OBJECTIVE -To determine whether addition of Salba (Salvia hispanica L.), a novel whole grain that is rich in fiber, ␣-linolenic acid (ALA), and minerals to conventional treatment is associated with improvement in major and emerging cardiovascular risk factors in individuals with type 2 diabetes.RESEARCH DESIGN AND METHODS -Using a single-blind cross-over design, subjects were randomly assigned to receive either 37 Ϯ 4 g/day of Salba or wheat bran for 12 weeks while maintaining their conventional diabetes therapies. Twenty well-controlled subjects with type 2 diabetes (11 men and 9 women, aged 64 Ϯ 8 years, BMI 28 Ϯ 4 kg/m 2 , and A1C 6.8 Ϯ 0.9%) completed the study. This study was set in the outpatient clinic of the Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada.RESULTS -Compared with the control treatment, Salba reduced systolic blood pressure (SBP) by 6.3 Ϯ 4 mmHg (P Ͻ 0.001), high-sensitivity C-reactive protein (hs-CRP) (mg/l) by 40 Ϯ 1.6% (P ϭ 0.04), and vonWillebrand factor (vWF) by 21 Ϯ 0.3% (P ϭ 0.03), with significant decreases in A1C and fibrinogen in relation to the Salba baseline but not with the control treatment. There were no changes in safety parameters including liver, kidney and hemostatic function, or body weight. Both plasma ALA and eicosapentaenoic polyunsaturated fatty acid levels were increased twofold (P Ͻ 0.05) while consuming Salba.CONCLUSIONS -Long-term supplementation with Salba attenuated a major cardiovascular risk factor (SBP) and emerging factors (hs-CRP and vWF) safely beyond conventional therapy, while maintaining good glycemic and lipid control in people with well-controlled type 2 diabetes.

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Insulin resistance is a prevalent condition, in which insulin loses its normal physiological action. Since people were first classified as insulin resistant over 60 years ago, one of the main discoveries has been that insulin resistance clusters with other risk factors such as obesity, elevated triglycerides, and low high-density lipoprotein cholesterol, increasing cardiovascular disease risk. Although insulin resistance appears to manifest first in the periphery and then in the liver, other sites, such as the brain and the pancreatic &b.beta-cell, may play pathogenic roles. Factors contributing to insulin resistance at these sites include perturbations in free fatty acids, glucose, and hormone-signalling, some of which may be linked to various genetic polymorphisms. Appropriate nutritional treatment for insulin resistance is controversial. Two main approaches are drawn from diabetes recommendations: i) a high-carbohydrate, low-fat, high-fibre diet emphasizing low glycemic-index foods and ii) sharing calories between monounsaturated fat and complex carbohydrate at the expense of saturated fat. Recent interest in insulin resistance has prompted the development of new guidelines. Promising data have also emerged, showing that a high-carbohydrate, high-fibre, low-fat diet plus exercise programs maintained through intensive counselling can decrease diabetes risk by over 40%. Additional research is required to confirm the sustainability of this approach and sort out the determinants of insulin resistance so that more effective nutritional interventions will result.

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Offer collaborative and interactive self-management education (SME) interventions as they are more effective than didactic SME. Incorporate problem-solving skills for ongoing self-management of medical, social and emotional aspects of care into the traditional knowledge and technical skills content of educational interventions. Design patient-centred learning to empower individuals to make informed decisions toward achievement of patient-chosen goals. Individualize SME interventions according to type of diabetes and recommended therapy, the patient's ability and motivation for learning and change, and his or her culture and literacy level. Provide ongoing SME and comprehensive healthcare collaboratively to make SME most effective. Interventions targeting knowledge and skills Basic knowledge and skill areas that are essential for SME are monitoring of relevant health parameters, healthy eating, physical activity, pharmacotherapy, prevention and management of hypo-/ hyperglycemia, and prevention and surveillance of complications. Skill training should include using self-monitoring of blood glucose (SMBG), making appropriate dietary choices, incorporating an exercise regimen, using medications as recommended and adjusting medication (20,21). Contents lists available at SciVerse ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w. c a n a d ia n j o u r n a l o f d i a b e t e s. c o m

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