The effect of education and mobile health management on improvement of blood glucose with type 2 diabetes mellitus

Aim

The purpose of this study was to evaluate the effect of education and mobile health management on improvement of blood glucose levels in patients with type 2 diabetes mellitus.

Subjects and methods

A total of 209 patients (91 women, 118 men) with type 2 diabetes mellitus using both basal insulin and oral hypoglycemic agents participated in the study from August to December 2015. They were followed up at week 1, 2, 4, 8, 12, and 16, respectively. During follow-up, patients received education from professional diabetes educator nurses. Meanwhile, patients needed to upload their fasting plasma glucose levels three times or more and their postprandial plasma glucose level on a panel computer. The program duration was 16 weeks.

Results

Compared with baseline, fasting plasma glucose (9.7 mmol/l vs. 6.8 mmol/l, P?<?0.001) and postprandial plasma glucose (10.4 mmol/l vs. 9.5 mmol/l, P?<?0.001) levels had decreased significantly at week 16. The number of patients with hemoglobin A1c < 7% increased significantly from 33 at baseline to 115 at week 16 (P?<?0.001).

Conclusion

Our study indicated that education and the mobile health management can effectively improve blood glucose levels of patients with postprandial plasma glucose.

     

A pilot,randomized controlled trial to examine the health outcomes of raisin consumption in patients with diabetes

ObjectivesDried fruits, like their fresh homologues, contain relatively high concentrations of antioxidants. The aim of this study was to determine the health outcomes of raisin consumption on patients with diabetes.MethodsWe examined the effects of dried grapes (Vitis vinifera) cultivated in Greece, namely Corinthian Raisins (CR) on blood pressure, fasting glucose, glucated hemoglobin (HbA_1c), lipid peroxidation, high-sensitivity C-reactive protein, antioxidant status, and cytokines in patients with type 2 diabetes mellitus (T2DM). Forty-eight well-controlled patients with T2DM from the diabetes outpatient clinic of our hospital were recruited to a two-armed, randomized, controlled, 24-wk prospective intervention trial in order to examine the health outcomes of CR consumption. All participants were reported to consume less fruits and vegetables than the recommended amount of five servings daily. Participants in the intervention were instructed to consume CR equal to two fruit servings (36 g/d), replacing snacks with similar energy density twice during the day. Anthropometric and blood pressure measurements, assessment of dietary intake, and fasting blood draws were conducted at baseline and at week 24. Also, phenolic compounds present in CR were analyzed in plasma of the patients. t Test for parametric data and Mann-Whitney test or Wilcoxon test for non-parametric data were performed. Significance was set at P < 0.05.ResultsBody weight, glycemic control, and lipid profile were not affected in either arm. Patients in the CR arm reduced their diastolic blood pressure and increased their total antioxidant potential significantly compared with baseline. The differences between the two groups at week 24 were significant. No change in high-sensitivity C-reactive protein was observed. A significant difference in plasma circulating p-hydroxybenzoic acid was observed between groups at the end of the trial.ConclusionsOur study shows that naturally CR may improve health features in patients with well-controlled T2DM.     

The effect of ginger consumption on glycemic status,lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus

Objective: To assess the effect of ginger consumption on glycemic status, lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus. Methods: In a double-blinded, placebo-controlled clinical trial, 70 type 2 diabetic patients were enrolled. They allocated randomly into ginger group and control group. They consumed 1600?mg ginger versus 1600?mg wheat flour placebo daily for 12 weeks. Serum sugar, lipids, CRP, PGE2 and TNFα were measured before and after intervention. Results: Ginger reduced fasting plasma glucose, HbA_1C, insulin, HOMA, triglyceride, total cholesterol, CRP and PGE₂ significantly compared with placebo group (p?p?>?0.05). Conclusion: Ginger improved insulin sensitivity and some fractions of lipid profile, and reduced CRP and PGE₂ in type 2 diabetic patients. Therefore ginger can be considered as an effective treatment for prevention of diabetes complications.     

Cinnamon extract improves fasting blood glucose and glycosylated hemoglobin level in Chinese patients with type 2 diabetes

For thousands of years, cinnamon has been used as a traditional treatment in China. However, there are no studies to date that investigate whether cinnamon supplements are able to aid in the treatment of type 2 diabetes in Chinese subjects. We hypothesized cinnamon should be effective in improving blood glucose control in Chinese patients with type 2 diabetes. To address this hypothesis, we performed a randomized, double-blinded clinical study to analyze the effect of cinnamon extract on glycosylated hemoglobin A_1c and fasting blood glucose levels in Chinese patients with type 2 diabetes. A total of 66 patients with type 2 diabetes were recruited and randomly divided into 3 groups: placebo and low-dose and high-dose supplementation with cinnamon extract at 120 and 360 mg/d, respectively. Patients in all 3 groups took gliclazide during the entire 3 months of the study. Both hemoglobin A_1c and fasting blood glucose levels were significantly reduced in patients in the low- and high-dose groups, whereas they were not changed in the placebo group. The blood triglyceride levels were also significantly reduced in the low-dose group. The blood levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and liver transaminase remained unchanged in the 3 groups. In conclusion, our study indicates that cinnamon supplementation is able to significantly improve blood glucose control in Chinese patients with type 2 diabetes.     

Energy Intake and Glycemia in Lactating Women with Type 1 Diabetes

Objective To describe glycemia and insulin administration in lactating women with type 1 diabetes and compare their energy intake, lactation onset, and postpartum weight to lactating women without diabetes.Design A prospective observational study conducted at 2, 3, 6, 14, 42, and 84 days postpartum. Insulin dosage and glucose levels after fasting and at 80 and 110 minutes after eating (by measuring capillary blood glucose concentrations and glycated hemoglobin [HbA_1c] values) are described for women with type 1 diabetes. Dietary intake, weight, and lactation onset for women with type 1 diabetes are compared with those without the disease.Subjects/setting Fourteen lactating women with type 1 diabetes and 25 women without diabetes (control subjects) were recruited from private obstetrician offices and high-risk prenatal clinics at 3 major medical centers.Statistical analyses A repeated-measures 2-factor analysis of variance was used to determine group, time, and interaction effects between women with type 1 diabetes and the control group at 2, 3, 7, 14, 42, and 84 days postpartum.Results Seven women with type 1 diabetes breast-fed through 84 days postpartum, although they perceived later onset of milk and had fasting and postprandial hyperglycemia. Their HbA_1c levels increased by 20%, confirming relative hyperglycemia. After adjustment for prepregnancy weight, women with type 1 diabetes consumed 7 kcal fewer per kilogram per day than control subjects. Average insulin dose was returned to prepregnancy levels of 45.3±3.6 U/d (least square means±standard error of the mean) by 1 week.Application Achieving desired metabolic control during the establishment of lactation is difficult. A better understanding of energy and insulin needs and their relationship to lactation in women with type 1 diabetes is needed. J Am Diet Assoc. 1998; 98: 642–648.     

Insulin Therapy in Patients with Type 2 Diabetes Mellitus

Objective: To support policy-making for patients with diabetes mellitus we compared the costs and effectiveness of initiation of insulin therapy in patients with type 2 diabetes mellitus in 2 settings in The Netherlands. Design: Retrospective cohort study. Setting: A shared-care setting and an outpatient care setting of a university hospital. Both settings are located in Amsterdam, The Netherlands. Patients: All patients with type 2 diabetes mellitus above 40 years of age who were transferred to insulin therapy in 1993 in both settings. Intervention: Initiation and monitoring of insulin therapy in patients with type 2 diabetes mellitus. Study perspective: Healthcare sector. Main outcome measures: Baseline and 12 months glycosylated hemoglobin (HbA_1c) values and fasting blood glucose levels, and direct healthcare costs of insulin therapy. Costs were expressed in 1996 Dutch guilders (NLG) [NLG1 = 0.5 US dollars ($US)]. Results: In the shared-care setting (n = 57) the per patient healthcare costs during 1 year of follow-up averaged NLG2467. In the secondary care setting (n = 45) healthcare costs averaged NLG2740. A sensitivity analysis demonstrated that healthcare costs per patient were in the same range in both settings, ranging from NLG2000 to about NLG3400 ($US1000 to $US1700). Mean HbA_1c values fell from 9.1 to 7.9% (shared-care setting; p < 0.05) and from 10.2 to 8.2% (secondary care setting; p < 0.05). The percentage of patients with poor glycemic control (HbA_1c >8.5%) decreased from 56 to 30% (shared-care setting) and from 76 to 36% (secondary care setting). The percentage of patients with good glycemic control (HbA_1c <7%) increased from 4 to 23% (shared-care setting) and from 2 to 18% (secondary care setting). Conclusions: The study shows that in the first year of insulin therapy in patients with type 2 diabetes mellitus, acceptable glycemic control (HbA_1c >8.5%) can be attained in the majority of patients in both a shared-care and a secondary care setting, at comparable low average costs per patient.     

Diabetes mellitus in Irish general practice: Level of care as reflected by HbA1c values

Objective: To assess the level of care given to people with diabetes by general practitioners and factors affecting it. Methods: A cross-sectional study of Irish general practitioners, looking at practice characteristics and patient care over the previous 2 years; a nationally representative sample of 27 general practitioners. A total of 1030 people with diabetes were studied, of whom 201 were type 1 and 829 were type 2. Results: The response rate was 27 out of 52 (52%). HbA_1c values were not related to the patient's socioeconomic status. The average HbA_1c for type 1 people with diabetes was 7.81%, and for type 2 it was 7.1%. HbA_1c values were measured 3.02 times for type 1 and 3.16 times for people with type 2 diabetes. This is a good standard of care, especially for type 2 disease. Computerized practices and those patients whose care was shared with the hospital achieved better control, even though HbA_1c levels were checked less frequently with computerization. The use of a protocol in the practices also improved care. Those practices employing a nurse had increased frequency of measurement of HbA_1c and better control on univariate but not on multivariate analysis. Possible reasons for this are discussed.

Conclusion: Diabetes Mellitus is treated to a good standard in Irish general practice, especially type 2 disease. This standard appears to be independent of the patient's socio-economic status, is improved by GPs being computerised, in group practices and by providing care according to a protocol. Shared care also improves control. Employing a practice nurse may also improve care.     

Glycemic control of type 2 diabetic patients after short-term zinc supplementation

This study was carried out to determine whether a short-term zinc supplementation contributes to beneficial changes in glycemic control among type 2 diabetic patients. Seventy-six diabetic subjects and 72 normal adults participated in this study. Subjects were divided into supplemented and control groups. Forty-four diabetic patients and 34 normal subjects were supplemented with 50 mg zinc daily as zinc gluconate for 4 weeks. Zinc status was assessed from fasting plasma levels and urinary excretion. The effects of zinc supplementation on fasting blood glucose, HbA_1c, insulin, and C-peptide were measured at the beginning of the study and after 4 weeks of supplementation. The changes in glycemic control indicators were compared between diabetic groups, classified by baseline HbA_1c levels, and by diabetic duration. At baseline, the incidence of marginal zinc deficiency in the diabetic group, as determined by plasma zinc level, was approximately twice as high as in the normal adult group. The changes of HbA_1c concentration, and fasting blood glucose following supplementation were not statistically significant in diabetic subjects. In normal subjects, a significant decrease of HbA_1c occurred only in the zinc supplemented group. No significant changes were observed for serum insulin and C-peptide in diabetic as well as normal subjects. However, when the changes were compared by baseline HbA_1c level, we found that diabetic subjects with HbA_1c ≥ 7.5% showed significantly improved levels of HbA_1c and fasting glucose after Zn supplementation. While such improvement in fasting blood glucose was significant among diabetics with shorter diabetic duration, significant levels of increase in serum insulin and C-peptide were observed in zinc supplemented subjects with longer diabetic duration. Fasting blood glucose was significantly decreased, whereas serum insulin and C-peptide were increased in diabetics with marginal zinc status. Therefore, we suggest that Zn supplementation for a short-term period may improve glycemic control in diabetic patients with higher HbA_1c levels and marginal zinc status.     

Effect of fruits and vegetables on metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials

Abstract

Evidence regarding the effect of fruit and vegetable consumption on metabolic syndrome remains inconclusive. Using MEDLINE, EMBASE, and Cochrane, we searched for relevant studies published before 10 December 2013. Of the 383 articles identified, eight randomized controlled trials with 396 participants (205 in intervention groups and 191 in control groups) were included in the final analyses. Fruit and vegetable intake was associated with a reduction in diastolic blood pressure (standardized mean difference: ?0.29; 95% confidence interval: ?0.57 to ?0.02; p?=?0.04); however, such intake did not affect waist circumference, systolic blood pressure, fasting glucose, high-density lipoprotein cholesterol, and triglyceride levels in metabolic syndrome patients. In a subgroup analysis, there were no statistically significant differences found according to the intervention period and provision type. Our results suggest an inverse association between fruit and vegetable consumption and diastolic blood pressure in metabolic syndrome patients.     

Carbohydrate Intake Interacts With SNP276G>T Polymorphism in the Adiponectin Gene to Affect Fasting Blood Glucose,HbA1C,and HDL Cholesterol in Korean Patients With Type 2 Diabetes

Background/Objective: The SNP276G>T polymorphism in the adiponectin gene has been reported to be associated with type 2 diabetes and impaired glucose tolerance. The objective of this study was to examine whether SNP276G>T polymorphism influences the blood glucose levels in relation to dietary carbohydrate intake.

Subjects/Methods: In an ongoing, prospective study, 673 patients with type 2 diabetes (339 men and 334 women, aged 40–85 years) were recruited from one of two diabetes clinics in Seoul, Korea. The levels of carbohydrate intake were categorized as <55%, 55%–65%, and >65% of total energy intake.

Results: Significant gene–nutrient interactions between SNP276G>T polymorphism and the level of carbohydrate intake were found, which modulated plasma fasting blood glucose ( p = 0.0277), HbA1C ( p = 0.0407), and high-density lipoprotein (HDL) cholesterol ( p = 0.0134) concentrations. The G allele was associated with higher fasting blood glucose only in subjects consuming a low-carbohydrate diet (<55% of energy). However, when carbohydrate intake was intermediate (55%–65%), carriers of the T allele had greater fasting blood glucose and HbA1C concentrations. When carbohydrate intake was high (>65%), carriers of the T allele had greater HDL cholesterol concentrations. This interaction was significant even when carbohydrate intake was considered a continuous variable ( p = 0.0200 for fasting blood glucose, p = 0.0408 for HbA1C, and p = 0.0254 for HDL cholesterol), suggesting a strong dose–response relation.

Conclusions: Our data show that the effect of the SNP276G>T polymorphism on plasma fasting blood glucose, HbA1C, and HDL cholesterol concentrations depends on dietary carbohydrate intake.     

The effects of folate supplementation on glucose metabolism and risk of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Purpose: Observationally, homocysteine is associated with higher risk of diabetes. Folate, which reduces homocysteine, is promising for the prevention and treatment of diabetes. Previous meta-analysis of three trials suggested folate might lower hemoglobin A_1c (HbA_1c). Methods: An updated systematic review and meta-analysis of placebo-controlled randomized trials was conducted. We searched PubMed using (“folate” or “folic acid”) and trial and (“glucose” or “diabetes” or “insulin” or “hemoglobin A_1c” or “HbA_1c”) in any field until February 3, 2017. We also conducted a bibliographic search of selected studies and relevant reviews. Relative risk of diabetes and mean differences in indicators of glucose metabolism between folate and placebo were summarized in a meta-analysis using inverse variance weighting with random effects. Heterogeneity, publication bias, and risk of bias were also assessed. Results: Eighteen trials of 21,081 people with/without diabetes were identified. Folate decreased fasting glucose (?0.15 mmol/L, 95% confidence interval [CI] ?0.29 to ?0.01), homeostatic model assessment–insulin resistance (?0.83, 95% CI ?1.31 to ?0.34), and insulin (?1.94 μIU/mL, 95% CI ?3.28 to ?0.61) but had no clear effect on diabetes or HbA_1c. Conclusions: Our study suggests a potential benefit of folate on insulin resistance and glycemic control; the latter requires examination in more high-quality trials.     

Use of HbA<Subscript>1c</Subscript> in Screening for Cuban-Americans with Undiagnosed Type 2 Diabetes

This study evaluated the use of HbA_1c as a screening tool for undiagnosed type 2 diabetes (fasting plasma glucose ≥7.0 mmol/l) in a sample of Cuban-Americans aged ≥ 30 years old. Subjects were randomly recruited from Miami-Dade and Broward counties, FL. Fasting plasma glucose was measured by hexokinase enzymatic method. HbA_1c was measured by the DCA2000 + system using the monoclonal antibody method. HbA_1c demonstrated a high predictive value in detecting undiagnosed diabetes. The area under the receiver operating characteristics (ROC) curve was 0.87. Also, HbA_1c had high sensitivity and specificity when using a cut off value of 6.37 (71 and 86%, respectively). Moderate sensitivity and very high specificity were shown with a cut off value of 6.84 (57 and 96%, respectively). HbA_1c is a reliable alternative to fasting plasma glucose in screening for undiagnosed diabetes in Cuban-Americans.     

Glycemic Control and Insulin Improve Muscle Mass and Gait Speed in Type 2 Diabetes: The MUSCLES-DM Study

ObjectivesType 2 diabetes is a risk factor for sarcopenia. Evidence on the prevention of sarcopenia using blood glucose–lowering therapy is limited. We aimed to examine the relationship between changes in glycemic control and sarcopenia and the effect of antidiabetic agents against sarcopenia in patients with type 2 diabetes.DesignWe conducted an observational longitudinal study.Setting and ParticipantsIn total, 588 Japanese patients with diabetes of an ongoing multicenter study completed 1-year follow-up measurements for sarcopenia and clinical data.MethodsThe data set of the Multicenter Study for Clarifying Evidence for Sarcopenia in patients with Diabetes Mellitus (the MUSCLES-DM study) was analyzed.ResultsDuring the follow-up period, the frequency of sarcopenia marginally increased, and the means of skeletal muscle mass index (SMI), handgrip strength, and gait speed did not show any changes. However, on dividing into 5 groups depending on the degree of changes in glycated hemoglobin (HbA_1c) value, the patients with a decrease of ≥1% in HbA_1c exhibited a significant increase in SMI. Our analysis revealed similar results for gait speed but not handgrip strength. Using the multiple linear regression model, we identified that a ≥1% decrease in HbA_1c value was an independent determinant of the changes in SMI and gait speed. We also determined that insulin use at baseline was an independent factor for the changes in SMI.Conclusions and ImplicationsCorrection of poor glycemic control and use of insulin were significantly associated with the increase in skeletal muscle mass or gait speed in Japanese patients with type 2 diabetes. The current finding increases our understanding of the importance of glycemic control for the prevention of cardiovascular diseases and sarcopenia.     

Prognostic association of HbA1c and fasting plasma glucose with reduced kidney function in subjects with and without diabetes mellitus. Results from a population-based cohort study from Germany

Objective

To determine the risk for incident reduced kidney function (RKF) of subjects with pre-diabetes (impaired fasting glucose (IFG, 5.6–6.9 mmol/L)) or HbA_1c-defined pre-diabetes (5.7%–6.4%) and to determine dose–response relationships of fasting glucose and HbA_1c with RKF in subjects with manifest diabetes mellitus.

Method

In a German population-based cohort, recruited 2000–2002 with ages 50–74 years, log-binomial regression was used to estimate relative risks (RR) with 95% confidence intervals (95%CI) and restricted cubic splines to plot dose–response relationships.

Results

During 8 years of follow-up, 678 of 3538 study participants developed primary RKF. Although RKF risk factor prevalences and RKF incidences were higher in subjects with pre-diabetes than in subjects with normal FPG and/or HbA_1c levels, an increased risk did not persist after adjusting for established cardiovascular risk factors (RR(IFG): 0.97 (95% CI: 0.75–1.25) and RR(HbA_1c-defined pre-diabetes): 1.03 (95% CI: 0.86–1.23)). In subjects with manifest diabetes, RKF risk increased linearly to a more than three-fold risk with increasing fasting glucose and HbA_1c levels (at HbA_1c > 6.4%).

Conclusion

This study provides further evidence that pre-diabetes may not directly contribute to the development of kidney disease. Subjects with pre-diabetes might nevertheless profit from preventive efforts reducing their cardiovascular risk profile because cardiovascular and kidney disease share common risk factors.     

5-aminolevulinic acid,a precursor of heme,reduces both fasting and postprandial glucose levels in mildly hyperglycemic subjects

ObjectiveThe aim of this study was to evaluate the combined effects of 5-aminolevulinic acid phosphate (ALA-P) and iron on the glycemic index in mildly hyperglycemic adults.MethodsThis double-blind, randomized placebo-controlled trial comprised 212 subjects (ages 35–70 y, fasting plasma glucose 105–125 mg/dL or hemoglobin (Hb)A_1c 6.1%–7.1%). These participants were randomly assigned to four groups receiving either one of three doses of ALA-P and iron as sodium ferrous citrate (5 mg and 0.6 mg, 5 mg and 1.8 mg, or 15 mg and 1.8 mg, respectively) or a placebo, administered orally once a day over a 12-wk period.ResultsFifteen mg ALA-P plus 1.8 mg iron decreased the fasting plasma glucose level (2.32 mg/dL, 95% confidence interval [CI], 0.24–4.42, P = 0.029), serum glycoalbumin (0.22%, 95% CI, 0.02–0.42; P = 0.031), and 2h-oral glucose tolerance test levels (14.2 mg/dL, 95% CI, 1.8–26.6; P = 0.025) more than the placebo. However, the levels of HbA_1c, fasting insulin, serum 1,5-anhydro-d-glucitol, and Homeostasis Model of Assessment-Insulin Resistance showed no appreciable changes. The participant numbers with impaired glucose tolerance and impaired fasting glucose decreased in the highest dosage group of ALA-P plus iron compared with the placebo group.ConclusionAn oral intake of ALA would be a novel approach to prevent type 2 diabetes mellitus.     

The Relationship of Diabetes Mellitus Performance Indicators with Self-Reported Health and Patient Satisfaction

Introduction: Disease management programs often strive to enhance patient outcomes through improvements in the process of care. The purpose of this study was to determine the relationship of diabetes care process measures with self-rated health and patient satisfaction among managed care patients with diabetes mellitus, while controlling for the influence of demographics, co-morbidities and severity of illness. Study design and methods: This study was an integrated analysis of cross-sectional survey and retrospective claims data. The sample included 300 adult patients with diabetes mellitus enrolled in an Independent Practice Association—model health maintenance organization. Analyses consisted of two multiple regression models with self-rated health (100-point scale, higher score = better health) and patient satisfaction (9-point scale, higher score = greater satisfaction) being the dependent variables, respectively. Predictor variables in both models included: demographics (age, gender, education, income), severity of illness (insulin use, duration of diabetes mellitus), number of co-morbidities, receipt of foot and eye exams, diabetes mellitus education, lipid tests, microalbumin tests, frequency of self-monitoring of blood glucose and the frequency of tests for glycosylated hemoglobin (HbA_1c) and blood glucose. Results: Mean (SD) for self-rated health and patient satisfaction scores were 49.8 (25.0) and 7.8 (1.8), respectively. The squared multiple regression coefficients (R²) for model 1 (self-rated health) and model 2 (patient satisfaction) were 0.20 and 0.10, respectively. Significant predictors of self-rated health included co-morbidities (standardized regression coefficient [β] = ?0.12), income (β = 0.27), and HbA_1c tests (β = 0.19). Significant predictors of patient satisfaction included co-morbidities (β = ?0.16), foot exams (β = 0.16), and diabetes mellitus education (β = 0.16). Conclusion: When controlling for demographics, co-morbidities and severity of illness, those patients who received more frequent HbA_1c monitoring reported better health, and patients who received foot exams and diabetes education were more satisfied with the care they received for diabetes mellitus. Thus, disease management initiatives that optimize the education and monitoring of patients with diabetes mellitus are likely to produce better patient-reported outcomes.     

The effects of social support on health, well-being and management of diabetes mellitus: a black South African perspective

Objectives To determine the underlying dimensions of a social support measure and investigate the effects of social support on health, well-being and management of diabetes mellitus (metabolic control and blood pressure (BP) control).

Design A cross-sectional, analytical design was used with a structured questionnaire, comprising demographic characteristics, the MOS Social Support Survey scale and the health perceptions and mental health sub-scales from the SF-20.

Setting Two outpatient diabetes mellitus clinics in Pretoria, South Africa.

Participants Over a three-month period, the questionnaire was administered to 263 black diabetes mellitus outpatients (174 women and 89 men), aged between 16 and 89 years. The majority of patients (91%) were diagnosed as type 2 diabetes mellitus. Only 22% of the patients had acceptable metabolic control (HbA₁c<8.0%), in comparison with 46% who had good BP control (130/85 mmHg). There were significant differences between the clinics on BP control: participants from clinic 1 had better BP control than participants from clinic 2.

Results Principal components analysis, followed by an orthogonal (VARIMAX) rotational solution, resulted in two social support factors accounting for 78.9% of the variance. The first factor was labelled socio-emotional support, due to the emphasis on close caring relationships. The second factor was concerned with the more tangible aspects of social support, such as the provision of assistance. Coefficient alpha was 0.97 (socio-emotional support), 0.95 (tangible support) and 0.97 (overall social support). Patients with lower levels of social support had poorer general health and well-being than patients with higher levels of social support. Controlling for clinic, patients with controlled BP had significantly more socio-emotional and tangible support than patients with poor BP control.

Conclusions The study demonstrated that: (1) socio-emotional and tangible support were the underlying dimensions of social support; (2) socio-emotional support is an important determinant of health and well-being; and (3) social support is beneficial for one aspect of diabetes mellitus management, namely, BP control.     

Effectiveness of Medical Nutrition Therapy Provided by Dietitians in the Management of Non–Insulin-Dependent Diabetes Mellitus: A Randomized, Controlled Clinical Trial

Objective To assess the the effect of medical nutrition therapy (MNT) provided by dietitians on medical and clinical outcomes for adults with non–insulin-dependent diabetes mellitus (NIDDM), and to compare MNT administered according to practice guidelines nutrition care (PGC) to MNT administered with basic nutrition care (BC).Design A prospective, randomized, controlled clinical trial of two levels of MNT on metabolic control in persons newly diagnosed with or currently under treatment for NIDDM was conducted at diabetes centers in three states (Minnesota, Florida, and Colorado). BC consisted of a single visit with a dietitian; PGC involved an initial visit with a dietitian followed by two visits during the first 6 weeks of the study period. Data were collected at entry to the study and at 3 and 6 months.Subjects Results are reported for 179 men and women aged 38 to 76 years: 85 assigned randomly to BC and 94 to PGC. This represents 72% of the 247 subjects enrolled. An additional 62 adults with NIDDM at one site who had no contact with a dietitian were identified as a nonrandom comparison group.Outcomes Medical outcome measures included fasting plasma glucose (FPG), glycated hemoglobin (HbA_1c), and serum lipid levels. Clinical outcomes included weight, body mass index, waist-to-hip ratio, and changes in medical therapy.Statistical analyses Initial analysis of the discrete variables was done using the χ² statistic with Yates' correction. Initial analysis of continuous variables was done by analysis of variance. The changes in variables between time periods were analyzed by paired t test, and comparisons between groups were analyzed using a t test for independent groups.Results At 6 months, PGC resulted in significant improvements in blood glucose control as indicated by FPG and HbA_1c levels and BC resulted in significant improvements in HbA_1c level. Participants assigned to the PGC group had a mean FPG level at 6 months that was 10.5% lower than the level at entry, and those in the BC group had a 5.3% lower value. Among subjects who had diabetes for longer than 6 months, those who received PGC had a significantly better HbA_1c level at 3 months compared with those receiving BC. The comparison group showed no improvement in glycemic control over a comparable 6 months. PGC subjects had significant improvements in cholesterol values at 6 months, and subjects in both the PGC and the BC groups had significant weight loss.Conclusions MNT provided by dietitians resulted in significant improvements in medical and clinical outcomes in both the BC and PGC groups and is beneficial to persons with NIDDM. Persons with a duration of diabetes longer than 6 months tended to do better with PGC than with BC. Because of the upward trend in glucose levels after 3 months, ongoing MNT by dietitians is important for long-term metabolic control. J Am Diet Assoc. 1995; 95:1009-1017.     

Probiotic yogurt improves antioxidant status in type 2 diabetic patients

ObjectiveOxidative stress plays a major role in the pathogenesis and progression of diabetes. Among various functional foods with an antioxidant effect, probiotic foods have been reported to repress oxidative stress. The objective of this clinical trial was to assess the effects of probiotic and conventional yogurt on blood glucose and antioxidant status in type 2 diabetic patients.MethodsSixty-four patients with type 2 diabetes mellitus, 30 to 60 y old, were assigned to two groups in this randomized, double-blind, controlled clinical trial. The patients in the intervention group consumed 300 g/d of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 and those in the control group consumed 300 g/d of conventional yogurt for 6 wk. Fasting blood samples, 24-h dietary recalls, and anthropometric measurements were collected at the baseline and at the end of the trial.ResultsProbiotic yogurt significantly decreased fasting blood glucose (P < 0.01) and hemoglobin A1c (P < 0.05) and increased erythrocyte superoxide dismutase and glutathione peroxidase activities and total antioxidant status (P < 0.05) compared with the control group. In addition, the serum malondialdehyde concentration significantly decreased compared with the baseline value in both groups (P < 0.05). No significant changes from baseline were shown in insulin concentration and erythrocyte catalase activity within either group (P > 0.05).ConclusionThe consumption of probiotic yogurt improved fasting blood glucose and antioxidant status in type 2 diabetic patients. These results suggest that probiotic yogurt is a promising agent for diabetes management.     

Potato consumption and cardiovascular disease risk factors among Iranian population

Background: Previous studies investigated the effects of dietary glycaemic index and glycaemic load on cardiovascular risk factors. Little evidence is available regarding the association between potato intake and cardiovascular risk factors in Iran. Objective: This cross-sectional study was conducted in the first stage of Isfahan Healthy Heart Programme. Methods: A total of 4774 subjects were included in the present study. Dietary intake was assessed with a 49-item food frequency questionnaire. Biochemical assessments were done according to the standard protocol. Results: There were significant associations between potato consumption and diabetes mellitus (odds ratio (OR): 1.38; 95% CI: 1.14–1.67; p < 0.001), high fasting blood sugar level (OR: 1.40; 95% CI: 1.17–1.68; p < 0.001) and low serum high density lipoprotein level (OR: 1.10; 95% CI: 1.01–1.20; p = 0.02) remained after adjustments for possible confounding factors. Conclusion: We found a positive relation between potato consumption, high fasting blood glucose level and diabetes mellitus.