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1.
Nutr Metab Cardiovasc Dis ; 31(4): 1238-1246, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33632598

RESUMO

BACKGROUND AND AIMS: During aerobic physical activity (PA), hypoglycemia is common in people with type 1 diabetes (T1D). Few studies have compared the effectiveness of different carbohydrate (CHO) intake strategies to prevent PA-induced hypoglycemia. Our objective was to compare the efficacy of two CHO intake strategies, same total amount but different CHO intake timing, to maintain glucose levels in the target range (4.0-10.0 mmol/L) during PA in people with T1D. METHODS AND RESULTS: An open-label, randomized, crossover study in 33 participants (21 adults; 12 adolescents). Participants practiced 60 min PA sessions (ergocyle) at 60% VO2peak 3.5 h after lunch comparing an intake of 0.5 g of CHO per kg of body weight applied in a pre-PA single CHO intake (SCI) or in a distributed CHO intake (DCI) before and during PA. The percentage of time spent in glucose level target range during PA was not different between the two strategies (SCI: 75 ± 35%; DCI: 87 ± 26%; P = 0.12). Hypoglycemia (<4.0 mmol/L) occurred in 4 participants (12%) with SCI compared to 6 participants (18%) with DCI (P = 0.42). The SCI strategy led to a higher increase (P = 0.01) and variability of glucose levels (P = 0.04) compared with DCI. CONCLUSIONS: In people living with T1D, for a 60 min moderate aerobic PA in the post-absorptive condition, a 0.5 g/kg CHO intake helped most participants maintain acceptable glycemic control with both strategies. No clinically significant difference was observed between the SCI and DCI strategies. ClinicalTrials.gov Identifier: NCT03214107 (July 11, 2017).


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/dietoterapia , Carboidratos da Dieta/administração & dosagem , Exercício Físico , Hipoglicemia/prevenção & controle , Adolescente , Adulto , Fatores Etários , Biomarcadores/sangue , Estudos Cross-Over , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Carboidratos da Dieta/metabolismo , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/sangue , Hipoglicemia/etiologia , Masculino , Pessoa de Meia-Idade , Quebeque , Fatores de Tempo , Resultado do Tratamento
2.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(10): 658-664, dic. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-197678

RESUMO

AIMS: To study the incidence of type 1 diabetes (T1D) in children <14 years in the island of Gran Canaria (Canary Islands, Spain) during the 2006-2018 period and to evaluate its temporal trend, seasonality, age and sex distribution. Subjects and methods: We studied children <14 years of age living in Gran Canaria. We calculated the annual and overall incidence using recorded data from the Pediatric Endocrinology Department as the primary source and the local Diabetes Association and the hospital's pharmacy as secondary sources. The primary source is the only paediatric endocrine unit in the island. RESULTS: 453 new T1D cases were observed during the 13-year period. The overall incidence of T1D between 2006 and 2018 was 30.48/100,000 (95% CI: 27.74-33.42). Distribution among age groups was 24.8%, 38.2% and 36.9% for children between 0-4, 5-9 and 10-13.9 years old respectively. No significant temporal trend, seasonality or sex differences were found. CONCLUSIONS: Our study shows that the Island of Gran Canaria has one of the highest childhood incidences of T1D reported worldwide: among the highest rates in Europe, and higher than the rates published for the neighbouring African countries


OBJETIVOS: Estudiar la incidencia de diabetes mellitus tipo 1 (DM1) en niños menores de 14 años en la isla de Gran Canaria (Islas Canarias, España) durante el período 2006-2018, así como evaluar su tendencia temporal, estacionalidad y distribución por sexo y edad. Sujetos y métodos: Los sujetos objeto de estudio fueron los niños menores de 14 años que habitan la isla de Gran Canaria. Calculamos la incidencia para todo el período, y la incidencia anual usando los datos recogidos en nuestra unidad de endocrinología pediátrica como fuente primaria y los datos de la asociación local de diabetes y la farmacia hospitalaria como fuentes secundarias. La fuente primaria es la única unidad de endocrinología pediátrica de la isla. RESULTADOS: Observamos un total de 453 nuevos casos de DM1 durante el período de estudio. La incidencia global para el período 2006-2018 fue de 30,48/100.000 (IC 95%: 27,74-33,42). La distribución por grupos de edad fue del 24,8, 38,2 y 36,9% para niños entre 0-4, 5-9 y 10-13,9 años de edad, respectivamente. No encontramos la aparición de ninguna tendencia temporal significativa. Tampoco encontramos la presencia de estacionalidad ni diferencias significativas en cuanto a la aparición de DM1 en base al sexo. CONCLUSIONES: Nuestro estudio muestra que la isla de Gran Canaria presenta una de las incidencias de DM1 más altas del mundo. Se encuentra entre las más altas de Europa, y es claramente superior a la publicada para los países vecinos africanos


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/dietoterapia , Espanha/epidemiologia , Incidência , Saúde Global
3.
Cochrane Database Syst Rev ; 5: CD012885, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449201

RESUMO

BACKGROUND: Products sweetened with non-nutritive sweeteners (NNS) are widely available. Many people with type 1 or type 2 diabetes use NNS as a replacement for nutritive sweeteners to control their carbohydrate and energy intake. Health outcomes associated with NNS use in diabetes are unknown. OBJECTIVES: To assess the effects of non-nutritive sweeteners in people with diabetes mellitus. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Scopus, the WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases (except for Scopus) was May 2019. We last searched Scopus in January 2019. We did not apply any language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with a duration of four weeks or more comparing any type of NNS with usual diet, no intervention, placebo, water, a different NNS, or a nutritive sweetener in individuals with type 1 or type 2 diabetes. Trials with concomitant behaviour-changing interventions, such as diet, exercise, or both, were eligible for inclusion, given that the concomitant interventions were the same in the intervention and comparator groups. DATA COLLECTION AND ANALYSIS: Two review authors independently screened abstracts, full texts, and records retrieved from trials registries, assessed the certainty of the evidence, and extracted data. We used a random-effects model to perform meta-analysis, and calculated effect estimates as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs). We assessed risk of bias using the Cochrane 'Risk of bias' tool and the certainty of evidence using the GRADE approach. MAIN RESULTS: We included nine RCTs that randomised a total of 979 people with type 1 or type 2 diabetes. The intervention duration ranged from 4 to 10 months. We judged none of these trials as at low risk of bias for all 'Risk of bias' domains; most of the included trials did not report the method of randomisation. Three trials compared the effects of a dietary supplement containing NNS with sugar: glycosylated haemoglobin A1c (HbA1c) was 0.4% higher in the NNS group (95% CI -0.5 to 1.2; P = 0.44; 3 trials; 72 participants; very low-certainty evidence). The MD in weight change was -0.1 kg (95% CI -2.7 to 2.6; P = 0.96; 3 trials; 72 participants; very low-certainty evidence). None of the trials with sugar as comparator reported on adverse events. Five trials compared NNS with placebo. The MD for HbA1c was 0%, 95% CI -0.1 to 0.1; P = 0.99; 4 trials; 360 participants; very low-certainty evidence. The 95% prediction interval ranged between -0.3% and 0.3%. The comparison of NNS versus placebo showed a MD in body weight of -0.2 kg, 95% CI -1 to 0.6; P = 0.64; 2 trials; 184 participants; very low-certainty evidence. Three trials reported the numbers of participants experiencing at least one non-serious adverse event: 36/113 participants (31.9%) in the NNS group versus 42/118 participants (35.6%) in the placebo group (RR 0.78, 95% CI 0.39 to 1.56; P = 0.48; 3 trials; 231 participants; very low-certainty evidence). One trial compared NNS with a nutritive low-calorie sweetener (tagatose). HbA1c was 0.3% higher in the NNS group (95% CI 0.1 to 0.4; P = 0.01; 1 trial; 354 participants; very low-certainty evidence). This trial did not report body weight data and adverse events. The included trials did not report data on health-related quality of life, diabetes complications, all-cause mortality, or socioeconomic effects. AUTHORS' CONCLUSIONS: There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes. Data on health-related quality of life, diabetes complications, all-cause mortality, and socioeconomic effects are lacking.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Adoçantes não Calóricos/administração & dosagem , Adulto , Idoso , Viés , Peso Corporal , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Adoçantes não Calóricos/efeitos adversos , Adoçantes Calóricos/administração & dosagem , Placebos/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
PLoS Med ; 17(3): e1003053, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32142510

RESUMO

BACKGROUND: Fibre is promoted as part of a healthy dietary pattern and in diabetes management. We have considered the role of high-fibre diets on mortality and increasing fibre intake on glycaemic control and other cardiometabolic risk factors of adults with prediabetes or diabetes. METHODS AND FINDINGS: We conducted a systematic review of published literature to identify prospective studies or controlled trials that have examined the effects of a higher fibre intake without additional dietary or other lifestyle modification in adults with prediabetes, gestational diabetes, type 1 diabetes, and type 2 diabetes. Meta-analyses were undertaken to determine the effects of higher fibre intake on all-cause and cardiovascular mortality and increasing fibre intake on glycaemic control and a range of cardiometabolic risk factors. For trials, meta regression analyses identified further variables that influenced the pooled findings. Dose response testing was undertaken; Grading of Recommendations Assessment, Development and Evaluation (GRADE) protocols were followed to assess the quality of evidence. Two multicountry cohorts of 8,300 adults with type 1 or type 2 diabetes followed on average for 8.8 years and 42 trials including 1,789 adults with prediabetes, type 1, or type 2 diabetes were identified. Prospective cohort data indicate an absolute reduction of 14 fewer deaths (95% confidence interval (CI) 4-19) per 1,000 participants over the study duration, when comparing a daily dietary fibre intake of 35 g with the average intake of 19 g, with a clear dose response relationship apparent. Increased fibre intakes reduced glycated haemoglobin (HbA1c; mean difference [MD] -2.00 mmol/mol, 95% CI -3.30 to -0.71 from 33 trials), fasting plasma glucose (MD -0.56 mmol/L, 95% CI -0.73 to -0.38 from 34 trials), insulin (standardised mean difference [SMD] -2.03, 95% CI -2.92 to -1.13 from 19 trials), homeostatic model assessment of insulin resistance (HOMA IR; MD -1.24 mg/dL, 95% CI -1.72 to -0.76 from 9 trials), total cholesterol (MD -0.34 mmol/L, 95% CI -0.46 to -0.22 from 27 trials), low-density lipoprotein (LDL) cholesterol (MD -0.17 mmol/L, 95% CI -0.27 to -0.08 from 21 trials), triglycerides (MD -0.16 mmol/L, 95% CI -0.23 to -0.09 from 28 trials), body weight (MD -0.56 kg, 95% CI -0.98 to -0.13 from 18 trials), Body Mass Index (BMI; MD -0.36, 95% CI -0·55 to -0·16 from 14 trials), and C-reactive protein (SMD -2.80, 95% CI -4.52 to -1.09 from 7 trials) when compared with lower fibre diets. All trial analyses were subject to high heterogeneity. Key variables beyond increasing fibre intake were the fibre intake at baseline, the global region where the trials were conducted, and participant inclusion criteria other than diabetes type. Potential limitations were the lack of prospective cohort data in non-European countries and the lack of long-term (12 months or greater) controlled trials of increasing fibre intakes in adults with diabetes. CONCLUSIONS: Higher-fibre diets are an important component of diabetes management, resulting in improvements in measures of glycaemic control, blood lipids, body weight, and inflammation, as well as a reduction in premature mortality. These benefits were not confined to any fibre type or to any type of diabetes and were apparent across the range of intakes, although greater improvements in glycaemic control were observed for those moving from low to moderate or high intakes. Based on these findings, increasing daily fibre intake by 15 g or to 35 g might be a reasonable target that would be expected to reduce risk of premature mortality in adults with diabetes.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos , Dieta Saudável , Fibras na Dieta/administração & dosagem , Valor Nutritivo , Comportamento de Redução do Risco , Grãos Integrais , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Dieta para Diabéticos/efeitos adversos , Dieta para Diabéticos/mortalidade , Dieta Saudável/efeitos adversos , Dieta Saudável/mortalidade , Fibras na Dieta/efeitos adversos , Humanos , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grãos Integrais/efeitos adversos
6.
Nutrients ; 12(1)2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31906543

RESUMO

This study aimed to assess the potential association between dietary patterns (i.e., the Mediterranean Diet (MedDiet) and healthy eating) and patient-reported quality of life (QoL) and treatment satisfaction (TS) in adults with type 1 diabetes (T1D). A food frequency questionnaire, the Audit of Diabetes-Dependent Quality of Life (ADDQoL-19), and the Diabetes Treatment Satisfaction Questionnaire-status version (DTSQ-s) were administered via personal interviews to 258 participants with T1D. Multivariable analysis showed that a moderate or high adherence to the MedDiet was associated with greater diabetes-specific QoL (ß = 0.32, 95% CI = 0.03; 0.61; p = 0.029). None of the dietary quality indexes (i.e., the alternate Mediterranean Diet Score (aMED) and the alternate Healthy Eating Index (aHEI)) were associated with the overall TS. However, the aHEI was positively associated with the specific items of TS "convenience" and "flexibility" (ß = 0.03, 95% CI = 0.00; 0.06; p = 0.042 and ß = 0.04; 95% CI = 0.01; 0.06; p = 0.011, respectively). On the other hand, the aHEI was negatively associated with the dimension "recommend to others" (ß = -0.5, 95% CI = -0.99; -0.02; p = 0.042). In conclusion, a moderate and high adherence to the MedDiet was associated with greater QoL. Although neither aMED nor aHEI were associated with the overall TS, some specific items were positively (i.e., "convenience", "flexibility") or negatively ("recommend to others") related to the aHEI. Further research is needed to assess how to improve medical nutrition therapy and its impact on patient-reported outcomes in people with T1D.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Dieta Mediterrânea , Qualidade de Vida , Adulto , Estudos Transversais , Dieta Saudável , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
7.
Nutrients ; 11(12)2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31835538

RESUMO

Although the benefits of regular exercise on cardiovascular risk factors are well established for people with type 1 diabetes (T1D), glycemic control remains a challenge during exercise. Carbohydrate consumption to fuel the exercise bout and/or for hypoglycemia prevention is an important cornerstone to maintain performance and avoid hypoglycemia. The main strategies pertinent to carbohydrate supplementation in the context of exercise cover three aspects: the amount of carbohydrates ingested (i.e., quantity in relation to demands to fuel exercise and avoid hypoglycemia), the timing of the intake (before, during and after the exercise, as well as circadian factors), and the quality of the carbohydrates (encompassing differing carbohydrate types, as well as the context within a meal and the associated macronutrients). The aim of this review is to comprehensively summarize the literature on carbohydrate intake in the context of exercise in people with T1D.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Carboidratos da Dieta/administração & dosagem , Exercício Físico , Comportamento Alimentar , Valor Nutritivo , Glicemia/análise , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Frutose/administração & dosagem , Índice Glicêmico/efeitos dos fármacos , Humanos , Hipoglicemia/prevenção & controle , Insulina/sangue , Masculino , Resistência Física
8.
J Pediatr Gastroenterol Nutr ; 69(6): 633-638, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31765333

RESUMO

The human genome has been proposed to contribute to interpersonal variability in the way we respond to nutritional intake. However, personalized diets solely based on gene-nutrient interactions have not lived up to their expectations to date. Advances in microbiome research have indicated that a science-based generation of a personalized diet based on a combination of clinical and microbial features may constitute a promising new approach enabling accurate prediction of dietary responses. In addition, scientific advances in our understanding of defined dietary components and their effects on human physiology led to the incorporation and testing of defined diets as preventive and treatment approaches for diseases, such as epilepsy, ulcerative colitis, Crohn disease, and type 1 diabetes mellitus. Additionally, exciting new studies show that tailored diet regiments have the potential to modulate pharmaceutical treatment efficacy in cancer treatment. Overall, the true therapeutic potential of nutritional interventions is coming to light but is also facing substantial challenges in understanding mechanisms of activity, optimization of dietary interventions for specific human subpopulations, and elucidation of adverse effects potentially stemming from some dietary components in a number of individuals.


Assuntos
Microbiota , Nutrigenômica/métodos , Medicina de Precisão/métodos , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/microbiologia , Epilepsia/dietoterapia , Epilepsia/microbiologia , Humanos , Doenças Inflamatórias Intestinais/dietoterapia , Doenças Inflamatórias Intestinais/microbiologia , Neoplasias/dietoterapia , Neoplasias/microbiologia , Terapia Nutricional/métodos , Obesidade Pediátrica/dietoterapia , Obesidade Pediátrica/microbiologia
9.
BMJ Open ; 9(9): e029859, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481560

RESUMO

INTRODUCTION: Clinical guidelines recommend that patients with type 1 diabetes (T1D) learn carbohydrate counting or similar methods to improve glycaemic control. Although systematic educating in carbohydrate counting is still not offered as standard-of-care for all patients on multiple daily injections (MDI) insulin therapy in outpatient diabetes clinics in Denmark. This may be due to the lack of evidence as to which educational methods are the most effective for training patients in carbohydrate counting. The objective of this study is to compare the effect of two different educational programmes in carbohydrate counting with the usual dietary care on glycaemic control in patients with T1D. METHODS AND ANALYSIS: The study is designed as a randomised controlled trial with a parallel-group design. The total study duration is 12 months with data collection at baseline, 6 and 12 months. We plan to include 231 Danish adult patients with T1D. Participants will be randomised to one of three dietician-led interventions: (1) a programme in basic carbohydrate counting, (2) a programme in advanced carbohydrate counting including an automated bolus calculator or (3) usual dietary care. The primary outcome is changes in glycated haemoglobin A1c or mean amplitude of glycaemic excursions from baseline to end of the intervention period (week 24) between and within each of the three study groups. Other outcome measures include changes in other parameters of plasma glucose variability (eg, time in range), body weight and composition, lipid profile, blood pressure, mathematical literacy skills, carbohydrate estimation accuracy, dietary intake, diet-related quality of life, perceived competencies in dietary management of diabetes and perceptions of an autonomy supportive dietician-led climate, physical activity and urinary biomarkers. ETHICS AND DISSEMINATION: The protocol has been approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03623113).


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Dieta para Diabéticos/métodos , Carboidratos da Dieta/farmacologia , Exercício Físico/psicologia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Autogestão/métodos , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/fisiopatologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino
10.
Rocz Panstw Zakl Hig ; 70(3): 259-265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31515985

RESUMO

Background: It has been established that in Type 1 Diabetes Mellitus (T1DM), regardless of the insulin therapy model used, diet and proper eating habits are still important in the treatment of the disease. The dietary intervention in these patients is aimed at maintaining proper body weight, obtaining target fasting and post meal blood glucose levels, optimizing lipid profiles. Objective: The aim of the study was to assess dietary habits in a homogeneous group of adults with T1DM treated with personal insulin pumps. Material and methods: The study included 141 adult patients (57% women) with type 1 diabetes treated with personal insulin pumps. The surveyed population was characterized by an average age of 25.8 ± 6.2 years, an average duration of diabetes 13.9 ± 6.9 years, and treatment with a personal pump for 8.2 ± 4.1 years and mean BMI 23.0 ± 2.8 g/m2. All were dwellers of south-eastern Poland. The validated KomPAN questionnaire was used to assess the frequency of consumption of individual food products. Results: The mean percentage of HbA1c in the study group was 7.3% [56 mmol/mol]. The mean total cholesterol level was 4.4 mmol/l, HDL - 1.7 mmol/l, LDL - 2.3 mmol/l and triglycerides - 0.8 mmol/l. In the multivariate regression model, no correlation was found between dietary quality parameters and metabolic compensation measured with HbA1c or lipidogram and the place of residence (village, small town, big city). However, there were differences in the quality of the diet depending on the sex. Women were characterized by higher index of a healthy diet (pHDI-10) (26.3 vs 21.4, p=0.005) and lower index of unhealthy diet (nHDI-14) (13.3 vs 18.6, p <0.001) than men. Conclusions: The results of this study clearly suggest, that despite good metabolic control, patients require more education on the choice of healthy product groups.


Assuntos
Glicemia/metabolismo , LDL-Colesterol/sangue , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Dietoterapia/métodos , Ingestão de Alimentos/fisiologia , Insulina/uso terapêutico , Triglicerídeos/sangue , Adulto , Feminino , Humanos , Masculino , Polônia , Adulto Jovem
11.
Intern Med ; 58(23): 3433-3439, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31391398

RESUMO

We herein report a 28-year-old woman with type 1 diabetes with an asymptomatic pontine lesion and diabetic amyotrophy. She had suffered from diabetes from 10 years old. Treatment in a hospital reduced the hemoglobin A1c level from 14.2% to 7.2% for approximately 2 months. She suffered from acute-onset pain and weakness of the lower limb muscles without central nervous system manifestations. Magnetic resonance imaging showed high-intensity lesions at the brainstem and lower limb muscles on T2-weighted images. These findings and symptoms gradually resolved. Rapid treatment of poor glycemic control might increase the risk of asymptomatic pontine lesions and diabetic amyotrophy.


Assuntos
Encefalopatias/etiologia , Diabetes Mellitus Tipo 1/dietoterapia , Neuropatias Diabéticas/dietoterapia , Ponte , Adulto , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/tratamento farmacológico , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Plexo Lombossacral , Imagem por Ressonância Magnética , Debilidade Muscular/etiologia , Dor/complicações , Dor/dietoterapia , Dor/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/dietoterapia , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Resultado do Tratamento
12.
Br J Nurs ; 28(15): 1015-1019, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31393762

RESUMO

Type 1 diabetes mellitus is a serious autoimmune disease for which no cure is available. The treatment includes insulin therapy, carbohydrate counting, eating healthy foods, exercising regularly, and maintaining a healthy weight. The goal is to keep blood glucose levels close to normal most of the time to delay or prevent complications. Despite the increase in the use of insulin pumps and continuous glucose monitors in recent years, the management of type 1 diabetes remains suboptimal in terms of glycaemic control and normal glycated haemoglobin (HbA1c) level. This article discusses the case of a child with type 1 diabetes who was successfully treated with a very low-carbohydrate diet, resulting in normal levels of HbA1c and normal blood glucose 95% of the time in a range of 70-180 mg/dL (4.0 mmol/L-10 mmol/L). Therefore, further studies are needed to verify how a very low carbohydrate diet impacts child development.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Dieta com Restrição de Carboidratos , Glicemia/metabolismo , Pré-Escolar , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Resultado do Tratamento
13.
Am J Clin Nutr ; 110(4): 891-902, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374573

RESUMO

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.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta , Índice Glicêmico , Glicemia , Humanos , Insulina/sangue
14.
Diabetes Res Clin Pract ; 155: 107818, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31425769

RESUMO

AIMS: Low-carbohydrate diet (LCD) has gained interest among individuals with diabetes as a means to manage glycaemia. We investigated the adherence to LCD in the Finnish Diabetic Nephropathy Study and whether carbohydrate restriction is associated with cardio-metabolic risk factors. METHODS: Cross-sectional data were available from 902 individuals with type 1 diabetes (44% men, age 47 ±â€¯13 years). Dietary data were collected twice with a 3-day diet record. Mean of the measurements was used. Carbohydrate intake <130 g/day or <26 E% was used as indication of LCD. Individuals reporting LCD were compared to sex-, diabetes duration- and eGFR-matched controls with higher carbohydrate intakes (>253 g/day or >48 E%). In the whole population, carbohydrate-to-fat ratio was calculated and its association with health variables was investigated. RESULTS: Higher carbohydrate-to-fat ratio was associated with higher blood glucose variability, higher blood pressure, lower HDL cholesterol concentration, and in men with lower waist-to-hip ratio. LCD adherence (n = 69) was associated with lower BMI (25.6 vs. 27.8 kg/m2, p = 0.030), lower variability of blood glucose measurements (0.38 vs. 0.45 mmol/l, p = 0.030), and lower diastolic blood pressure (74 vs. 79 mmHg, p = 0.048). Men reporting LCD had higher total (5.1 vs. 4.0 mmol/l, p = 0.007) and non-HDL cholesterol (3.4 vs. 2.7 mmol/l, p = 0.021). Women with LCD had higher HDL-cholesterol concentration (1.9 vs. 1.5 mmol/l, p = 0.014). CONCLUSIONS: Reduced blood glucose variability, related to LCD, could have clinical relevance to individuals with type 1 diabetes.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Dieta com Restrição de Carboidratos/métodos , Carboidratos da Dieta/efeitos adversos , Estudos Transversais , Diabetes Mellitus Tipo 1/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
BMJ Open Diabetes Res Care ; 7(1): e000663, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321060

RESUMO

Introduction: Young children with type 1 diabetes (T1D) consume more saturated fat and less fruit and vegetables than recommended. A common challenge in this age group is unpredictable appetite potentially impacting the way parents manage diabetes cares at mealtimes. This small study aimed to assess nutritional intake and mealtime routines of young children with T1D in a clinic where the majority of children were achieving glycemic targets. A secondary aim was to explore association of eating pattern with HbA1c. Methods: A retrospective, cross-sectional review of children aged less than 7.0 years with T1D attending a pediatric diabetes service in Australia was performed (n=24). Baseline characteristics, glycated hemoglobin (HbA1c), a 3-day weighed food diary and a mealtime management survey were collected. Results: Twenty-two children (55% male) were included aged 4.9±1.3 years (mean±SD), HbA1c 47±10 mmol/mol (6.4%±0.9%), body mass index Z-score 0.8±0.9 and diabetes duration 1.7±1.1 years. Preprandial insulin use was reported in 95% of children. Macronutrient distribution (% energy intake) was carbohydrate (48%±4%), protein (16%±2%) and fat (33%±5%) with saturated fat (15%±3%). The majority of children did not meet vegetable and lean meat/protein intake recommendations (0% and 28%, respectively). HbA1c was not correlated with daily total carbohydrate, protein or fat intake (p>0.05). HbA1c was significantly higher in children offered food in a grazing pattern compared with those offered regular meals (mean 61 mmol/mol vs 43 mmol/mol (7.7% vs 6.1%), p=0.01). Conclusions: Dietary quality is a concern in young children with T1D with excessive saturated fat and inadequate vegetable intake. Our results suggest that young children meeting glycemic targets give insulin before meals and follow a routine eating pattern.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 1/dietoterapia , Dieta , Ingestão de Energia , Comportamento Alimentar , Nutrientes/análise , Glicemia/análise , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Masculino , Prognóstico , Estudos Retrospectivos
16.
Diabetes Res Clin Pract ; 155: 107775, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31271811

RESUMO

AIM: Diet plays an important role in the kidney health of individuals with type 1 diabetes. However, not much is known about dietary practices at different stages of diabetic nephropathy. We aimed at investigating food intake, dietary patterns, and nutrient intakes in individuals with type 1 diabetes differing in renal status. METHODS: Data were available from 1874 individuals with type 1 diabetes (45% men, age 48 ±â€¯13 years). Diet was assessed at the levels of food items and diet patterns (diet questionnaire), and energy and nutrient intakes (food record). Six groups were formed based on the eGFR or dialysis and transplantation status. RESULTS: Reductions in liquid-milk product and salt consumption, and increase in special diet adherence were observed at the early stages of eGFR decline. Reduced coffee consumption was observed after eGFR was <30 ml/min/1.73 m2. With advancing kidney failure, rye bread consumption decreased, but that of wheat bread increased. Compared to those with intact kidney function (the index group), the Fish and vegetable diet pattern scores were higher in individuals with mildly-to-severely decreased eGFR. Instead, the Sweet pattern scores were lower than in the index group in all other groups. Energy intake was lower in all groups compared to those with intact kidney function. Advancing kidney failure was associated with reductions in protein intake per body weight, and in the intakes of sodium, potassium, calcium, and phosphorus. CONCLUSIONS: Differences in the dietary intake are seen already at the early stages of kidney function decline.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Nefropatias Diabéticas/prevenção & controle , Dieta/estatística & dados numéricos , Taxa de Filtração Glomerular , Adulto , Idoso , Peso Corporal , Estudos Transversais , Laticínios , Diabetes Mellitus Tipo 1/epidemiologia , Ingestão de Energia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Diálise Renal , Verduras
17.
Diabet Med ; 36(11): 1503-1507, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31197870

RESUMO

BACKGROUND: Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very-low-carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise. CASE REPORT: We report the case of a 37-year-old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very-low-carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9-10 mmol/l. Interstitial glucose was <3 mmol/l for 2.1% of this time, with only a single episode of symptomatic hypoglycaemia prompting brief interruption of exercise for carbohydrate administration. CONCLUSION: This case demonstrates the viability of a very-low-carbohydrate ketogenic diet in an individual with Type 1 diabetes undertaking exercise. While the effect of a very-low-carbohydrate ketogenic diet is yet to be examined more broadly in athletes with Type 1 diabetes, the glycaemic stability observed suggests that fat adaptation may attenuate glycaemic swings and reduce reliance on carbohydrate consumption during exercise for maintaining euglycaemia.


Assuntos
Atletas , Ciclismo , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Dieta Cetogênica , Tolerância ao Exercício/fisiologia , Adulto , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/fisiopatologia , Carboidratos da Dieta , Metabolismo Energético , Índice Glicêmico , Humanos , Hipoglicemia , Masculino
18.
Mol Nutr Food Res ; 63(17): e1801039, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31197949

RESUMO

SCOPE: Na+ /K+ -ATPase is an important membrane-bound enzyme and high levels of Na+ /K+ -ATPase activity in intestine result in increased monosaccharide absorption and aggravated undesirable postprandial hyperglycemia in diabetic. The aim is to characterize the effects of green and black tea extracts on the intestinal Na+ /K+ -ATPase. METHODS AND RESULTS: The STZ-induced type 1 diabetic mice model and high-fat diet combined with low-dose STZ-induced type 2 diabetic mice model are used in this study and the data indicate that both green and black tea extracts show significant hypoglycemic effect. The Na+ /K+ -ATPase activities in intestine associated with glucose absorption are increased in type 1 diabetic mice, while those are even normal in type 2 diabetic mice. Green and black tea extracts can attenuate type 1 diabetes-induced intestinal Na+ /K+ -ATPase disturbance to control postprandial hyperglycemia. Black tea is more effective than green tea in reducing of Na+ /K+ -ATPase activity and protein expression. Theaflavins are the major functional components of black tea and theaflavine-3,3'-digallate presents the strongest inhibitory effect exhibiting anticompetition with ATP and mixed inhibition with Na+ and K+ . CONCLUSION: Tea, especially black tea, can be considered a potential therapeutic agent against type 1 diabetes-induced intestinal Na+ /K+ -ATPase disturbance to control postprandial hyperglycemia.


Assuntos
Diabetes Mellitus Tipo 1/enzimologia , Diabetes Mellitus Tipo 2/enzimologia , Intestinos/enzimologia , ATPase Trocadora de Sódio-Potássio/metabolismo , Chá , Animais , Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Teste de Tolerância a Glucose , Hiperglicemia/dietoterapia , Intestinos/efeitos dos fármacos , Masculino , Camundongos Endogâmicos ICR , Extratos Vegetais/farmacologia , ATPase Trocadora de Sódio-Potássio/antagonistas & inibidores , Chá/química
19.
Nutrients ; 11(5)2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31035514

RESUMO

Low-carb and ketogenic diets are popular among clinicians and patients, but the appropriateness of reducing carbohydrates intake in obese patients and in patients with diabetes is still debated. Studies in the literature are indeed controversial, possibly because these diets are generally poorly defined; this, together with the intrinsic complexity of dietary interventions, makes it difficult to compare results from different studies. Despite the evidence that reducing carbohydrates intake lowers body weight and, in patients with type 2 diabetes, improves glucose control, few data are available about sustainability, safety and efficacy in the long-term. In this review we explored the possible role of low-carb and ketogenic diets in the pathogenesis and management of type 2 diabetes and obesity. Furthermore, we also reviewed evidence of carbohydrates restriction in both pathogenesis of type 1 diabetes, through gut microbiota modification, and treatment of type 1 diabetes, addressing the legitimate concerns about the use of such diets in patients who are ketosis-prone and often have not completed their growth.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Dieta Cetogênica , Humanos
20.
Nutrients ; 11(5)2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31067747

RESUMO

Around 80% of individuals with Type 1 diabetes (T1D) in the United States do not achieve glycaemic targets and the prevalence of comorbidities suggests that novel therapeutic strategies, including lifestyle modification, are needed. Current nutrition guidelines suggest a flexible approach to carbohydrate intake matched with intensive insulin therapy. These guidelines are designed to facilitate greater freedom around nutritional choices but they may lead to higher caloric intakes and potentially unhealthy eating patterns that are contributing to the high prevalence of obesity and metabolic syndrome in people with T1D. Low carbohydrate diets (LCD; <130 g/day) may represent a means to improve glycaemic control and metabolic health in people with T1D. Regular recreational exercise or achieving a high level of athletic performance is important for many living with T1D. Research conducted on people without T1D suggests that training with reduced carbohydrate availability (often termed "train low") enhances metabolic adaptation compared to training with normal or high carbohydrate availability. However, these "train low" practices have not been tested in athletes with T1D. This review aims to investigate the known pros and cons of LCDs as a potentially effective, achievable, and safe therapy to improve glycaemic control and metabolic health in people with T1D. Secondly, we discuss the potential for low, restricted, or periodised carbohydrate diets in athletes with T1D.


Assuntos
Desempenho Atlético , Glicemia , Diabetes Mellitus Tipo 1/dietoterapia , Dieta com Restrição de Carboidratos , Carboidratos da Dieta/administração & dosagem , Humanos
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