Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment--Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial

Abstract

Objective To determine the extent to which intensive dietary intervention can influence glycaemic control and risk factors for cardiovascular disease in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment.Design Randomised controlled trial.Setting Dunedin, New Zealand.Participants 93 participants aged less than 70 years with type 2 diabetes and a glycated haemoglobin (HbA1c) of more than 7% despite optimised drug treatments plus at least two of overweight or obesity, hypertension, and dyslipidaemia.Intervention Intensive individualised dietary advice (according to the nutritional recommendations of the European Association for the Study of Diabetes) for six months; both the intervention and control participants continued with their usual medical surveillance.Main outcome measures HbA1c was the primary outcome. Secondary outcomes included measures of adiposity, blood pressure, and lipid profile.Results After adjustment for age, sex, and baseline measurements, the difference in HbA1c between the intervention and control groups at six months (−0.4%, 95% confidence interval −0.7% to −0.1%) was highly statistically significant (P=0.007), as were the decreases in weight (−1.3 kg, −2.4 to −0.1 kg; P=0.032), body mass index (−0.5, −0.9 to −0.1; P=0.026), and waist circumference (−1.6 cm, −2.7 to −0.5 cm; P=0.005). A decrease in saturated fat (−1.9% total energy, −3.3% to −0.6%; P=0.006) and an increase in protein (1.6% total energy, 0.04% to 3.1%; P=0.045) in the intervention group were the most striking differences in nutritional intake between the two groups.Conclusions Intensive dietary advice has the potential to appreciably improve glycaemic control and anthropometric measures in patients with type 2 diabetes and unsatisfactory HbA1c despite optimised hypoglycaemic drug treatment.Trial registration Clinical trials NCT00124553.

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“…Coppell et al from Otago 223 carried out a randomised trial of an intensive nutritional intervention (seven individual sessions with a dietitian, one group session and telephone calls) compared with standard care (GP or hospital clinic). After 6 months, the intensive group recorded reductions in HbA 1c (0.5%), weight (2.1 kg), waist circumferences (3.5 cm), SBP (4.1 mmHg) and TC (0.24 mmol/l), whereas HDL-C was unchanged.…”

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria

“…This finding may be in part consistent with studies which reported that patients might be deviating from dietary recommendations due to contradictory and confusing advice from a variety of sources including healthcare professionals, media, and social contact 43,44 . The suboptimal commitment to dietary recommendations is a call for concern among diabetes primary care provider, and this possibly suggests the need to ensure provision of consistent and unequivocal dietary information for type 2 diabetes patients generally 42,45 . Although, frequent self-monitoring of blood glucose (SMBG) is significantly associated with better glycemic control 46,47 , the low level of SMBG practice among significant proportion of patients has been reported in numerous studies 48,49 .…”

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“…19 Com relação à alimentação saudável/controle/prevenção, observa-se que 57 (95%) pacientes sabem de sua importância. Segundo Coppell, 21 as modificações na alimentação são reconhecidas como um dos principais recursos para controle glicêmico e para redução do risco das doenças cardiovasculares, retardando assim outras complicações.…”