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1.
Nat Rev Endocrinol ; 15(7): 406-416, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30948803

RESUMO

Women with pre-existing (type 1 or type 2) diabetes mellitus are at increased risk of pregnancy complications, such as congenital malformations, preeclampsia and preterm delivery, compared with women who do not have diabetes mellitus. Approximately half of pregnancies in women with pre-existing diabetes mellitus are complicated by fetal overgrowth, which results in infants who are overweight at birth and at risk of birth trauma and, later in life, the metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus. Strict glycaemic control with appropriate diet, use of insulin and, if necessary, antihypertensive treatment is the cornerstone of diabetes mellitus management to prevent pregnancy complications. New technology for managing diabetes mellitus is evolving and is changing the management of these conditions in pregnancy. For instance, in Europe, most women with pre-existing diabetes mellitus are treated with insulin analogues before and during pregnancy. Furthermore, many women are on insulin pumps during pregnancy, and the use of continuous glucose monitoring is becoming more frequent. In addition, smartphone application technology is a promising educational tool for pregnant women with diabetes mellitus and their caregivers. This Review covers how modern diabetes mellitus management with appropriate diet, insulin and antihypertensive treatment in patients with pre-existing diabetes mellitus can contribute to reducing the risk of pregnancy complications such as congenital malformations, fetal overgrowth, preeclampsia and preterm delivery.


Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Insulina/uso terapêutico , Resultado da Gravidez , Gravidez em Diabéticas/terapia , Gravidez de Alto Risco , Automonitorização da Glicemia/métodos , Terapia Combinada/métodos , Diabetes Mellitus/epidemiologia , Dieta para Diabéticos , Feminino , Humanos , Saúde do Lactente , Recém-Nascido , Gravidez , Gravidez em Diabéticas/diagnóstico , Melhoria de Qualidade , Medição de Risco , Índice de Gravidade de Doença
2.
Diabetes Res Clin Pract ; 150: 227-235, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30872065

RESUMO

AIMS: Carbohydrate counting (CC) is a technique for managing diabetes particularly based on the counting of carbohydrates. It allows diabetic patients to vary their amount of carbohydrates from one meal to another by adjusting their insulin dose. The primary objective was to determine the variation of carbohydrate intake (CI) in children on CC. METHOD: This was a prospective study conducted between 2014 and 2016. We collected the amount of carbohydrates eaten at each meal by 77 diabetic over a period of 28 days (i.e. 8068 data). We analyzed the number and percentage of significant CI variation rates from one day to another, both for the whole day and for each meal. The CI variation rate was deemed significant if it was greater than or equal to 30%. RESULTS: The percentage of significant CI variation rates was 30% at the daily level, 34% for breakfast, 44% for lunch and dinner, and 53% for snack. The percentage of significant variation rates varied according to age, treatment and occurrence of events. CONCLUSION: Children varied their CI significantly from one meal to another more than one in three times. CC offers flexibility and a better quality of life for children using this method.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Dieta com Restrição de Carboidratos/estatística & dados numéricos , Dieta para Diabéticos/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Qualidade de Vida , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Glicemia/análise , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Humanos , Lactente , Masculino , Tamanho da Porção , Estudos Prospectivos
3.
Nutrients ; 11(2)2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30781348

RESUMO

Adherence to a healthy diet and regular physical activity are two important factors in sufficient type 2 diabetes mellitus management. It is recognized that the traditional treatment of outpatients does not meet the requirements for sufficient lifestyle management. It is hypothesised that a personalized diabetes management mHealth application can help. Such an application ideally measures food intake, physical activity, glucose values, and medication use, and then integrates this to provide patients and healthcare professionals insight in these factors, as well as the effect of lifestyle on glucose values in daily life. The lifestyle data can be used to give tailored coaching to improve adherence to lifestyle recommendations and medication use. This study describes the requirements for such an application: the Diameter. An iterative mixed method design approach is used that consists of a cohort study, pilot studies, literature search, and expert meetings. The requirements are defined according to the Function and events, Interactions and usability, Content and structure and Style and aesthetics (FICS) framework. This resulted in 81 requirements for the dietary (n = 37), activity and sedentary (n = 15), glycaemic (n = 12), and general (n = 17) parts. Although many applications are currently available, many of these requirements are not implemented. This stresses the need for the Diameter as a new personalized diabetes application.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Monitorização Fisiológica/métodos , Autogestão/métodos , Software , Telemedicina/métodos , Adulto , Glicemia/análise , Automonitorização da Glicemia/métodos , Estudos de Coortes , Dieta para Diabéticos/métodos , Exercício , Feminino , Humanos , Estilo de Vida , Masculino , Projetos Piloto , Literatura de Revisão como Assunto
4.
Nutrients ; 11(2)2019 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-30781485

RESUMO

Randomized controlled trials indicate that flavanol-rich cocoa intake may improve postprandial glucose and lipid metabolism in patients with type 2 diabetes (T2D), based on studies with meals that impose a strong metabolic load. Hence, the aim of the present study was to investigate whether flavanol-rich cocoa powder ingested as part of a diabetic-suitable meal may beneficially affect glucose, lipid metabolism, and blood pressure (BP) in patients with T2D. Twelve adults with T2D, overweight/obesity, and hypertension ingested capsules with 2.5 g of flavanol-rich cocoa or microcrystalline cellulose with a diabetic-suitable breakfast in a randomized, placebo-controlled, double-blind crossover study. BP was measured and blood samples were taken before, 2 and 4 h after breakfast and capsule intake. Cocoa treatment did not affect glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, and BP. For glucose, insulin and HOMA-IR, only effects by time were observed after both treatments. Thus, 2.5 g of flavanol-rich cocoa powder ingested as part of a diabetic-suitable meal does not seem to affect postprandial glucose and lipid metabolism and BP in stably-treated diabetics. Nevertheless, future studies with close-meshed investigations are desirable, providing realistic amounts of cocoa together with realistic meals rich in carbohydrates to subjects with T2D or metabolic syndrome, which do not afford pharmacological treatment.


Assuntos
Desjejum , Chocolate , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos/métodos , Flavonóis/administração & dosagem , Idoso , Glicemia/análise , Pressão Sanguínea/fisiologia , Colesterol/sangue , Estudos Cross-Over , Diabetes Mellitus Tipo 2/metabolismo , Método Duplo-Cego , Feminino , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Tamanho da Porção de Referência , Triglicerídeos/sangue
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(1): 49-55, ene. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-175793

RESUMO

Background and objective: This randomized crossover clinical trial investigated the effects of substituting legumes for meat consumption in the therapeutic lifestyle change (TLC) diet on leptin and adiponectin concentrations among type 2 diabetic patients. Material and methods: Thirty-one type 2 diabetic patients (24 women, age: 58.1±6.0 years) were randomly assigned to groups designated to consume a legume-free TLC diet or a legume-based TLC diet for 8 weeks. Both diets were similar except for the replacement of two servings of red meat with legumes 3 days per week in the legume-based TLC group. Leptin and adiponectin concentrations were measured at baseline and after the 8-week intervention. Results: The legume-based TLC diet significantly increased adiponectin concentrations in comparison with the legume-free TLC diet. There was no significant change in leptin concentrations after both intervention diets. Conclusions: Legumes increased serum adiponectin concentrations in type 2 diabetic patients. Registration number: IRCT201202251640N7


Antecedentes y objetivo: Este ensayo clínico cruzado aleatorizado investigó los efectos de la sustitución de legumbres por el consumo de carne en la dieta de Cambio Terapéutico en el Estilo de Vida (CTEV) sobre las concentraciones de leptina y adiponectina en pacientes con diabetes tipo 2. Material y métodos: Treinta y un pacientes diabéticos tipo 2 (24 mujeres, edad: 58,1±6,0 años) fueron asignados aleatoriamente a grupos designados para consumir una dieta CTEV libre de legumbres o una dieta CTEV basada en legumbres durante 8 semanas. Ambas dietas fueron similares, excepto por el reemplazo de 2 porciones de carne roja por legumbres 3 días por semana en el grupo de CTEV basado en leguminosas. Las concentraciones de leptina y adiponectina se midieron al inicio y después de la intervención de 8 semanas. Resultados: La dieta de CTEV basada en legumbres aumentó significativamente los niveles de adiponectina en comparación con la dieta de CTEV sin legumbres. No hubo cambios significativos en las concentraciones de leptina después de ambas dietas de intervención. Conclusiones: Las leguminosas aumentaron las concentraciones séricas de adiponectina en pacientes diabéticos tipo 2. Número de registro: IRCT201202251640N7


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Proteínas de Vegetais Comestíveis , Adiponectina/fisiologia , Diabetes Mellitus Tipo 2/metabolismo , Hormônios Peptídicos/fisiologia , Carne , Proteínas na Dieta , Dieta para Diabéticos , Leptina/fisiologia
6.
Enferm. glob ; 17(52): 97-136, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173982

RESUMO

Objetivo: Identificar el riesgo para el desarrollo de la diabetes mellitus tipo 2 en los usuarios de la red de atención primaria de salud. Método: Estudio transversal, descriptivo, con abordaje cuantitativo, constituido por 266 usuarios registrados en unidades de salud de la familia. Se utilizaron dos instrumentos. El primero, cuestionario compuesto por variables sociodemográficas: sexo, edad, estado civil, escolaridad. El segundo, la escala Finnish Diabetes Risk Score. Para el análisis, se utilizó la estadística inferencial, con el cálculo de las razones de prevalencias brutas con intervalo de confianza del 95%. Resultados: El riesgo bajo se encontró en 43 (16,2%) de los entrevistados y el riesgo muy alto encontrado en 4 (1,5%). La mayoría de los participantes presentaron un riesgo discretamente elevado 83 (31,2%). Se ha observado asociación estadísticamente significativa en las prevalencias de los factores de riesgo: edad aumentada, sobrepeso, obesidad, circunferencia abdominal aumentada, inactividad física, ingesta no habitual de legumbres y frutas, uso de medicación para hipertensión, antecedentes personales de hiperglucemia e historial familiar de diabetes mellitus tipo 2. Conclusión: El estudio mostró que todos los investigadores presentaron algún riesgo para el desarrollo de la diabetes mellitus tipo 2 y que varios factores de riesgo estuvieron presentes en los mismos, así pues, justificar la importancia del rastreo como una acción preventiva


Objetivo: Identificar o risco para o desenvolvimento do diabetes mellitus tipo 2 em usuários da rede de atenção básica de saúde. Método: Estudo transversal, descritivo, com abordagem quantitativa, constituído por 266 usuários cadastrados em unidades de saúde da família, foram utilizados dois instrumentos. O primeiro, questionário composto por variáveis sociodemográficas: sexo, idade, estado civil, escolaridade. O segundo, a escala Finnish Diabetes Risk Score. Para análise, foi utilizada a estatística inferencial, com o cálculo das razões de prevalências brutas com intervalo de confiança de 95%. Resultados: O risco baixo foi encontrado em 43 (16,2%) dos entrevistados e o risco muito alto encontrado em 4 (1,5%). A maioria dos participantes apresentaram risco discretamente elevado 83 (31,2%).Houve associação estatisticamente significativa nas prevalências dos fatores de risco: idade aumentada, sobrepeso, obesidade, circunferência abdominal aumentada, inatividade física, ingestão não habitual de legumes e frutas, uso de medicação para hipertensão, antecedentes pessoais de hiperglicemia e histórico familiar de diabetes mellitus tipo 2. Conclusão: O estudo mostrou que todos os investigados apresentaram algum risco para desenvolvimento do diabetes mellitus tipo 2 e que vários fatores de risco estiveram presentes nos mesmos, assim, justificar-se a importância do rastreamento como uma ação preventiva


Objective: To identify the risk for the development of type 2 diabetes mellitus in users of the basic health care network. Method: Across-sectional, descriptive study with a quantitative approach, consisting of 266 users enrolled in family health units, two instruments were used. The first, a questionnaire composed of sociodemographic variables: sex, age, marital status, schooling. The second, the Finnish Diabetes Risk Score scale. For analysis, inferential statistics were used, with the calculation of crude prevalence ratios with 95% confidence interval. Results: Low risk was found in 43 (16.2%) of the interviewees and the very high risk found in 4 (1.5%). The majority of the participants presented a slightly elevated risk 83 (31.2%). There was a statistically significant association in the prevalence of risk factors: increased age, overweight, obesity, increased abdominal circumference, physical inactivity, unusual intake of vegetables and fruits, use of hypertension medication, personal history of hyperglycemia and family history of type diabetes mellitus 2. Conclusion: The study showed that all the investigators presented some risk for the development of type 2 diabetes mellitus and that several risk factors were present in them, thus justifying the importance of screening as a preventive action


Assuntos
Humanos , Diabetes Mellitus Tipo 2/prevenção & controle , Prevenção de Doenças , Cuidados de Enfermagem/métodos , Fatores de Risco , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Transversais , Avaliação de Resultado de Ações Preventivas , Dieta para Diabéticos/enfermagem , Terapia por Exercício/enfermagem
7.
Nutr. hosp ; 35(n.extr.4): 109-115, sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-181552

RESUMO

La diabetes mellitus (DM) es una de las enfermedades crónicas con mayor prevalencia a nivel mundial, sobre todo debido al incremento de la diabetes tipo 2. Este creciente aumento se debe, sobre todo, al envejecimiento de la población, a la actual epidemia de obesidad y a los cambios del estilo de vida, con más dietas ricas en calorías y más sedentarismo. Además, es frecuente encontrar que la diabetes se asocia a obesidad, diabesidad o a hipertensión e hipercolesterolemia, y que forma parte del llamado síndrome metabólico (SM), que se relaciona con una alta probabilidad de desarrollar problemas cardiovasculares. A pesar de los avances en los tratamientos de la diabetes, lograr un adecuado control glucémico en individuos diabéticos sigue siendo una difícil tarea, no siempre exenta de riesgos. La dieta, uno de los pilares del tratamiento y de la prevención tanto de la diabetes como de la obesidad, debe aportar los nutrientes necesarios para el organismo, pero, además, en el caso de pacientes diabéticos, debe coordinarse con el tratamiento hipoglucemiante y la insulina, lo que se denomina "tratamiento médico nutricional", cuyo objetivo principal es la normoglucemia. El tratamiento dietético de la obesidad es difícil. Habitualmente se tiende a restringir las calorías que se consumen y se olvidan los factores psicológicos y el estilo de vida de los pacientes. Sin embargo, no existe una única dieta para la diabetes o la obesidad, que debe ser individualizada y estar basada en los objetivos terapéuticos, adaptando las recomendaciones dietéticas al estilo de vida del paciente


Diabetes mellitus (DM) is one of the chronic diseases with higher prevalence worldwide, mainly due to the increase of "type 2 diabetes". This increasing is mainly due to the aging of the population, the current epidemic of obesity and the changes in lifestyle, such as high-calorie diets and sedentary lifestyle. In addition, it is common to find that diabetes is associated with obesity, diabesity, or hypertension and hypercholesterolemia, forming part of the socalled Metabolic Syndrome (MS), which is associated with a high probability of developing cardiovascular problems. Despite the advances in the treatment of diabetes, achieving adequate glycemic control in people with diabetes remains difficult, and not always risk free. The diet is one of the bases of the treatment and prevention of diabetes and obesity. This should provide the necessary nutrients for the organism, but also, in the case of diabetic patients, should be coordinated with hypoglycaemic treatment and insulin, called "nutritional medical treatment", and whose main objective is normoglycemia. Dietary treatment of obesity is difficult, usually tends to restrict the calories consumed and forgets the psychological factors and lifestyle of patients. However, there is no a unique diet for these pathologies, but it must be individualized, based on the therapeutic objectives adapted to dietary recommendations for the patient's lifestyle


Assuntos
Humanos , Diabetes Mellitus/dietoterapia , Dieta para Diabéticos , Dieta Redutora , Política Nutricional , Obesidade/dietoterapia
8.
Nutrients ; 10(8)2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30104491

RESUMO

This study aimed to elucidate the effect of an energy restricted and carbohydrate restricted diet on the management of Japanese diabetes patients. Several databases including MEDLINE, EMBASE, and the Japan Medical Abstracts Society were searched for relevant articles published prior to June 2017. The articles identified were systematically reviewed. We identified 286 articles on an energy restricted diet, assessed seven and included two studies in our review. On a carbohydrate restricted diet, 75 articles were extracted, seven articles assessed and three included in the review, of which two were the studies that were selected for the energy restricted diet group, since they compared energy restricted diets with carbohydrate restricted diets. All selected studies were on Japanese patients with type 2 diabetes. No studies for type 1 diabetes were found in our search. Two randomized controlled trials on an energy restricted diet were also included in the three studies for a carbohydrate restricted diet. All the three randomized controlled trials showed better glucose management with the carbohydrate restricted diet. Our study revealed that there is very little evidence on diets, particularly in Japanese patients with diabetes, and that the energy restricted diet, which has been recommended by the Japan Diabetes Society in the sole dietary management approach, is not supported by any scientific evidence. Our findings suggest that the carbohydrate restricted diet, but not the energy restricted diet, might have short term benefits for the management of diabetes in Japanese patients. However, since our analysis was based on a limited number of small randomized controlled trials, large scale and/or long term trials examining the dietary approaches in these patients are needed to confirm our findings.


Assuntos
Restrição Calórica , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Dieta para Diabéticos , Idoso , Grupo com Ancestrais do Continente Asiático , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Metabolismo Energético , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Valor Nutritivo , Fatores de Tempo , Resultado do Tratamento
9.
Nutr Hosp ; 35(Spec No4): 109-115, 2018 Jun 12.
Artigo em Espanhol | MEDLINE | ID: mdl-30070132

RESUMO

Diabetes mellitus (DM) is one of the chronic diseases with higher prevalence worldwide, mainly due to the increase of "type 2 diabetes". This increasing is mainly due to the aging of the population, the current epidemic of obesity and the changes in lifestyle, such as high-calorie diets and sedentary lifestyle. In addition, it is common to find that diabetes is associated with obesity, diabesity, or hypertension and hypercholesterolemia, forming part of the socalled Metabolic Syndrome (MS), which is associated with a high probability of developing cardiovascular problems. Despite the advances in the treatment of diabetes, achieving adequate glycemic control in people with diabetes remains difficult, and not always risk free. The diet is one of the bases of the treatment and prevention of diabetes and obesity. This should provide the necessary nutrients for the organism, but also, in the case of diabetic patients, should be coordinated with hypoglycaemic treatment and insulin, called "nutritional medical treatment", and whose main objective is normoglycemia. Dietary treatment of obesity is difficult, usually tends to restrict the calories consumed and forgets the psychological factors and lifestyle of patients. However, there is no a unique diet for these pathologies, but it must be individualized, based on the therapeutic objectives adapted to dietary recommendations for the patient's lifestyle.


Assuntos
Diabetes Mellitus/dietoterapia , Dieta para Diabéticos , Dieta Redutora , Política Nutricional , Obesidade/dietoterapia , Humanos
10.
Nutrients ; 10(8)2018 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-30081574

RESUMO

Background Formula diets can improve glycemic control or can even induce remission in type 2 diabetes. We hypothesized that especially an individualized intense meal replacement by a low-carbohydrate formula diet with accompanied self-monitoring of blood glucose (SMBG) contributes to long-term improvements in HbA1c, weight, and cardiometabolic risk factors in poorly controlled type 2 diabetes. Methods Type 2 diabetes patients were randomized into either a moderate group (M-group) with two meal replacements/day (n = 160) or a stringent group (S-group) with three meal replacements/day (n = 149) during the first week of intervention (1300⁻1500 kcal/day). Subsequently, both groups reintroduced a low-carbohydrate lunch based on individual adaption due to SMBG in weeks 2⁻4. After week 4, breakfast was reintroduced until week 12. During the follow-up period, all of the participants were asked to continue replacing one meal per day until the 52-weeks follow-up. Additionally, an observational control group (n = 100) remained in routine care. Parameters were compared at baseline, after 12 and 52 weeks within and between all of the groups. Results 321 participants (83%) completed the acute meal replacement phase after 12 weeks and 279 participants (72%) the whole intervention after 52 weeks. Both intervention groups achieved improvements in HbA1c, fasting blood glucose, blood pressure, and weight (all p < 0.001) within 12 weeks. However, these results were not significantly different between both of the intervention groups. The estimated treatment difference in HbA1c reduction was (mean (95% confidence interval [CI]) -0.10% with 95% CI [-0.40; 0.21] also (p > 0.05) (S-group vs. M-group) not statistically different after 12 weeks. However, only the S-group showed a clinically relevant improvement in HbA1c of -0.81% [-1.06; -0.55] (p < 0.001) after 52 weeks of follow-up, whereas HbA1c was not statistically different between the M- and control group. Conclusion Individualized meal replacement with SMBG demonstrated beneficial effects on HbA1c and cardiometabolic parameters in type 2 diabetes. Furthermore, the initiation of a weight loss program with one week of full meal replacement (three meals per day) resulted in a clinically relevant long-term HbA1c reduction, as compared to an observational control group that had standard care.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Dieta para Diabéticos , Alimentos Formulados , Refeições , Adulto , Idoso , Biomarcadores/sangue , Pressão Sanguínea , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Ingestão de Energia , Feminino , Alemanha , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
11.
Nutrients ; 10(6)2018 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-29880772

RESUMO

GoCARB is a computer vision-based smartphone system designed for individuals with Type 1 Diabetes to estimate plated meals' carbohydrate (CHO) content. We aimed to compare the accuracy of GoCARB in estimating CHO with the estimations of six experienced dietitians. GoCARB was used to estimate the CHO content of 54 Central European plated meals, with each of them containing three different weighed food items. Ground truth was calculated using the USDA food composition database. Dietitians were asked to visually estimate the CHO content based on meal photographs. GoCARB and dietitians achieved comparable accuracies. The mean absolute error of the dietitians was 14.9 (SD 10.12) g of CHO versus 14.8 (SD 9.73) g of CHO for the GoCARB (p = 0.93). No differences were found between the estimations of dietitians and GoCARB, regardless the meal size. The larger the size of the meal, the greater were the estimation errors made by both. Moreover, the higher the CHO content of a food category was, the more challenging its accurate estimation. GoCARB had difficulty in estimating rice, pasta, potatoes, and mashed potatoes, while dietitians had problems with pasta, chips, rice, and polenta. GoCARB may offer diabetic patients the option of an easy, accurate, and almost real-time estimation of the CHO content of plated meals, and thus enhance diabetes self-management.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Dieta para Diabéticos , Carboidratos da Dieta/administração & dosagem , Aplicativos Móveis , Nutricionistas , Smartphone , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Carboidratos da Dieta/sangue , Humanos , Julgamento , Variações Dependentes do Observador , Fotografação , Tamanho da Porção , Reprodutibilidade dos Testes , Autocuidado , Percepção Visual
12.
Nutrients ; 10(6)2018 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-29882884

RESUMO

OBJECTIVE: In China, a low-fat diet (LFD) is mainly recommended to help improve blood glucose levels in patients with type 2 diabetes mellitus (T2DM). However, a low-carbohydrate diet (LCD) has been shown to be effective in improving blood glucose levels in America and England. A few studies, primarily randomized controlled trials, have been reported in China as well. METHOD: Firstly, we designed two 'six-point formula' methods, which met the requirements of LCD and LFD, respectively. Fifty-six T2DM patients were recruited and randomly allocated to the LCD group (n = 28) and the LFD group (n = 28). The LCD group received education about LCD's six-point formula, while the LFD group received education about LFD's six-point formula. The follow-up time was three months. The indicators for glycemic control and other metabolic parameters were collected and compared between the two groups. RESULTS: Forty-nine patients completed the study. The proportions of calories from three macronutrients the patients consumed met the requirements of LCD and LFD. Compared to the LFD group, there was a greater decrease in HbA1c level in the LCD group (-0.63% vs. -0.31%, p < 0.05). The dosages of insulin and fasting blood glucoses (FBG) in the third month were lower than those at baseline in both groups. Compared with baseline values, body mass index (BMI) and total cholesterol (TC) in the LCD group were significantly reduced in the third month (p < 0.05); however, there were no statistically significant differences in the LFD group. CONCLUSIONS: LCD can improve blood glucose more than LFD in Chinese patients with T2DM. It can also regulate blood lipid, reduce BMI, and decrease insulin dose in patients with T2DM. In addition, the six-point formula is feasible, easily operable, and a practical educational diet for Chinese patients with T2DM.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Dieta para Diabéticos , Dieta com Restrição de Gorduras , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , China , Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
13.
Acta Diabetol ; 55(8): 843-851, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29777369

RESUMO

AIMS: Not much is known about adherence to special diets in type 1 diabetes, characteristics of individuals with special diets, and whether such practices should raise concerns with respect to meeting the dietary recommendations. In this study, we assessed the frequencies of adherence to special diets, in a population of individuals with type 1 diabetes, and investigated the association between special diet adherence and dietary intake, measured as dietary patterns and nutrient intakes. METHODS: During the Finnish Diabetic Nephropathy Study visit, participants with type 1 diabetes (n = 1429) were instructed to complete a diet questionnaire inquiring about the adherence to special diets. The participants also completed a food record, from which energy and nutrient intakes were calculated. RESULTS: In all, 36.6% participants reported adhering to some special diet. Most commonly reported special diets were lactose-free (17.1%), protein restriction (10.0%), vegetarian (7.0%), and gluten-free (5.6%) diet. Special diet adherents were more frequently women, older, had longer diabetes duration, and more frequently had various diabetes complications. Mean carbohydrate intakes were close to the lower levels of the recommendation in all diet groups, which was reflected in low mean fibre intakes but high frequencies of meeting the sucrose recommendations. The recommendation for saturated fatty acid intake was frequently unmet, with the highest frequencies observed in vegetarians. Of the micronutrients, vitamin D, folate, and iron recommendations were most frequently unmet, with some differences between the diet groups. CONCLUSIONS: Special diets are frequently followed by individuals with type 1 diabetes. The adherents are more frequently women, and have longer diabetes duration and more diabetes complications. Achieving the dietary recommendations differed between diets, and depended on the nutrient in question. Overall, intakes of fibre, vitamin D, folate, and iron fell short of the recommendations.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/epidemiologia , Dieta/métodos , Dieta/estatística & dados numéricos , Política Nutricional , Cooperação do Paciente/estatística & dados numéricos , Adulto , Registros de Dieta , Dieta para Diabéticos/normas , Dieta para Diabéticos/estatística & dados numéricos , Ingestão de Energia/fisiologia , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Inquéritos Nutricionais
15.
Nutrients ; 10(5)2018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29695055

RESUMO

We previously showed that a non-calorie-restricted, moderately low-carbohydrate diet (mLCD) is more effective than caloric restriction for glycemic and lipid profile control in patients with type 2 diabetes. To determine whether mLCD intervention is sustainable, effective, and safe over a long period, we performed a 36-month observational study. We sequentially enrolled 200 patients with type 2 diabetes and taught them how to follow the mLCD. We compared the following parameters pre- and post-dietary intervention in an outpatient setting: glycated hemoglobin (HbA1c), body weight, lipid profile (total cholesterol, low and high-density lipoprotein cholesterol, triglycerides), systolic and diastolic blood pressure, liver enzymes (aspartate aminotransferase, alanine aminotransferase), and renal function (urea nitrogen, creatinine, estimated glomerular filtration rate). Data from 157 participants were analyzed (43 were lost to follow-up). The following parameters decreased over the period of study: HbA1c (from 8.0 ± 1.5% to 7.5 ± 1.3%, p < 0.0001) and alanine aminotransferase (from 29.9 ± 23.6 to 26.2 ± 18.4 IL/L, p = 0.009). Parameters that increased were high-density lipoprotein cholesterol (from 58.9 ± 15.9 to 61.2 ± 17.4 mg/dL, p = 0.001) and urea nitrogen (from 15.9 ± 5.2 to 17.0 ± 5.4 mg/dL, p = 0.003). Over 36 months, the mLCD intervention showed sustained effectiveness (without safety concerns) in improving HbA1c, lipid profile, and liver enzymes in Japanese patients with type 2 diabetes.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Dieta para Diabéticos , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Dieta com Restrição de Carboidratos/efeitos adversos , Dieta para Diabéticos/efeitos adversos , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Japão , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 53(2): 89-99, mar.-abr. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-171382

RESUMO

La prevalencia de la diabetes mellitus tipo 2 (DM2) se incrementa marcadamente con la edad. El tratamiento antidiabético y los objetivos de control glucémico en el anciano con DM2 deben individualizarse en función de sus características biopsicosociales. En los pacientes de edad avanzada, en los que los beneficios de un tratamiento antidiabético intensivo son limitados, los objetivos básicos deben ser mejorar la calidad de vida, preservar la funcionalidad y evitar los efectos adversos, muy especialmente las hipoglucemias. El tratamiento de la DM2 en el anciano fue objeto de un consenso, publicado en 2012 y avalado por varias sociedades científicas españolas. Desde entonces, han aparecido nuevos grupos terapéuticos y evidencias que hacen recomendable su actualización. El presente documento se centrará en los aspectos terapéuticos de la DM2 en el paciente anciano, entendiendo como tal el tener una edad mayor de 75 años o presentar fragilidad (AU)


The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia. Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail (AU)


Assuntos
Humanos , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Complicações do Diabetes/prevenção & controle , Hipoglicemiantes/uso terapêutico , Saúde do Idoso , Idoso Fragilizado/estatística & dados numéricos , Envelhecimento/fisiologia , Fatores de Risco , Hipoglicemia/prevenção & controle , Hiperglicemia/prevenção & controle , Dieta para Diabéticos
17.
Nutrients ; 10(3)2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29562676

RESUMO

BACKGROUND: The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear. OBJECTIVES: The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes. METHODS: Search methods: Randomised controlled studies were selected from a number of databases (EBSCOHost with links to Health Research databases, PubMed, and grey literature) based on the Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. The search terms included synonyms and Medical Subject Headings (MeSH) and involved the use of Boolean operators (AND/OR) which allowed the combination of words and search terms. SELECTION CRITERIA: As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between 2008 and 2018, including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies. Nine articles which met the inclusion criteria were selected for the systematic review, whereas only six articles which met the criteria were included in the meta-analysis. DATA COLLECTION AND ANALYSIS: Studies were evaluated for quality and risk of bias. In addition, heterogeneity, meta-analysis, and sensitivity tests of the extracted data were carried out using Review Manager 5.3 (Review Manager, 2014). RESULTS: The findings of the systematic review showed that the low-glycaemic index (low-GI) diet resulted in a significant improvement (<0.05) in glycated haemoglobin (HbA1c) in two studies: low-GI diet Δ = -0.5% (95% CI, -0.61% to -0.39%) vs. high-cereal fibre diet Δ = -0.18% (95% CI, -0.29% to -0.07%); and low-GI legume diet Δ = -0.5% (95%, -0.6% to -0.4%) vs. high-wheat fibre diet Δ = -0.3% (95% Cl, -0.4 to -0.2%). There was a slight improvement in one study (low glycaemic response = 6.5% (6.3-7.1) vs. control = 6.6% (6.3-7.0) and no significant difference (p > 0.05) in four studies compared with the control diet. Four studies showed improvements in fasting blood glucose in low-GI diets compared to higher-GI diets or control: low-GI diet = 150.8 ± 8.7 vs. higher-GI diet = 157.8 ± 10.4 mg/dL, mean ± SD p = 0.43; low-GI diet = 127.7 vs. high-cereal fibre diet = 136.8 mg/dL, p = 0.02; low-GI diet = 6.5 (5.6-8.4) vs. standard diabetic diet = 6.7 (6.1-7.5) mmol/L, median and interquartile range p > 0.05; and low-GI diet = 7.3 ± 0.3 vs. conventional carbohydrate exchange diet = 7.7 ± 0.4 mmol/L, mean ± SEM (Standard Error of Mean) p < 0.05. The results of the meta-analysis and sensitivity tests demonstrated significant differences (p < 0.001 and p < 0.001, respectively) between the low-GI diet and the higher-GI diet or control diet in relation to glycated haemoglobin. Differences between the low-GI diet and higher-GI diet or control were significant (p < 0.05) with respect to the fasting blood glucose following meta-analysis. CONCLUSION: The low-GI diet is more effective in controlling glycated haemoglobin and fasting blood glucose compared with a higher-GI diet or control in patients with type 2 diabetes.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos , Índice Glicêmico , Carga Glicêmica , Adulto , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Dieta para Diabéticos/efeitos adversos , Hemoglobina A Glicada/metabolismo , Humanos , Pessoa de Meia-Idade , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Rev. clín. esp. (Ed. impr.) ; 218(2): 74-88, mar. 2018. tab, ^ilus
Artigo em Espanhol | IBECS | ID: ibc-171168

RESUMO

La prevalencia de la diabetes mellitus tipo 2 (DM2) se incrementa marcadamente con la edad. El tratamiento antidiabético y los objetivos de control glucémico en el anciano con DM2 deben individualizarse en función de sus características biopsicosociales. En los pacientes de edad avanzada, en los que los beneficios de un tratamiento antidiabético intensivo son limitados, los objetivos básicos deben ser mejorar la calidad de vida, preservar la funcionalidad y evitar los efectos adversos, muy especialmente las hipoglucemias. El tratamiento de la DM2 en el anciano fue objeto de un consenso, publicado en 2012 y avalado por varias sociedades científicas españolas. Desde entonces, han aparecido nuevos grupos terapéuticos y evidencias que hacen recomendable su actualización. El presente documento se centrará en los aspectos terapéuticos de la DM2 en el paciente anciano, entendiendo como tal el tener una edad mayor de 75 años o presentar fragilidad (AU)


The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia. Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Hipoglicemia/prevenção & controle , Hiperglicemia/prevenção & controle , Idoso Fragilizado/estatística & dados numéricos , Envelhecimento/fisiologia , Fatores de Risco , Sarcopenia/fisiopatologia , Terapia por Exercício , Dieta para Diabéticos
19.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(1): 5-12, ene.-feb. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-171182

RESUMO

Purpose. The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. Methods. This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. Results. The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. Conclusion. This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management (AU)


Objetivo. El objetivo del presente estudio fue caracterizar la educación que reciben los pacientes con diabetes mellitus tipo 2 e identificar las diferencias existentes en función de la presencia o ausencia de terapia insulínica. Métodos. En este estudio transversal, multicéntrico y descriptivo participaron 1.066 médicos españoles que completaron una encuesta por Internet. Resultados. Los médicos participantes tenían una experiencia media de 26 años en atención sanitaria y principalmente trabajaban en centros de atención primaria de áreas urbanas. Los médicos determinaron el grado de conocimiento de cada paciente en relación con su enfermedad empleando una escala de 5 puntos. El 50% de los médicos indicaron que habían empleado entre 15 y 30min en educar al paciente en el momento del diagnóstico. Los niveles de HbA1c>9%, la presencia de complicaciones microvasculares y un nivel sociocultural bajo fueron los factores asociados a la necesidad de dedicar un mayor tiempo a la educación. Conclusión. (AU)Este es el primer estudio diseñado para evaluar la educación proporcionada al paciente con diabetes mellitus tipo 2 en España. El tiempo dedicado y la individualización de la educación son factores asociados con un mejor control a largo plazo de la enfermedad y, consecuentemente, con una mayor eficacia en su manejo clínico (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos , Educação de Pacientes como Assunto/métodos , Complicações do Diabetes/prevenção & controle , Autocuidado/métodos , Avaliação de Eficácia-Efetividade de Intervenções , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
20.
Nutrients ; 10(1)2018 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-29361766

RESUMO

Carbohydrate counting (CC) is a meal-planning tool for patients with type 1 diabetes (T1D) treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion. It is based on an awareness of foods that contain carbohydrates and their effect on blood glucose. The bolus insulin dose needed is obtained from the total amount of carbohydrates consumed at each meal and the insulin-to-carbohydrate ratio. Evidence suggests that CC may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c). Moreover, CC might reduce the frequency of hypoglycaemia. In addition, with CC the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own lifestyles. CC and the bolus calculator can have possible beneficial effects in improving post-meal glucose, with a higher percentage of values within the target. Moreover, CC might be integrated with the counting of fat and protein to more accurately calculate the insulin bolus. In conclusion, in children and adolescents with T1D, CC may have a positive effect on metabolic control, might reduce hypoglycaemia events, improves quality of life, and seems to do so without influencing body mass index; however, more high-quality clinical trials are needed to confirm this positive impact.


Assuntos
Comportamento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Diabetes Mellitus Tipo 1/dietoterapia , Dieta com Restrição de Carboidratos , Dieta para Diabéticos , Cooperação do Paciente , Tamanho da Porção , Adolescente , Comportamento do Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Criança , Terapia Combinada , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Insulina/uso terapêutico , Masculino , Qualidade de Vida
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