Special Article

Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus

Diabetes self-management behavior is important for patients to lessen disease-related complications, obtain optimum glycemic control and achieve a better quality of life. The study aimed to determine the relationship between dietary intake, nutrition knowledge, and self-management behaviors in Bangladeshi patients with type 2 diabetes mellitus (T2DM), with a focus on achieving optimal glycemic control, improving their quality of life. A cross-sectional study was conducted among T2DM patients from seven districts throughout Bangladesh. Data were collected using a validated semi-structured questionnaire for evaluating diabetes-related self-management behavior and existing nutrition knowledge. Dietary intakes were obtained using 24 h 3-days diet recall. Logistic regression analysis, Pearson's correlation and independent t-test were used to observe correlation and association among variables. A total of 411 patients with T2DM participated in the study, 59.4 % of patients achieved good dietary control, while 14.4 % were physically active, 49.4 % adhered well to medication, 44.0 % practiced effective self-monitoring, and 27.0 % possessed good diabetic nutrition knowledge. In fully adjusted multivariate logistic regression analysis, patients with a better glycemic control showed 14 times more control in their dietary intake [AOR: 14.21; 95 % CI: 5.62–35.94], and performing a good physical exercise 5 times more than the patients with high blood glucose level [AOR: 5.671; 95 % CI: 1.55–20.686]. Adherence toward medication prescription was also significantly higher among these patients. Glucose level was significantly higher among patients who had moderate [AOR: 3.367; 95 % CI: 1.29–8.73] and poor [AOR: 9.87; 95 % CI: 3.19–30.57] diabetes related nutritional knowledge. Patients with poor glycemic control consumed significantly more carbohydrates (251 ± 62 g vs 213 ± 47 g) and less dietary fiber (16.7 ± 4.5 g vs 20.5 ± 6.1 g) compared to the patients with optimum glycemic control. Our study findings suggest that, an improved level of nutrition knowledge may be beneficial to ensure optimum dietary intake, thus aid in an effective diabetes self-management behavior among Bangladeshi T2DM patients. Efforts should be made to help patient achieve optimum glycemic control, thus reduce their health-related complications and contribute to overall well-being.

Glycemic index (GI) is a measure of the ability of carbohydrate food to raise blood glucose concentration. The GI of a food and its negative effects has caused an adverse increase in the prevalence of diabetes and other metabolic diseases.

This study aimed to determine the effect of Alchornea cordifolia on glycemic indices of varieties of fufu.

The research was a crossover experimental study involving 10 healthy individuals. A 50-g measure of pure glucose was served on 2 separate occasions and, subsequently, a measured amount of the test foods containing 50 g of available carbohydrates. The GI values were determined by the measure of the blood glucose concentrations of the subjects at fasting and after ingestion of the glucose and the test foods (fufu) within 2 h. Collection of capillary blood for blood glucose measurement started 30 min after consumption and was subsequently taken at 60, 90, and 120 min for both noncomposited and composited fufu GI determination. The phytoconstituents of the A. cordifolia were also determined.

For the noncomposited fufu, plantain fufu had the least glycemic response (46%), followed by cassava fufu (50%) and cassava–plantain fufu (53%); however, all were in the low-GI category. For the composited fufu, plantain fufu had the least response (12%), followed by cassava–plantain fufu (14%) and cassava fufu (14%), with all in the low-GI category. A multiple comparison of GI on the various foods by analysis of variance revealed a significant difference between the GI of cassava–plantain fufu and composite cassava–plantain fufu (P = 0.001); cassava fufu and composite cassava fufu (P = 0.004); and plantain fufu and composite plantain fufu (P = 0.006). The phytochemical screening of the A. cordifolia revealed the presence of flavonoids and tannins.

Composited A. cordifolia fufu affects the glycemic response.

To investigate associations between avocado intake and glycemia in adults with Hispanic/Latino ancestry.

The associations of avocado intake with measures of insulin and glucose homeostasis were evaluated in a cross-sectional analysis of up to 14,591 Hispanic/Latino adults, using measures of: average glucose levels (hemoglobin A1c; HbA1c), fasting glucose and insulin, glucose and insulin levels after an oral glucose tolerance test (OGTT), and calculated measures of insulin resistance (HOMA-IR, and HOMA-%β), and insulinogenic index. Associations were assessed using multivariable linear regression models, which controlled for sociodemographic factors and health behaviors, and which were stratified by dysglycemia status.

In those with normoglycemia, avocado intake was associated with a higher insulinogenic index (β = 0.17 ± 0.07, P = 0.02). In those with T2D (treated and untreated), avocado intake was associated with lower hemoglobin A1c (HbA1c; β = −0.36 ± 0.21, P = 0.02), and lower fasting glucose (β = −0.27 ± 0.12, P = 0.02). In the those with untreated T2D, avocado intake was additionally associated with HOMA-%β (β = 0.39 ± 0.19, P = 0.04), higher insulin values 2-h after an oral glucose load (β = 0.62 ± 0.23, P = 0.01), and a higher insulinogenic index (β = 0.42 ± 0.18, P = 0.02). No associations were observed in participants with prediabetes.

We observed an association of avocado intake with better glucose/insulin homeostasis, especially in those with T2D.

Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D.

An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24−64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367.

Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: −0.80 to −0.16), while it increased in the control group by 0.22 (95% CI: −0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: −1.04 to −0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: −36.12 to −1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group.

The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs.

The research was funded by the University Grants Commission (UGC), Nepal.

This study was performed to assess the effects of long-term intake of a very high carbohydrate (VHCHO) diet (76% of total energy from carbohydrate [CHO]) on whole-body glucose tolerance and hepatic insulin resistance.

Male Sprague Dawley rats were fed either a control high-CHO diet (59% total energy from CHO; n = 8) or a VHCHO diet (76% total energy from CHO; n = 8) for 17 wk. At 4, 8, 12, and 16 wk of the dietary intervention, oral glucose tolerance test and homeostasis model assessment of insulin resistance (HOMA-IR) measurements were taken to assess whole-body glucose tolerance and hepatic insulin resistance, respectively. The triacylglycerol concentration in the liver was measured at the end of the 17-wk intervention period.

The VHCHO diet group showed significantly higher muscle glucose transporter 4 content and a smaller area under the curve for plasma glucose, but not insulin, in the oral glucose tolerance test compared with the control group. On the other hand, the VHCHO diet group had a significantly higher hepatic triacylglycerol concentration and HOMA-IR measurement compared with the control group. The hepatic triacylglycerol concentration was significantly and positively correlated with HOMA-IR.

The results of the present study suggest that long-term intake of a VHCHO diet exerts differential effects on whole-body glucose tolerance and hepatic insulin resistance.

Diabetes self-management education and support (DSME/S) is an efficient tool that allows individuals with diabetes to manage self-care behaviors and empowers decision-making and problem-solving skills necessary to maintain good diabetic control. Appropriate nutritional care and education specific to diabetes and multimorbidity should be provided by a professional to patients with diabetes (PWDs) to promote healthy eating patterns. Physical activity improves glycemic control and cardiovascular endurance, promotes weight loss, and decreases insulin resistance in PWDs. Self-monitoring of blood glucose gives an estimation of PWDs current glycemic status and subsequent interventions taken for its optimization. There are customized recommendations for festivals, holidays, traveling, driving, etc., which ought to be shared with PWDs. Frequent medical consultations with healthcare providers, in addition to measures such as skincare, foot care, teeth, and gum hygiene, along with weight loss and cessation of smoking, are helpful in achieving glycemic goals.