Aim. There is insufficient evidence for the efficacy of a low-glycemic index (GI) diet in the management of diabetes. The goal of this study was to measure the effect of a low GI versus a standard diabetic diet in adults with diabetes type 2. Methods. This was an open label, randomized, crossover study. Twenty persons with type 2 diabetes were randomized to two groups. Each group followed a standard diabetic diet or a low glycemic index diet for 3 months. The effectiveness of the two diets was evaluated using a hyperinsulinemic euglycemic clamp with endogenous glucose production measurement, indirect calorimetry and bioimpedance analysis. Outcome measures were body mass, BMI, body fat, glycosylated hemoglobin, fasting glucose, lipid profile, insulin sensitivity and hepatic glucose production. Results. Body mass after 3 months following the diabetic diet was 93 kg (83-104) (median and interquartile range). There was no statistically significant difference between diets for glycosylated hemoglobin, fasting glucose, lipid profile, insulin sensitivity or hepatic glucose production.
Conclusions.The results are comparable with other studies showing a modest effect of a low GI diet in the management of diabetes. We found a modestly greater weight loss, body fat and BMI reduction on the low GI diet.
Reactivity of the skin microcirculation is worse on the foot than on the hand. This study confirmed a close relationship of DN and impaired skin microcirculation. It seems that autonomous neuropathy (assessed using the Neuropad) precedes the manifestation of somatosensory neuropathy.
Aim. The aim of our retrospective study was to answer the question if the presence of cardiovascular autonomic neuropathy (CAN) affects mortality in type 1 diabetic patients during a 10-year follow-up. Methods. Patients with type 1 diabetes mellitus examined for CAN in 2003 were enrolled in this retrospective study. A total of 278 patients were included and divided into two groups according to the presence or absence of CAN (111 CAN+, 167 CAN-). The group characteristics and outcomes were compared at baseline and after ten years (in 2013). Results. In the follow-up period, a total of 18 patients died; CAN+ (14/111; 12.6%) and CAN-(4/167; 2.4%) (P < 0.001). At baseline, the CAN+ patients were older (47 vs. 33 years; P < 0.001), had longer duration of diabetes (20 vs. 12 years; P < 0.05), had worse glycemic control assessed by HbA1c (73 vs. 68 mmol/mol; P < 0.05), higher systolic (130 vs. 120 mmHg; P < 0.001) and diastolic (80 vs. 70 mmHg; P < 0.01) blood pressure and had more diabetic complications. In our analysis we found the strongest predictor of mortality to be the presence of CAN (P < 0.01) and the blood pressure value at baseline (P < 0.05). Other baseline characteristics, including the duration of diabetes, age and the presence of micro-and macrovascular complications were not significant. The statistical analysis was performed using logistic regression step-wise analysis. Conclusions. During the 10-year follow-up, CAN+ patients had a 5-fold higher mortality rate than CAN-patients. The strongest predictor of mortality was the presence of CAN.
According to our results, asymptomatic CAN is very frequent in patients with DM1. By using multifactorial logistic regression (step-wise) analysis we demonstrated that if albuminuria, peripheral neuropathy and elevated systolic BP are present simultaneously, there is a high probability that the patient also has CAN (84.9% of initial group correctly predicted, p < 0.001).
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