Secular Trends in Dietary Intake over a 20-Year Period in People with Type 2 Diabetes in Japan: A Comparative Study of Two Nationwide Registries; Japan Diabetes Complications Study (JDCS) and Japan Diabetes Clinical Data Management Study (JDDM)

Background: In order to provide effective dietary guidance, it is necessary to consider dietary intake, which can change over time. This study analyzed changes in the diet of Japanese patients with type 2 diabetes over a 20-year period. Methods: We compared the results of two dietary surveys that used the food frequency questionnaire format. The first was conducted in 1996 by the Japan Diabetes Complications Study (JDCS) (n = 1509; males 53.3%), and the second in 2014–2018 by the Japan Diabetes Clinical Data Management Study (JDDM) (n = 1145; males 65.6%). Both are nationwide representative registries of outpatients with type 2 diabetes in Japan. Results: Over a 20-year period, both men and women with type 2 diabetes had a significant increase in body mass index (BMI). Nonetheless, there was only a small change in energy intake. Conversely, there was a significant increase in fat intake and thus in the fat-to-energy ratio. With regard to food groups, there was a significant increase in meat intake and a decrease in the intake of fish, soybeans/soy products, vegetables, and fruits, with a particularly significant decrease in vegetables. Conclusions: Even in Japan, an industrialized country with a stable socioeconomic environment, there were many significant changes in the dietary intake of patients with type 2 diabetes over the 20-year period.     

Association between Obesity and Intake of Different Food Groups among Japanese with Type 2 Diabetes Mellitus—Japan Diabetes Clinical Data Management Study (JDDM68)

Background: We investigated the association between various food groups and obesity in Japanese patients with type 2 diabetes. Methods: 2070 patients with type 2 diabetes who attended 26 diabetes clinics throughout Japan were analyzed and were divided into obese and non-obese groups. Intakes of food groups determined by a food frequency questionnaire were compared. Odds ratios for obesity for quartiles of individual food groups were calculated using a logistic regression model. Results: Non-obese patients consumed a larger variety of food groups than obese patients, with the diets of non-obese individuals closer to the traditional Japanese diet characterized by fish, seaweed, and soybeans/soy products. Among 21 food groups, low vegetable intake and high sweets intake were the most strongly associated with obesity in both men and women. Low intake of both fruits and vegetables and the combination of high intake of sweets and low intake of fruits were associated with obesity. Conclusions: Food groups and their combinations that were strongly associated with obesity in Japanese patients with type 2 diabetes were identified. Our findings also suggested an inverse association between the traditional Japanese diet and obesity.     

Comparing Associations of Dietary Energy Density and Energy Intake,Macronutrients with Obesity in Patients with Type 2 Diabetes (JDDM 63)

To investigate the association between dietary energy density (DED) and obesity in people with type 2 diabetes mellitus. Moreover, we compared the strength of the associations of DED with intake of energy and macronutrients in terms of obesity as well as nutritional factors that have long been used for medical nutritional therapy. Cross-sectionally investigated were 1615 outpatients with type 2 diabetes who attended 26 clinics nationwide with diabetes specialists. Odds ratios (ORs) were calculated for the association between obesity and DED, energy, and macronutrients by quintile categories and a 1 SD increment with adjustment for potential confounders. β coefficients were calculated for the association between body mass index (BMI) and each nutritional factor by 1 SD increments in nutritional values. Multi-adjusted OR for obesity between extreme quintiles of DED was 2.99 (95% confidence interval (95% CI): 2.01–3.12). Conversely, the ORs did not differ significantly according to the quintiles of other nutrient factors. Multi-adjusted β coefficient of BMI per 1 SD according to DED was far higher than those of other nutrient factors (β coefficient 0.65, 95% CI: 0.41–0.88). These findings indicated that DED in persons with type 2 diabetes was positively associated with BMI and the prevalence of obesity. DED was also much more potently associated with obesity and BMI than nutritional indicators such as intake of energy or macronutrients.     

Quality and Quantity of Protein Intake Influence Incidence of Type 2 Diabetes Mellitus in Coronary Heart Disease Patients: From the CORDIOPREV Study

Evidence suggests that enriching a diet with plant-based proteins could reduce the risk of developing type 2 diabetes mellitus. In the present work, we evaluated the association between the change in plant protein intake (adjusted by energy) and incidence of type 2 diabetes mellitus in patients with coronary heart disease from the CORDIOPREV (coronary diet intervention with olive oil and cardiovascular prevention) study. At baseline and during the follow-up, patients underwent medical examination and blood and oral glucose tolerance tests. Information on patient’s dietary intake was gathered by registered dietitians using a validated food frequency questionnaire. A total of 106 out of 436 nondiabetic patients at baseline developed type 2 diabetes mellitus after a median follow-up of 60 months. Cox regression analyses showed that patients who belonged to the group that increased plant protein intake exhibited a lower risk of developing the disease (HR = 0.64, (0.43–0.96)). Changes in plant protein intake were positively correlated with changes in carbohydrates, fibre, and legumes intake and negatively correlated with changes in saturated fatty acids intake. Results of the present study support the need of improving diet with plant-based proteins to prevent the onset of type 2 diabetes mellitus.     

社区老年人2型糖尿病患者实行自我管理教育干预效果评价

目的探索建立老年2型糖尿病患者社区医院自我管理教育干预效果,提高糖尿病指标控制,节约医疗资源的新模式。方法江浦社区2型糖尿病患者经问询筛选出"四不"对象84名,随机分成两组,教育组与对照组,教育组接受全科医师自我管理教育干预,对照组只门诊随诊不做教育指导。结果空腹血糖、餐后2h血糖和糖化血红蛋白3项指标经3个月自我管理教育干预后,教育组教育前后指标差异有统计学显著意义(P﹤0.01)。对照组同期教育前后空腹血糖、糖化血红蛋白差别无统计学检验意义(P﹥0.05),餐后2h血糖同期教育前后差别有统计学意义。结论自我管理教育能有效提高"四不"糖尿病患者血糖等指标的控制,节约医疗资源有积极意义。     

Impact of Long-Term Complications on Quality of Life in Patients with Type 2 Diabetes not Using Insulin

Objectives: The complications of diabetes have the potential to greatly impact the health-related quality of life (HRQOL) of patients with type 2 diabetes. The effect of diabetic complications on HRQOL was assessed in 1233 patients with type 2 diabetes who were not using insulin.
Methods and data: Patients were aged 35 and older and had stable fasting serum glucose (FSG) after washout of antidiabetic therapy. Patients who required insulin or suffered from severe cardiovascular or hepatic disease, neuropathy, or retinopathy were excluded. Patients completed the SF-36 generic quality of life questionnaire. Demographic data, including body mass index (BMI), blood glucose hemoglobin A1c (HbA_1c), FSG, and the presence and severity of eight specified diabetic complications were also collected. A linear regression analysis was performed for each of the SF-36 domains and for the physical and mental health summary scales.
Results: The most prevalent diabetic complications were hypertension (46% of patients), peripheral sensory neuropathy (PSN; 12%), coronary artery disease (CAD; 8%), retinopathy (8%), and peripheral vascular disease (PVD; 7%). Most (73%) of the complications were assessed to be mild. PSN was associated with significantly lower scores (i.e., worse quality of life) in the mental health scale; CAD was associated with significant reductions of all but role-emotional and mental health scales of the SF-36; and PVD was associated with significantly lower physical and social functioning scales. Hypertension did not have an independent effect on HRQOL.
Conclusions: The presence of even mild diabetic complications has a significant impact on patients' quality of life. Early diagnosis and treatment is essential to help prevent deterioration of HRQOL in these patients.     

八段锦锻炼干预辅助治疗社区2型糖尿病108例效果评价

目的 观察八段锦锻炼对社区2型糖尿病患者血糖和血脂的影响.方法 对辖区内纳入社区慢病管理系统的108例糖尿病患者进行八段锦锻炼干预,干预疗程6个月,监测干预前、干预3个月和干预6个月后患者空腹血糖（FPG）、糖化血红蛋白（HbAlc）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）和低密度脂蛋白（LDL-C）变化情况.结果 与干预前相比,干预后3个月、6个月患者上述指标均有不同程度的改善,其中FPG分别下降4.07％、7.85％,HbAlc分别下降1.84％、6.23％,TG分别下降13.66％、22.03％,LDL-C分别下降8.12％、12.89％,干预前后各指标比较差异有统计学意义（P＜0.05）.结论 八段锦锻炼能够改善社区2型糖尿病患者血糖和血脂水平,是一种安全有效的辅助治疗措施.     

Assessment of Daily Food and Nutrient Intake in Japanese Type 2 Diabetes Mellitus Patients Using Dietary Reference Intakes

Medical nutrition therapy for the management of diabetes plays an important role in preventing diabetes complications and managing metabolic control. However, little is known about actual eating habits of individuals with type 2 diabetic mellitus (T2DM), especially in Japan. Therefore, we sought to (1) assess the dietary intake of individuals with T2DM, and (2) characterize their intake relative to national recommendations. This cross-sectional study involved 149 patients (77 males and 72 females) aged 40–79 years with T2DM recruited at a Kyoto hospital. Dietary intake was assessed using a validated self-administered diet history questionnaire. Under-consumption, adequacy, and over-consumption, of nutrients were compared to the age- and sex-based standards of the Japanese Dietary Reference Intakes. Among the results, most notable are (1) the inadequacy of diets in men with respect to intake of vitamins and minerals, likely owing to low intake of vegetables and fruits; (2) excess contributions of fat intake to total energy in both sexes; and (3) excess consumption of sweets and beverages relative to the national average. The prevalence of diabetes complications may be increasing because of a major gap between the typical dietary intake of individuals with T2DM and dietary recommendation.     

CysC对2型糖尿病慢性并发症的相关性分析

目的：探讨血清胱抑素C与2型糖尿病（T2DM）慢性并发症的相关性。方法：100例T2DM患者根据是否合并T2DM慢性并发症分为无合并糖尿病并发症的糖尿病对照组（NC组）,合并周围血管病变（PAD）组、合并肾脏病变（DN）组、合并视网膜病变（DR）组,合并周围神经病变（DPN）组,测定空腹血糖（FBG）、糖化血红蛋白（Hb A1c）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、血清胱抑素C并分析血清胱抑素C与各指标的相关性。结果：2型糖尿病合并PAD、DN、DR以及DPN组的血清CysC水平均高于不合并糖尿病并发症的糖尿病对照组（NC组）（P〈0.05）。结论：血清胱抑素C升高可作为提示糖尿病周围血管病变、肾脏病变、视网膜病变、周围周围神经病变危险性增加的参考指标,并可能是T2DM患者慢性并发症的独立危险因素。     

Habitual Dietary Fiber Intake,Fecal Microbiota,and Hemoglobin A1c Level in Chinese Patients with Type 2 Diabetes

High-fiber diet interventions have been proven to be beneficial for gut microbiota and glycemic control in diabetes patients. However, the effect of a low level of fiber in habitual diets remains unclear. This study aims to examine the associations of habitual dietary fiber intake with gut microbiome profiles among Chinese diabetes patients and identify differential taxa that mediated associations of dietary fiber with HbA1c level. Two cross-sectional studies and one longitudinal study were designed based on two follow-up surveys in a randomized trial conducted during 2015–2017. The study included 356 and 310 participants in the first and second follow-ups, respectively, with 293 participants in common in both surveys. Dietary fiber intake was calculated based on a 3-day 24-h diet recall at each survey and was classified into a lower or a higher group according to the levels taken based on the two surveys using 7.2 g/day as a cut-off value. HbA1c was assayed to assess glycemic status using a cut-off point of 7.0% and 8.0%. Microbiome was profiled by 16S rRNA sequencing. A high habitual dietary fiber intake was associated with a decrease in α-diversity in both the cross-sectional and longitudinal analyses. At the first follow–up, phylum Firmicutes and Fusobacteria were negatively associated with a higher dietary fiber intake (p < 0.05, Q < 0.15); at the second follow-up, genus Adlercreutzia, Prevotella, Ruminococcus, and Desulfovibrio were less abundant in patients taking higher dietary fiber (p < 0.05, Q < 0.15); genus Desulfovibrio and Ruminococcaceae (Unknown), two identified differential taxa by HbA1c level, were negatively associated with dietary fiber intake in both the cross-sectional and longitudinal analyses, and mediated the dietary fiber-HbA1c associations among patients taking dietary fiber ≥ 7.2 g/day (mediation effect β [95%CI]: −0.019 [−0.043, −0.003], p = 0.018 and −0.019 [−0.046, −0.003], p = 0.016). Our results suggest that habitual dietary fiber intake has a beneficial effect on gut microbiota in Chinese diabetes patients. Further studies are needed to confirm our results.     

2型糖尿病并发症患者的生命质量及其影响因素

目的探讨2型糖尿病并发症患者的生命质量及其影响因素。方法采用特异性糖尿病生命质量量表,调查102例2型糖尿病并发症患者的生命质量。采用非条件Logistic回归模型对资料进行分析。结果2型糖尿病并发症患者生命质量普遍降低,年长患者的生命质量优于年轻患者。主食、荤油摄入过多、喜食咸味是2型糖尿病并发症患者低生命质量的危险因素,OR值分别为2.515,2.167,1.920.强化治疗、适当增加业余体力活动量是其保护因素,OR值分别为0.976,0.485。结论鼓励2型糖尿病并发症患者加强糖尿病治疗,适当增加业余体力活动,限制主食、荤油、盐的摄入,将有助于改善生命质量。     

某三甲医院2007—2011年2型糖尿病住院费用分析

目的:通过对2型糖尿病住院费用的实证分析,探索其费用变化趋势及相关因素,为相关制度设计、控制费用增长、合理利用卫生资源、减轻经济负担提供参考。方法:收集某三甲医院2007—2011年出院的2型糖尿病住院费用资料,对其按照年度、年龄、费别及亚型分组进行描述性统计及方差分析。结果:住院费用呈逐年上升趋势,差异性显著(P<0.01),其中检查与非药品治疗费用上升较明显;费用变化与年龄、费别及亚型均相关,但费用在政策控制下仍可回落。结论:应通过规范治疗、加强预防控制、设计合理有效制度,有效利用医疗卫生资源、提高糖尿病患者生存质量、降低患者与社会经济负担。     

超敏C反应蛋白与2型糖尿病血管并发症的相关性研究

目的探讨超敏C反应蛋白（hs-CRP）与2型糖尿病（T2DM）患者血管并发症的相关性及其临床意义。方法236例T2DM患者分为大血管病变组107例,微血管病变组76例,无血管病变组53例,检测三组患者的血清hs-CRP水平并与32名健康人进行比较。结果T2DM大血管病变组、微血管病变组、无血管病变组hs-CRP平均水平分别为（8.03±3.36）、（7.54±1.72）和（4.35±1.34）mg/L,显著高于对照组（0.86±0.21）mg/L,差异有统计学意义（P均〈0.01）;大血管病变组和微血管病变组hs-CRP水平均显著高于无血管病变组,差异有统计学意义（P均〈0.01）;hs-CRP与血管病变严重程度、体重指数（BMI）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）呈正相关（P均〈0.01）。结论血清hs-CRP与T2DM血管并发症的发生有明显相关性,可作为T2DM患者监测病情变化及早期血管并发症的生物标志物。     

老年2型糖尿病合并急性脑梗死的护理干预

目的对老年2型糖尿病合并急性脑梗死的护理干预效果对比。方法随机抽取2011年5月至2012年5月期间患2型糖尿病合并急性脑梗死的老年患者60例,随机分为两组,对照组和改良组,各30例患者。对两组患者进行常规的护理干预,而对改良组中的患者在常规护理上加心理指导干预。对两组患者的疾病改善情况以及对于护理满意程度情况进行比较。结果30例对照组患者中,对于护理满意的患者有26例．占86．67％,而30例改良组患者中对于护理满意的患者有29例,占96．67％,即相对于对照组,改良组中的患者对于护理的满意程度更高,且患者的疾病改善情况更好;两组满意程度和疾病改善情况比较,差异均有统计学意义（P〈0．05）。结论在对2型糖尿病合并急性脑梗死患者进行一定的了解后,积极地对患者进行及时的治疗与护理．从而有效改善患者的疾病情况。     

上海市某社区2型糖尿病患者饮食干预效果评价

[目的]探索在社区开展糖尿病综合防治工作中对患者进行饮食干预的效果。[方法]2005年1-5月,在上海市嘉定区慢性病综合防治试点社区对83例2型糖尿病患者进行饮食干预,观察有关指标的变化。[结果]饮食干预前与干预后比较,患者的总能量摄入减少,蛋白质摄入量增加,脂肪与碳水化合物摄入减少（P〈0.01或〈0.05）;蛋白质供能比例增加,脂肪与碳水化合物供能比例降低;早餐和午餐供能比例增加,晚餐供能比例减少;空腹血糖值明显降低（P〈0.01）。[结论]对糖尿病病人进行膳食营养干预效果明显。     

Association of Estimated Salt and Miso Intake with the Prevalence of Obesity in People with Type 2 Diabetes: A Cross-Sectional Study

Salt intake is often estimated by the amount of sodium excreted in urine, and miso has been reported to increase it. This cross-sectional study investigated the relationship between obesity and high estimated salt intake with and without habitual miso consumption. Estimates of salt intake (g/day) were calculated using urinary sodium excretion, and a high estimated intake was defined as greater than the median amount of 9.5 g/day. Participants were divided into four groups based on estimated salt intake and miso consumption. Among 300 people, the proportions of obesity were 77.8% (n = 14/18), 40.2% (n = 53/132), 26.0% (n = 33/127), and 34.8% (n = 8/23) in the (+/−), (+/+), (−/+), and (−/−) groups of high estimated salt intake/habitual miso consumption, respectively. Compared with the (+/−) group, the adjusted odds ratios for obesity were 0.07 (95% confidence interval (CI): 0.02–0.26, p < 0.001), 0.16 (95% CI: 0.03–0.76, p = 0.022), and 0.14 (95% CI: 0.04–0.51, p = 0.003) in the (−/+), (−/−), and (+/+) groups, respectively. The presence of obesity was not much higher in people with high estimated salt intake with habitual miso consumption than that in people without. Clinicians should be aware that miso consumption promotes salt excretion, which may lead to an apparently higher estimated salt intake than actual.     

The Reliability and Validity of the Perceived Dietary Adherence Questionnaire for People with Type 2 Diabetes

Nutrition therapy is essential for diabetes treatment, and assessment of dietary intake can be time consuming. The purpose of this study was to develop a reliable and valid instrument to measure diabetic patients’ adherence to Canadian diabetes nutrition recommendations. Specific information derived from three, repeated 24-h dietary recalls of 64 type 2 diabetic patients, aged 59.2 ± 9.7 years, was correlated with a total score and individual items of the Perceived Dietary Adherence Questionnaire (PDAQ). Test-retest reliability was completed by 27 type 2 diabetic patients, aged 62.8 ± 8.4 years. The correlation coefficients for PDAQ items versus 24-h recalls ranged from 0.46 to 0.11. The intra-class correlation (0.78) was acceptable, indicating good reliability. The results suggest that PDAQ is a valid and reliable measure of diabetes nutrition recommendations. Because it is quick to administer and score, it may be useful as a screening tool in research and as a clinical tool to monitor dietary adherence.     

2型糖尿病合并高血压与单纯2型糖尿病的各项指标对比分析

目的进一步比较2型糖尿病合并高血压与单纯2型糖尿病的各项指标。方法本文选取了我院2010年8月至2012年3月间入院治疗的相关患者为研究对象,其中2型糖尿病合并高血压患者与单纯2型糖尿病患者各22例。针对两组患者的相关临床指标、各项生化指标以及血清脂联素水平、血清内脏脂肪素水平指标进行了测定,并针对测定结果进行了比较分析。结果两组患者在收缩压SBP、舒张压DBP等指标组间比较上,差异显著,且P均〈0．05,差异具有统计学意义：在血清脂联素水平和血清内脏脂肪素水平组间比较,差异显著,且P均〈0．05,差异具有统计学意义;其它指标相比较无显著意义。结论通过临床上的各项指标比较,提示内脏脂肪素、脂联素的表达与高血压和2型糖尿病的发生发展存在一定的相关性。     

Role of Gut Microbiota on Onset and Progression of Microvascular Complications of Type 2 Diabetes (T2DM)

Type 2 diabetes mellitus (T2DM) remains one of the most problematic and economic consumer disorders worldwide, with growing prevalence and incidence. Over the last years, substantial research has highlighted the intricate relationship among gut microbiota, dysbiosis and metabolic syndromes development. Changes in the gut microbiome composition lead to an imbalanced gastrointestinal habitat which promotes abnormal production of metabolites, inflammatory status, glucose metabolism alteration and even insulin resistance (IR). Short-chain fatty acids (SCFAs), trimethylamine N-oxide (TMAO), lipopolysaccharide, aromatic amino acids and their affiliated metabolites, contribute to T2DM via different metabolic and immunologic pathways. In this narrative review, we discuss the immunopathogenic mechanism behind gut dysbiosis, T2DM development and the major known diabetic microvascular complications (retinopathy, neuropathy and nephropathy), the beneficial use of pre- and pro-biotics and fecal microbiota transplantation in T2DM management and new findings and future perspectives in this field.     

Association Between Magnesium Status,Dietary Magnesium Intake,and Metabolic Control in Patients with Type 2 Diabetes Mellitus

Background: Hypomagnesemia could worsen glycemic control by impairing insulin release and promoting insulin resistance. On the contrary, type 2 diabetes mellitus (T2DM) may induce and/or exacerbate low serum magnesium levels, and this could, in turn, worsen glycemic control of diabetes.

Objective: The aim of this study was to investigate the relationship between serum magnesium level, dietary magnesium intake, and metabolic control parameters in patients with T2DM.

Methods: The study included 119 patients with T2DM (26 male, 93 female; mean age 54.7?±?8.4 years). Serum magnesium level was measured by spectrophotometric method. Magnesium intake was assessed by food frequency questionnaire. Anthropometric measurements were taken. The General Linear Model procedure was applied to determine the relationship of serum magnesium with quantitative variables.

Results: Of the 119 patients, 23.5% of the patients had inadequate magnesium intake (lower than 67% of the recommended daily allowance), and 18.5% had hypomagnesemia. In patients with hypomagnesemia (< 0.75?mmol/l), serum levels of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and serum glycosylated hemoglobin (HbA1c) were higher compared to patients with normomagnesemia. FPG levels were significantly higher in patients with hypomagnesemia in Model 1 (179.0?±?64.9 vs. 148.7?±?52.0?mg/dl, p?=?0.009) but the significance disappeared in other models. PPG levels were significantly higher in patients with hypomagnesemia in all models (287.9?±?108.4 vs. 226.8?±?89.4?mg/dl, p?=?0.006 for Model 1, p?=?0.027 for Model 2, p?=?0.016 for Model 3). Serum HbA1c levels were significantly higher in patients with hypomagnesemia, and this significance proceeded (8.0?±?1.9% vs. 6.5?±?1.2%, p?=?0.000 for all models). Body fat mass was significantly higher in patients with hypomagnesemia as compared to patients with normomagnesemia in model 3 (35.4?±?9.4?kg, 34.6?±?10.2?kg; p?=?0.034). Dietary magnesium intake was not significantly associated with either metabolic parameters or anthropometric measurements.

Conclusion: Hypomagnesemia in T2DM is directly associated with poor metabolic control. Clinical assessment should, therefore, focus on augmentation of magnesium status and adequate magnesium intake in patients with T2DM.