Prevention and management of type 2 diabetes in adults elsevier,gc university faisalabad vacancies 2016,what food group prevents type 2 diabetes and heart disease - New On 2016


There are a number of risk factors for diabetes which include dietary habits, obesity, physical inactivity, hypertension, genetic susceptibility, certain diseases or syndromes and other environmental factors that determine the chances of developing diabetes in an individual [1].
The first and foremost step to prevent diabetes is to have control over diet to prevent the risk of developing Type II Diabetes or may follow a diabetes diet [2]. Diabetics should avoid or limit the consumption of sugar-sweetened beverages especially those with caloric sweeteners like sucrose or high fructose containing a sugar that occurs naturally in fruits and honey. The general population should reduce sodium intake to less than 2300 mg per day which is also applicable for diabetic patients, with even more reductions for the ones with high blood pressure.
The consumption of omega-3 supplements EPA or DHA for the preventing or treating cardiovascular disease is not of much use to the diabetic patients disease of the heart and blood vessels (arteries, veins and capillaries)..
It is also stated that there are no clear evidence of benefits from mineral or vitamin supplements for diabetics without any underlying mineral or vitamin deficiency.
The first and foremost tip regarding a diabetic diet is to choose slow releasing carbohydrates which are high in fiber.
Foods which have a low glycemic level should be resorted to as these foods are slow to be digested and sugar is released at a much slower rate than otherwise [3]. Water foods: These foods are considered to be neutral and diabetics can have as much of these foods as they feel like.
Coal foods: These foods are low in their glycemic index and are high in both protein and fiber.
These days, all nutritional information with regards to manufactured or packaged foods is provided and diabetics must take care to ensure that they choose only those foods that have a low glycemic index. Processed foods and packaged cereal should be avoided and in general, the consumption of refined carbohydrates should be reduced as much as possible. The second tip with regards to a diabetic diet includes being smart about the way sugary foods are handled.
Desserts which contain healthy fat may be included in the diet as these are slow to be digested. If anything can be sweetened, diabetics should do so by themselves rather than accept other people’s measure of sugar.
There are many fruits and low fat frozen yogurt options that can be used to replace ice creams and other unhealthy desserts.
The dessert of a diabetic should ideally be half of that of a normal person and the other half should comprise of healthy fruits.
Sugar must be avoided at all costs: This is one of the most commonly heard of myths which is quite far from the truth. Diabetic foods will be needed: There are many branded supplements and special foods marketed as diabetic foods.
Carbohydrates will need to be cut down: While this is true to some extent, the key to a diabetic diet is to maintain a healthy and balanced diet which contains a mix of fats, proteins and carbohydrates in appropriate proportions.
Regular physical activities: It is important for people susceptible with diabetes to take up physical activities regularly to prevent or control diabetes. Losing weight: Losing weight and burning calories is must for reducing the risk of diabetes. Plenty of water consumption: It is also recommended to consume plenty of water to make up for the loss by urination. Consuming more fibers: Consuming fibrous diet including fruits, leafy vegetables, whole grains potentially lowers the risk of developing diabetes by keeping healthy and also keeps away other heart related diseases.
Regular blood tests: Regular health check-up especially blood tests is a must now days to keep a check on the blood sugar status and timely prevention of developing diabetes. In some special cases of prediabetes, oral medications such as Glucophage, metformin, Glumetza and many others may be used in order to prevent the onset of Type II Diabetes. Use of this website constitutes acceptance of our [my_terms_of_service_and_privacy_policy]. The American Academy of Pediatrics (AAP) recently published the first ever guidelines on how to manage type 2 diabetes in children.
With type 2 diabetes, the most common type of diabetes, either the body does not produce enough insulin or the cells ignore the insulin, which is necessary for the body to be able to use glucose for energy. Over the past thirty years, the prevalence of childhood obesity has increased dramatically in North America, ushering a host of health problems, including type 2 diabetes, that formerly was only seen much later in life.
Due to that fact, until recently, pediatricians have mostly had to deal with type 1 diabetes, which has a different cause and usually a different management than type 2 diabetes. To assist physicians in caring for this population, the AAP issued a set of guidelines to provide evidence-based recommendations on managing type 2 diabetes in children ages 10 to 18.
The guidelines, and an accompanying technical report, published in the February 2013 issue of Pediatrics recommend beginning treatment with insulin at the time of diagnosis in all patients who are ketotic or in ketoacidosis, markedly hyperglycemic, or in whom the distinction between type 1 and type 2 diabetes is not clear. The guidelines include recommendations for monitoring pediatric patients’ glycemic control, implementing insulin regimens, and diet and physical activity recommendations. The guidelines were written in consultation with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics. Search the NHLBI, use the drop down list to select: the entire site, the Health Topics section only, or the News and Resources section. This section of the Guidelines provides recommendations for pediatric care providers on managing cardiovascular (CV) risk factors in children and adolescents with diabetes mellitus and other conditions that predispose them to accelerated atherosclerosis.
The evidence review for these Guidelines was designed to identify systematic reviews, meta-analyses, randomized controlled trials (RCTs), and observational studies from selected large longitudinal cohorts.
The evidence review for these Guidelines identified only two studies relevant to CV risk reduction in children or adolescents with T2DM . In certain pediatric disease states, the process of atherosclerosis is dramatically accelerated, with clinical coronary events occurring in childhood and in early adulthood. The Expert Panel recognized the importance of reviewing the evidence for these conditions so that appropriate recommendations could be made to guide pediatric practice.
In the first of these, a small number of children with advanced chronic kidney disease were treated with folic acid and placebo, and red cell folate levels, homocysteine levels, and FMD were compared.[48] On folic acid treatment, red cell folate levels increased, homocysteine levels decreased, and FMD improved significantly.
Children with T1DM or T2DM represent the prototype of the child at special risk for accelerated atherosclerosis and early clinical CVD.
A very limited number of high-quality studies were found addressing CV risk reduction in children with conditions predisposing them to accelerated atherosclerosis, including diabetes mellitus, which is insufficient for development of evidence-based recommendations.
The AHA statement recommends specific risk identification and management stratified by risk based on defined conditions that parallel the recommendations for adults with diabetes or other CVD equivalents (see Table 11?2).
The Expert Panel believes that these recommendations should be used for the management of children and adolescents with diabetes and other conditions predisposing to the development of accelerated atherosclerosis, as outlined in the algorithm in Figure 11?1 and in Tables 11?2 and 11?3. The figure 11-1 is a flow chart with three different starting points, presented here as separate lists with numbered steps. For T2DM, intensive weight management and glucose control, in consultation with an endocrinologist as needed to maintain optimal plasma glucose and HbA1c for age. Assess body mass index (BMI), fasting lipids: Step 4 lifestyle management of weight, lipids for 6 months. Assess BMI, BP, lipids, FG: Initiate Step 5 therapy, including statins, immediately in all patients age ?
Antithrombotic therapy, activity restriction, ongoing myocardial perfusion evaluation per cardiologist.
Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas.
Insufficient production of insulin (either absolutely or relative to the body’s needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes.
In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body’s needs, or not used properly by the body.
From an economic perspective, the total annual cost of diabetes in 1997 was estimated to be 98 billion dollars in the United States.
Diabetes is the third leading cause of death in the United States after heart disease and cancer.
I can tell you that I experienced three of these and it seemed to me that they started almost overnight. So, it was off to the doctor for me so I could get the official answer and, of course, I did have diabetes.


A family history of diabetes, you are over the age of 45 or you are under the age of 45 and are overweight. In addition to your current blood sugar level, which the doctor can check right in his office, the blood test will give your doctor (and you) additional information about your blood sugar that can be traced back 90 days.
If you have any reason to believe that you have Diabetes Symptoms it is better to find out sooner rather than later. A Celebration of Women™ Foundation Inc., was born to shape a better world through building residential homes that are mandated to enable the education of young women, support self sustainable programs, graduating future women leaders.
It is important to keep them in account and undergo regular blood sugar monitoring to prevent the development of diabetes at any stage of life. The American Diabetes Association has made few recommendations in October 2013 for preventing and controlling diabetes. Instead it is recommended to take at least 2 servings of fatty fish or at least 2 times per week for the general public and is also appropriate for diabetic people. There is no evidence to support that the use of cinnamon or other herbs or supplements are effective for the treatment of diabetes.
Such foods include only fresh fruits and vegetables and not any processed forms or even juices. This will need to be done and if adhered to properly, diabetics can still follow a healthy life.
It is not necessary to completely eliminate sugar but the consumption of sugar should be limited and diabetics should be smart about handling such foods. Both the alcohol, as well as the mixers used in the drink can upset the calorie count in a diet. Unsaturated fats, which are obtained from fish and plants, are considered to be the healthiest of fats and these should be used to replace the sources of unhealthy fat. Meals should never be skipped and it is often recommended that diabetics have up to six meals every day, keeping the calorie intake the same throughout each day. If combined with a healthy exercise regime and a properly followed diet, with careful planning, a treat can be enjoyed, but only rarely. Too much protein in the diet, especially animal protein can prove to cause resistance to insulin to be developed in the body and this is a key factor to the worsening of diabetes. Physical activity helps to lose weight and lowers blood sugar by increasing blood circulation and adding to the responsiveness of insulin. One can start with mild exercise or even brisk walking to proper fitness training to reduce susceptibility to diabetes.
While this is recommended for everybody, people who face the risk factors of diabetes should definitely make sure to undergo these tests. These artificial sweeteners are high in calorie content and can cause the normal blood sugar level to increase. But, today, due largely to the rise in childhood obesity, as many as one in three children diagnosed with diabetes has type 2.
In all others, metformin is recommended as first-line therapy, along with a lifestyle modification program including nutrition and physical activity. The evidence review did not address management of hyperglycemia, and this is not addressed in the recommendations. The evidence review identified only two RCTs relevant to T1DM that met the inclusion criterion of having CV outcomes. The hallmark of T2DM is insulin resistance, which is strongly associated with obesity.[30] Among obese adolescents, insulin resistance has been reported in 16 percent of Caucasians, 27 percent of African Americans, and 26 percent of Hispanics. A single systematic review addressing community-based lifestyle interventions to prevent T2DM in children included eight studies published between 1990 and 2001.[44] The interventions were all set in high-risk populations, and design problems included the absence of comparison groups and brief intervention periods.
Probably the best example of this is homozygous familial hypercholesterolemia, an extremely rare condition in which low-density lipoprotein cholesterol (LDL?C) levels are markedly elevated from birth due to the absence or near absence of functional hepatic LDL receptors. A separate category was created as part of the evidence review that identified potential relevant diagnoses and included Kawasaki disease, postorthotopic heart transplant, chronic kidney disease, nephrotic syndrome, human immunodeficiency virus (HIV) infection, and chronic inflammatory disease—all of which may increase the risk for early atherosclerosis and may require more aggressive control of CV risk factors.
To maximize identification of T2DM in childhood and adolescence, the ADA screening algorithm is recommended for screening in all children (see Table 11?1).
For the high-risk category, the disease process has been associated with clinical coronary disease before age 30 years.
90th percentile: Step 4 lifestyle management plus no added salt, increased activity for 6 months. Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies. Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Regression of carotid atherosclerosis by control of postprandial hyperglycemia in type 2 diabetes mellitus.
Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. The British Diabetic Association Cohort Study, II: Cause-specific mortality in patients with insulin-treated diabetes mellitus. Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging.
Impaired vascular reactivity in insulin dependent diabetes mellitus is related to disease duration and low density lipoprotein cholesterol levels.
High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents and young adults with type 1 diabetes.
Longitudinal lipid screening and use of lipid-lowering medications in pediatric type 1 diabetes.
Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Advanced glycation end products are associated with pulse pressure in type 1 diabetes: the EURODIAB Prospective Complications Study. Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. Relation of body mass index and insulin resistance to cardiovascular risk factors, inflammatory factors, and oxidative stress during adolescence.
Insulin resistance, hyperinsulinemia, and coronary artery disease: a complex metabolic web. Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. Veterans Affairs cooperative study of glycemic control and complications in diabetes mellitus type 2. Lipid and glucose alterations in HIV-Infected children beginning or changing antiretroviral therapy. Influence of puberty on endothelial dysfunction and oxidative stress in young patients with type 1 diabetes. Early structural and functional changes of the vasculature in HIV-infected children: impact of disease and antiretroviral therapy.
The absolute lack of insulin, usually secondary to a destructive process affecting the insulin producing beta cells in the pancreas, is the main disorder in type 1 diabetes. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. These types of damage are the result of damage to small vessels, referred to as microvascular disease.
I had a family history of diabetes that went directly back to my father and his mother, so the chances of my getting diabetes were always pretty good.
If you think you have any of the Diabetes Symptoms mentioned above, a simple blood test will give you the answer.


Corn syrup should be used to avoid any weight gain that may lead to worsening of cardiovascular risks. Examples of fire foods include white foods such as white pasta, white rice, sweets, fries and chips, processed foods, potatoes, white bread and baked food goods. Examples of coal foods include legumes, seeds, nuts, sea food, lean types of meat, whole wheat pasta, brown rice and whole wheat bread. It will enable diabetics to fell fuller for longer periods of time, while also reducing the blood sugar concentration by being digested much slower than other foods. It is recommended that women have no more than a single drink and men have no more than two drinks a day. Omega 3 fatty acids as found in salmon and some other fish are excellent sources of healthy fat. An old fashioned diet consisting of fresh fruits, vegetables and whole grains, with the appropriate balance of nutrients is good enough to keep the symptoms of diabetes in check.
This means that the body cells are able to accept the inflow of sugar more easily and consequently, the glucose levels in the blood are lowered. Various studies have proved that there is up to 60% reduction in risk to develop diabetes in people who have lost over 7% of their body weight. Use of this website constitutes acceptance of our Terms of Service and Privacy Policy.This website is for informational purposes only. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications.
The section begins with background information on the importance of diabetes as a risk factor for CV disease (CVD).
A randomized crossover trial in a small number of children with T1DM showed a decline in diastolic blood pressure during sleep with melatonin therapy.[28] The authors propose that melatonin be considered in trials to prevent the development of hypertension in individuals with T1DM. Although type 2 diabetes is widely diagnosed in adults, its frequency has markedly increased in the pediatric age group over the past two decades. On short-term followup, results indicated improvements only in knowledge and preventive behaviors. In this diagnosis, clinical coronary events begin in the first decade of life, and aggressive lipid management is needed. Although data exist demonstrating a higher prevalence of early CVD and CV risk factors in conditions such as these, the evidence review for these Guidelines was designed to identify high-level studies, including systematic reviews, meta-analyses, RCTs, and observational studies from selected large longitudinal cohorts.[46],[47] Given the relatively small number of children with these diagnoses and the early stage of knowledge in this area, it is not surprising that the evidence review identified only three relevant RCTs, all in patients with chronic kidney disease. For the moderate-risk category, the disease process has been shown to be associated with pathologic, physiologic, or subclinical evidence of accelerated atherosclerosis.
Patients in the high-risk category require intensive management, with more aggressive goals for therapy than those in the moderate-risk category as outlined in the algorithm in Figure 11?1. Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension: plausible mechanisms for improving cardiovascular health. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.
When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars.
Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. The reason for this is that the symptoms can be so mild and develop so gradually that you do not even notice them or you do not even have any symptoms. Wow, for as bad as it was I might as well have pitched a tent in my bathroom and brought along a cooler full of drinks. I mean, even if you are not experiencing the above symptoms, there are still reasons to have your blood sugar tested anyway. Such sufferers of Type I Diabetes will need to carefully monitor and choose their actions throughout the course of their lives.
This is followed by the Expert Panel's summary of the evidence review relative to diabetes, separated for type 1 and type 2 diabetes mellitus, and then by a subsection on other predisposing conditions. T1DM presents at a younger age, with 25 percent of patients diagnosed between ages 5 and 10 years and another 40 percent between ages 10 and 15 years. In children with T1DM, administration of folate and vitamin B6 each led to immediate normalization of FMD, which was sustained at 8-week followup.[29] Findings suggest that, in the setting of T1DM with a high risk for vascular disease, folate and B6 therapy could be beneficial, but the findings in these two trials have not been duplicated. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia.
Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. The evidence review and the development process for the Guidelines are outlined in the Section I. If not treated adequately, the degree of hyperglycemia is severe, and patients are highly symptomatic. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops.
Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream.
Diabetes affects approximately 17 million people (about 8% of the population) in the United States. Diabetes, another high-risk diagnosis, is addressed above, but there are other conditions in which the risk of accelerated atherosclerosis is known to be high, that are not necessarily identified in a risk factor-based evidence review such as the one preformed for these Guidelines. In addition, an estimated additional 12 million people in the United States have diabetes and don’t even know it. Nevertheless, knowing I had this family history, whenever my doctor would have me get a blood test, the first thing I always asked was, “how is my blood sugar?” and I was always relieved when the answer came back “good”. I am far sighted, but all of a sudden I could not see things 10 feet away, they were all blurry.
As described, the evidence review augments a standard systematic review, where the findings from the studies reviewed constitute the only basis for recommendations, with each study described in detail. Step 5: For tier II, if goals are not met, consider medication per risk factor specific recommendations in these guidelines.
It’s funny or sad, depending on how you look at it, here I am concerned over the results of my blood sugar test, but not concerned enough to do anything about my eating habits.
This evidence review combines a systematic review with an Expert Panel consensus process that incorporates and grades the quality of all relevant evidence based on preidentified criteria. I guess a better way to characterize my concern would be to say I was relieved, that way I could keep on with my bad eating habits and feel alright about it.
Because of the diverse nature of the evidence, the Expert Panel provides a critical overview of the studies reviewed for each risk factor. Following its review of the limited available evidence for this subject, the Expert Panel elected to employ expert opinion by expanding on the recommendations of the 2006 guidelines from the American Heart Association (AHA),[1] which addressed CV risk management in high-risk pediatric patients, including those with diabetes. This approach is described in detail in this section, relative to the management of other conditions predisposing to the development of accelerated atherosclerosis.
References are listed sequentially at the end of the section, with references from the evidence review identified by unique PubMed identifier (PMID) number in bold text.



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