Importance of Glycemic Control in Diabetes

Based on the Diabetes Control and Complications Trial data in type-1 diabetes 27 , it was considered that improved glycemic control would help in the prevention of diabetes-associated complications 28 . This view has been confirmed by the results of the UK Prospective Diabetes Study in type-2 diabetes 19 . Loss of excess body weight continues to be a goal for patients with type-2 diabetes to improve blood glucose control and serum lipid profiles. Furthermore, in view of the threefold to...

Safety Considerations

As with any population, increasing physical activity has some potential risk for the patient with type-2 diabetes. Individuals who have underlying coronary heart disease, as in non-diabetic patients with heart disease, exercise may theoretically precipitate angina, myocardial infarction, arrhythmias or even sudden death. As with other patients with coronary heart disease, physical activity is contraindicated in the presence of unstable angina. High intensity aerobic exercise and isometric...

HP Sauerwein

Department of Endocrinology and Metabolism, Academic Medical Centre, Amsterdam, The Netherlands The metabolic syndrome is a common metabolic disorder that results from the increasing prevalence of obesity. It also refers to a clustering of specific cardiovascular disease risk factors whose underlying pathophysiology is thought to be related to insulin resistance with an excessive flux of fatty acids implicated. Opinions have varied as to whether the metabolic syndrome should be defined to...

Body Mass The Elusive Trigger of Type1 Diabetes

If the rising incidence and earlier presentation of diabetes were to be explained by an ever heavier population at all ages, weight gain would have as much a role in the changes of demography of type-1 diabetes as it does in that of type 2. Ascribing the rising incidence of type-1 diabetes to metabolic, rather than to immunological, factors has novel and important implications. Clinical research over the past 30 years has focused almost exclusively on exogenous factors (viruses, toxins,...

Special Considerations for Physical Activity and Type2 Diabetes

Exercise testing is recommended for many persons with type-2 diabetes before beginning an exercise conditioning program because of the high prevalence of occult cardiovascular disease, symptoms of which may only be manifested during exercise 30, 31 . Specifically, many patients with diabetes may have ischemia or infarction without angina. Most experts recommend that persons with type-2 diabetes be tested if the individual has previously been inactive, has had diabetes for more than 10 years, or...

Aims and Goals of Nutritional Advice

There is a general agreement among the various scientific organizations mentioned above regarding the goals of MNT in diabetes. These goals are generally the following, as addressed in the ADA statement 5 Attain and maintain recommended metabolic outcomes, including glucose and HbA1c levels, LDL cholesterol, HDL cholesterol, triglyceride levels, blood pressure and body weight. Prevent and treat the chronic complications and comorbidities of diabetes. Modify nutrient intake and lifestyle as...

Therapeutic Patient Education of Obese Patients

Cognitive Analytic Therapy Formulation

Much of our experience has come through the treatment of type-2 diabetic patients suffering from obesity 24 . More than 80 of our type-2 diabetic patients are overweight, very often due to dietary behavior of a binge-eating disorder. The usual nutritional approach is insufficient, since even ideal teaching of dietary knowledge, and the fat contents of foods does not bring about a lasting loss of weight. Even multiplying the number of practical teaching exercises on food management, shopping...

Cyril WC Kendall Livia SA Augustin Azadeh Emam Andrea R Josse Nishta Saxena David JA Jenkins

Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, and Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital Toronto, Ont., Canada The glycemic index concept owes much to the dietary fiber hypothesis that fiber would reduce the rate of nutrient absorption and increase the value of carbohydrate foods in the maintenance of health and treatment of disease. However, properties and components of food other than its fiber content contribute to the...

Lifestyle Modification Works

The largest, most comprehensive and impressive study to date to document the beneficial effects of lifestyle modification is the Diabetes Prevention Program (DPP) 11 . The DPP randomly assigned 3,234 non-diabetic individuals with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice a day), or a lifestyle modification invention with the goals of a 7 weight loss and 150 min of physical activity per week. Average follow-up was 2.8 years. Results were...

Increased Oxidative Load in Diabetes the Role of Hyperglycemia

Many but not all studies have found increased accumulation of oxidation byproducts in diabetes. Lipid peroxidation byproducts such as exhaled ethane or pentane, malondialdehyde, conjugated dienes and F2-isoprostanes are increased in diabetic subjects and in animal models of diabetes for review see 3, 4 . Similarly, oxidation byproducts of proteins and deoxynucleic acids (DNA) are increased. The mechanisms underlying the increased oxidative byproducts in diabetes are multiple. These mechanisms...

HaiLu Zhao Peter CY Tong Juliana CN Chan

Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China This review focuses on the efficacy and safety of Chinese medicine in the treatment of type-2 diabetes. Included were 84 controlled clinical studies of type-2 diabetes treated with Chinese medicine for at least 1 month. Reported outcomes were symptom relief improvement in glycemia, insulin resistance and secondary failure, and adverse events. Symptom relief was achieved...

Pathophysiology and Pathogenesis of GDM

Normal pregnancy and GDM are states of profound insulin resistance and the mediating factors are similar, if not identical. However, women who develop GDM tend also to be insulin-resistant when not pregnant and become even more insulin-resistant during pregnancy 18 . GDM develops when p cells are unable to compensate the increasing insulin resistance with sufficiently greater insulin secretion to maintain normal fasting and or postprandial glucose concentrations 18, 19 . For many years,...

Conclusion

The dietary glycemic index concept supports a role for the rate of carbohydrate digestion in the prevention and treatment of chronic disease, including those diseases which have been highlighted in the dietary fiber and insulin-resistance syndrome hypotheses. This concept should not be seen as particularly radical at a time when pharmacological approaches to slowing absorption, notably the a-glycoside hydrolase inhibitors, are now accepted in the management of diabetes. Further longer term...

Other Evidence for Dietary Effects

Although the technical review published by the American Diabetes Association found insufficient evidence for recommending food selection based on the glycemic index 3 , there is some evidence suggesting that a lower glycemic index effect of a food on raising the blood glucose or glycemic load a product of the amounts of food with their glycemic indices may reduce the incidence of type-2 diabetes. The Health Professional Follow-up Study of Men reported that neither glycemic load nor cereal fiber...