Diabetic Diets and Nutritional Recommendations: What Happens in Real Life?

Close, E.J.; Wiles, Philip; Lockton, J. A.; Walmsley, D.; Oldham, J; Wales, J. K.

doi:10.1111/j.1464-5491.1992.tb01756.x

Cited by 34 publications

(26 citation statements)

References 19 publications

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“…Findings from our own and other Lifestyle intervention in people with IDDM TL Perry et al studies (DCCT Research Group 1995;Capper et al, 1985;Close et al, 1992;Humphreys et al, 1994) Close et al, 1992;Humphreys et al, 1994). Similar ®ndings have been reported for people with NIDDM (Milne et al, 1994).…”

Section: Discussionsupporting

confidence: 75%

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Mann

Lewis‐Barned

et al. 1997

Eur J Clin Nutr

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Objective: To investigate the impact of intensive lifestyle education on dietary practices, exercise and metabolic measurements in people with insulin-dependent diabetes mellitus (IDDM). Design: Sixty-one volunteer subjects with IDDM were randomised to intensive (Group 1) or standard (Group 2) education programmes for six months. During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice (phase 2). Current insulin regimens were modi®ed to optimise glycaemic control before the start of the intervention phase. Nutrient intakes, weight, blood pressure, glycated haemoglobin (HbA 1 ), plasma lipids, lipoproteins and maximal oxygen consumption (VO 2 max) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2. Setting: Department of Human Nutrition at the University of Otago. Results: Glycated haemoglobin decreased signi®cantly in both groups between recruitment and randomisation, the improvement being sustained during the six months of the randomised trial and for group 1 during the six months of post trial observation. A further decrease was seen in Group 2 during the second six month period when they were given intensive advice. Comparable changes were seen with total and low density lipoprotein (LDL) cholesterol in Group 1 during the trial, but signi®cant decreases were only seen in Group 2 in association with intensive intervention (phase 2). These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids, a reduction in intakes of total and saturated fat, and an improvement in maximum oxygen consumption. Conclusions: A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits suf®cient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime. More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater bene®cial changes than those observed here.

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Section: Discussionsupporting

confidence: 75%

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Mann

Lewis‐Barned

et al. 1997

Eur J Clin Nutr

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“…Although dieticians and doctors try to adapt the instructions to each patient's individual needs, compliance to these recommendations seems to be quite difficult. Thus in a study of 92 Type 1 and Type 2 diabetic patients, less than 10% adhered to the recommendations for individual nutrients [33]. In the EURODIAB study, the proportion of Type 1 diabetic patients who achieved the recommended intake for protein was 77%, whereas for carbohydrates and fat it was very low (15% and 14% respectively).…”

Section: Discussionmentioning

confidence: 99%

Nutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD)

Thanopoulou¹,

Karamanos²,

Angelico

et al. 2004

Diabetologia

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Aims/hypothesis. The aim of this study was to compare the nutritional habits of Type 2 diabetic patients among Mediterranean countries and also with those of their background population and with the nutritional recommendations of the Diabetes and Nutrition Study Group. Methods. We did a cross-sectional study of 1833 nondiabetic subjects and 1895 patients with Type 2 diabetes, in nine centres in six Mediterranean countries. A dietary questionnaire validated against the 3-Day Diet Diary was used.Results. In diabetic patients the contribution of proteins, carbohydrates and fat to the energy intake varied greatly among centres, ranging from 17.6% to 21.0% for protein, from 37.7% to 53.0% for carbohydrates and from 27.2% to 40.8% for fat, following in every centre the trends of the non-diabetic population. Furthermore, diabetic patients compared to the corresponding background population had: (i) lower energy intake, (ii) lower carbohydrate and higher protein contribution to the energy intake, (iii) higher prevalence of obesity, ranging from 9 to 50%. The adherence to the nutritional recommendations for proteins, carbohydrate and fat was very low ranging from 1.4 to 23.6%, and still decreased when fibre was also considered. Conclusion/interpretation. In diabetic patients of the Mediterranean area: (i) dietary habits vary greatly among countries, according to the same trends of the background population; (ii) the prevalence of obesity is much lower than the 80% reported for patients with diabetes in Western countries; (iii) Carbohydrate intake is decreased with a complementary increase of protein and fat consumption, resulting to a poor compliance with the nutritional recommendations. [Diabetologia (2004) 47:367-376]

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“…In the present context, it is noteworthy that our diabetic subjects appear representative in many respects of type 2 diabetes in Norway (9), as well as of Northern European eating habits (10,18). Also, the variability in several diabetes-related characteristics between individuals that we find can be considered typical for type 2 diabetes (21).…”

Section: Discussionmentioning

confidence: 99%

Acute lowering of circulating fatty acids improves insulin secretion in a subset of type 2 diabetes subjects

Qvigstad

Mostad

Bjerve

et al. 2003

American Journal of Physiology-Endocrinology and Metabolism

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Qvigstad, Elisabeth, Ingrid L. Mostad, Kristian S. Bjerve, and Valdemar E. Grill. Acute lowering of circulating fatty acids improves insulin secretion in a subset of type 2 diabetes subjects. Am J Physiol Endocrinol Metab 284: E129-E137, 2003; 10.1152/ajpendo.00114.2002.-We tested the effects of acute perturbations of elevated fatty acids (FA) on insulin secretion in type 2 diabetes. Twenty-one type 2 diabetes subjects with hypertriglyceridemia (triacylglycerol Ͼ2.2 mmol/l) and 10 age-matched nondiabetic subjects participated. Glucose-stimulated insulin secretion was monitored during hyperglycemic clamps for 120 min. An infusion of Intralipid and heparin was added during minutes 60-120. In one of two tests, the subjects ingested 250 mg of Acipimox 60 min before the hyperglycemic clamp. A third test (also with Acipimox) was performed in 17 of the diabetic subjects after 3 days of a low-fat diet. Acipimox lowered FA levels and enhanced insulin sensitivity in nondiabetic and diabetic subjects alike. Acipimox administration failed to affect insulin secretion rates in nondiabetic subjects and in the group of diabetic subjects as a whole. However, in the diabetic subjects, Acipimox increased integrated insulin secretion rates during minutes 60-120 in the 50% having the lowest levels of hemoglobin A 1c (379 Ϯ 34 vs. 326 Ϯ 30 pmol ⅐ kg Ϫ1 ⅐ min Ϫ1 without Acipimox, P Ͻ 0.05). A 3-day dietary intervention diminished energy from fat from 39 to 23% without affecting FA levels and without improving the insulin response during clamps. Elevated FA levels may tonically inhibit stimulated insulin secretion in a subset of type 2 diabetic subjects. insulin sensitivity; hypertriglyceridemia; lipotoxicity; Acipimox; low-fat diet AN ELEVATED PLASMA LEVEL of fatty acids (FA) is a risk factor for type 2 diabetes (8, 24). The risk has been ascribed to an insulin resistance-inducing effect of FA in skeletal muscle and in liver (3). Randle and colleagues proposed many years ago that resistance may be due to a glucose-fatty acid cycle, i.e., a reciprocal relationship between the metabolism of FA and glucose in which abundance of FA decreases the uptake and metabolism of glucose (reviewed in Refs. 27, 28). The pyruvate dehydrogenase (PDH) complex played a key role in this concept. It was demonstrated in liver, heart, and skeletal muscle that FA decreased PDH activity through activation of PDH kinase (27, 28). Evidence was presented that an ambient effect of FA on PDH kinase activity was supplemented by a timedependent one. Many data support the operation of the glucose-fatty acid cycle (27), although alternative concepts have also been put forward (17, 37).More recent evidence indicates that elevated FA can exert negative effects on pancreatic ␤-cells and that such effects add to the diabetogenicity of elevated FA. In the obese and diabetic Zucker rat, triacylglycerols accumulate in ␤-cells in conjunction with elevated plasma FA (for review see Ref. 19). Such accumulation has been associated with ␤-cell damage, with proposed implications i...

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Diabetic Diets and Nutritional Recommendations: What Happens in Real Life?

Cited by 34 publications

References 19 publications

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Nutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD)

Acute lowering of circulating fatty acids improves insulin secretion in a subset of type 2 diabetes subjects

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