tea consumption restores sperm quality in prediabetic rats preventing testicular oxidative damage.

Prediabetes represents a major risk factor for the development of type 2 diabetes mellitus (T2DM). It encompasses some, but not all, T2DM diagnostic criteria. Prediabetes has been recently associated with altered testicular function and increased testicular oxidative stress (OS). Tea is widely consumed and its anti-hyperglycaemic/antioxidant properties are known. This study aimed to evaluate whether white tea (WTEA) consumption by prediabetic rats could prevent testicular OS, preserving sperm quality. For that purpose, WTEA (presenting a high catechin content) was given to 30-day-old streptozotocin-induced prediabetic rats for 2 months. Testicular antioxidant potential and OS were evaluated, as well as sperm parameters, by standard techniques. WTEA consumption improved glucose tolerance and insulin sensitivity in prediabetic rats. Testicular antioxidant potential was increased by WTEA consumption, restoring protein oxidation and lipid peroxidation, although glutathione content and redox state were not altered. WTEA consumption improved sperm concentration and sperm quality (motility, viability and abnormality) was restored. Overall, WTEA consumption improved reproductive health of male prediabetic rats. Based on the study results, WTEA consumption appears to be a natural, economical and effective strategy to counteract the deleterious effects of prediabetes on male reproductive health, but further studies will be needed before a definitive recommendation is made.

Dietary restriction and exercise for diabetic patients with chronic kidney disease: a systematic review.

BACKGROUND: Obesity and sedentary lifestyle are major health problems and key features to develop cardiovascular disease. Data on the effects of lifestyle interventions in diabetics with chronic kidney disease (CKD) have been conflicting. STUDY DESIGN: Systematic review. POPULATION: Diabetes patients with CKD stage 3 to 5. SEARCH STRATEGY AND SOURCES: Medline, Embase and Central were searched to identify papers. INTERVENTION: Effect of a negative energy balance on hard outcomes in diabetics with CKD. OUTCOMES: Death, cardiovascular events, glycaemic control, kidney function, metabolic parameters and body composition. RESULTS: We retained 11 studies. There are insufficient data to evaluate the effect on mortality to promote negative energy balance. None of the studies reported a difference in incidence of Major Adverse Cardiovascular Events. Reduction of energy intake does not alter creatinine clearance but significantly reduces proteinuria (mean difference from -0.66 to -1.77 g/24 h). Interventions with combined exercise and diet resulted in a slower decline of eGFR (-9.2 vs. -20.7 mL/min over two year observation; p<0.001). Aerobic and resistance exercise reduced HbA1c (-0.51 (-0.87 to -0.14); p = 0.007 and -0.38 (-0.72 to -0.22); p = 0.038, respectively). Exercise interventions improve the overall functional status and quality of life in this subgroup. Aerobic exercise reduces BMI (-0.74% (-1.29 to -0.18); p = 0.009) and body weight (-2.2 kg (-3.9 to -0.6); p = 0.008). Resistance exercise reduces trunk fat mass (-0,7±0,1 vs. +0,8 kg ±0,1 kg; p = 0,001-0,005). In none of the studies did the intervention cause an increase in adverse events. LIMITATIONS: All studies used a different intervention type and mixed patient groups. CONCLUSIONS: There is insufficient evidence to evaluate the effect of negative energy balance interventions on mortality in diabetic patients with advanced CKD. Overall, these interventions have beneficial effects on glycaemic control, BMI and body composition, functional status and quality of life, and no harmful effects were observed.

[Micronutrients in diabetology: complementary medicine update 2014]. / Mikronährstoffe in der Diabetologie. Komplementäre Medizin: Update 2014.

Diabetes mellitus is one of the most prevalent endocrine diseases that is associated with high oxidative stress and vascular inflammation. Type 1 and 2 diabetes are characterized by significant losses of important micronutrients such as vitamin C, magnesium, zinc or vitamin D due to metabolic basis of the disease, medication and/or its complications. The evidence of changes in micronutrient metabolism as a consequence of the disease and the influence of selective supplementation are reviewed in this paper. The importance of micronutrients, notably vitamin C, B-group vitamins, vitamin D, vitamin K, coenzyme Q10, magnesium, zinc, chromium and copper under practical conditions are assessed. There is a lot of evidence that demonstrates the positive influence ofmicronutrient supplementation on glycemic control and the risk of diabetic complications.

Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet.

BACKGROUND: Inflammation may play an important role in type 2 diabetes. It has been proposed that dietary strategies can modulate inflammatory activity. METHODS: We investigated the effects of diet on inflammation in type 2 diabetes by comparing a traditional low-fat diet (LFD) with a low-carbohydrate diet (LCD). Patients with type 2 diabetes were randomized to follow either LFD aiming for 55-60 energy per cent (E%) from carbohydrates (n = 30) or LCD aiming for 20 E% from carbohydrates (n = 29). Plasma was collected at baseline and after 6 months. C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1Ra), IL-6, tumour necrosis factor receptor (TNFR) 1 and TNFR2 were determined. RESULTS: Both LFD and LCD led to similar reductions in body weight, while beneficial effects on glycaemic control were observed in the LCD group only. After 6 months, the levels of IL-1Ra and IL-6 were significantly lower in the LCD group than in the LFD group, 978 (664-1385) versus 1216 (974-1822) pg/mL and 2.15 (1.65-4.27) versus 3.39 (2.25-4.79) pg/mL, both P < 0.05. CONCLUSIONS: To conclude, advice to follow LCD or LFD had similar effects on weight reduction while effects on inflammation differed. Only LCD was found significantly to improve the subclinical inflammatory state in type 2 diabetes.