Dietary control of type 2 diabetes uk,general information about diabetes mellitus type,portal m zone jp - Videos Download

Science, Technology and Medicine open access publisher.Publish, read and share novel research. 1) found a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe. 1) reported a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe. 3) a significant increase in energy adjusted total and LDL-cholesterol levels was associated with higher intakes of total fat, saturated fat and cholesterol.
Table 4 summarizes the nutritional recommendations as well as the lifestyle recommendations for type 1 and type 2 diabetic patients. Socio-Ecological Approach to Self-Management of Type 2 Diabetes: Physical Activity and Dietary InterventionRashid M. A Beck, J Scott, P Williams, et al1997A randomized trial of group outpatient visits for chronically older HMO members: the cooperative health care clinic.
R Ewing, T Schmid, R Killingsworth, 2003Relationship between urban sprawl and physical activity, obesity, and morbidity. H Frumkin, L Frank, R Jackson, 2004Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities.
D Haire-joshu, 1996Management of Diabetes Mellitus: Perspectives of care across the lifespan.
Instead of using expensive artificially created water ionizers, use ? of fresh-squeezed lemon in two cups of lukewarm water. Take this drink in the morning in order to clean your digestive system, balance the acids in the system and boost your metabolism. Leafy greens, vegetables, wheat grass, seeds, nuts and certain fruits can be used for creation of tasty and highly effective organic green juices and green smoothies. Their ingredients like minerals, vitamins, phytonutrients, oxygen and chlorophyll, alkalize the body and even prevent occurrence of damaged, unhealthy cells, bacteria and other potentially dangerous microorganisms.
On the other hand, consuming processed food stimulates the appearance of these harmful organisms.
Engage in physical activity, control your stress, sleep better and get rid of your nasty habits. Although many people consider stress to be a myth when it comes to developing diseases, the truth is that emotional stress triggers release of acid-forming hormones like adrenaline and cortisol, which disturb the normal functioning of the system.
Some claim that certain type of food is more acidic while others say that food is less acidic. Throw Away Your Glasses By Using Only THIS One Ingredient to Increase Your Vision Up To 97%! Contains gurmarin component which has same molecular structure like insulin and that supports the control and regulation of sugar level in the body. Its constituent lectin is useful to control the level of blood sugar that has lipogenic and antilipolytic properties. Besides being helpful in the diabetic conditions, Bitter Melon is also useful in managing the leprosy, piles and jaundice. If you are in a serious trouble due to diabetes, then just move ahead with Bitter Melon supplements because along with providing relief in diabetic conditions, it also supports the preventive mechanism to get rid of its side effects. Bitter melon helps to control the diabetes and its effect in the patient because it contains anti-diabetic components that help to reduce the effect of diabetes. The extract of Bitter melon helps to provide the medium between secreted and produced insulin in the pancreas gland. Bitter Melon also contains such components that are useful in the regeneration of beta cells.
The significance of using Bitter melon supplements is that it doesna€™t contain any artificial ingredients so, it provides the natural formulation for controlling and preventing from diabetes. Bitter melon has several curative properties and these properties have been effectively harnessed in this capsule. Karela has many health benefits because of its bitter taste and in these capsules you can get same benefits without the bitterness. The main reason of the occurrence of diabetes is the excessive formation of glucose in the blood. Along with providing the relief in diabetes, Bitter melon supplements are also useful in providing relaxation in various other blood disorders as well.
Eating a diet low in refined foods (white flour, juice, packaged foods) would be a great start.
With regards to supplements, I always start with minerals, primarily Magnesium, Chromium and Vanadium. Another supplement that is helpful with supporting healthy blood sugar levels is Alpha Lipoic Acid.
The previous supplements are on my top list of nutritional supplements for blood sugar control.
If you are looking to take control of balancing your blood sugar, then you need to be aware that poping a pill or pills is not the answer. In the 1950s an average meal of a cheeseburger, French fries and soda pop would be about 600 calories, slightly under one third of the total calories an average person needs in one day. In order to provide a frame of reference for food portions, standard serving sizes have been developed by the USDA as part of their Dietary Guidelines for Americans. Make a point of reviewing the Guidelines to learn how to create a healthier lifestyle for yourself and your family. To see our content at its best we recommend upgrading if you wish to continue using IE or using another browser such as Firefox, Safari or Google Chrome. A healthy diet should include 10 portions of fruit and vegetables a day, doubling the five-a-day official advice, health experts have said. The findings suggest that the five-a-day recommendation, suggested by the World Health Organisation and backed by the Government and NHS, is not adequate — although only 30 per cent of people even manage to eat that amount. Mean fiber intake in 1102 individuals with type 1 diabetes across Europa (Toeller M, Soedamah-Muthu 2011). One study (Riley MD& Dwyer T 1998) found no significant association between energy adjusted monounsaturated fat intake or energy adjusted polyunsaturated fat intake and microalbuminuria, but reported a positive association between usual dietary saturated fat intake and microalbuminuria. They also found more frequent acute and chronic complications (including nephropathy) in Eastern Europe people.
They also found more frequent acute and chronic complications (including retinopathy) in Eastern European people. Higher fiber intake had a protective significant effect against CVD in type 1 diabetic women but not in men. This was associated with a higher prevalence of CVD, although after adjusting for dietary fiber intake, these associations were attenuated. They also found more frequent acute and chronic complications (including CVD) in Eastern European people. These recommendations are for all diabetic patients in general, based in the majority of cases on evidence from type 2 diabetic patients. Diabetes Criteria for patientsAll the participants will adhere to their usual medications as recommended by their doctors.
M Ansari, 2009Effect of physical activity and obesity on type 2 diabetes in middle-aged population.
A Brown, 1990Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited.
P French, V Senior, J Weinman, et al2001Causal attributions for heart disease: a systematic review.
H Jafar, N Chaturvedi, G Pappas, 2006Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population.
What most people don’t know is that lemons have acidic properties in their natural form, but when they are mixed with water they have alkaline properties. It is very important to take care of our diet, but it is also very important to pay attention to the physical activity we have during the day.
There are many ways to avoid this situation – meditation, pilates, yoga, exercising in a gym or at home, breathing exercises, developing stress management strategy etc. It contains the benefits of bitter gourd which is popular for its anti-diabetic properties.
Bitter melon supplements show faster and quicker results than any other medicine for diabetes. Everyone is known to the fact that how much dangerous is the diabetes disorder for human body. Insulin is a kind of hormone which is secreted in pancreas and it is responsible for regulating the fat and carbohydrate metabolism. Beta cells are also produced in the pancreas that helps in increasing the secretion and production of insulin naturally.
And the other important thing is that there is no chance of suffering from any side effects because it is absolutely safe and natural remedy to get rid of diabetes.
Simply take the Bitter Melon capsules daily and watch your blood sugar level return close to the normal range. You know, I took this Bitter Melon capsule for three weeks and my blood and urine sugar level came down to normal level. Its good and effective for the proper management of my diabetes and to keep my sugar level in check. Bitter melon helps to increase the tolerance level of glucose and it also helps to increase the activity of insulin receptors so that most of the glucose can be absorbed by the body. Bitter melon is useful to reduce the blood disorders such as scabies, blood boils, psoriasis, itching, fungal diseases like ring worm. Alpha Lipoic Acid could end up being the big winner in the future for those with blood sugar control issues.
Even if you subject yourself to the pharmaceutical answers to blood sugar control, you are not going to “cure” yourself of the problem without other lifestyle modifications.
In general, foods that are high in fiber (like whole grains, fresh vegetables and fruits) increase satiety. In type 1 diabetic men it leads to positive changes of the serum cholesterol pattern (higher HDL, lower LDL, lower ratio total cholesterol:HDL cholesterol). The recommended intake is <10% of the total energy intake which was only achieved by a small minority (14%) (Toeller M et al. In order to assess the effectiveness of this intervention, it was advised not to modify the medications during this trial. Statistical analysis The primary outcome will be analysed by an un-paired sample t-test (mean difference between baseline and final HbA1c). V Hedges, 1994Predicting metabolic control in diabetes: a pilot study using meta-analysis to estimate a linear model.
X Zhang, K Merrell, et al1998Diabetes in the African-American Medicare population: morbidity, quality of care, and resource utilization. A Brownson, O Tool, ML et al2005Ecological approaches to self-management: The case of diabetes. H Jensen, et al2003Multifactorial intervention and cardiovascular disease in patients with Type 2 diabetes. A Strycker, D Toobert, J et al2000The Chronic Illness Resources Surveys: A social-ecologic approach to assessing support for disease self-management. G Eakin, et al1997Quality of life and associated characteristics in a large diverse sample of adults with diabetes. E Glasgow, L Strycker, 2000Beliefs versus feelings: a comparison of personal models and depression for predicting multiple outcomes in diabetes.
R Evenson, P Bors, et al2003Neighbourhood environment, access to places for activity, and leisure-time physical activity in a diverse North Carolina population. In addition, stress, drugs and cigarettes increase the level of acids in the body and lead to inflammation. Scientists usually burn samples of food to ashes when they want to check the acidic or alkaline foods properties. Along with improving the diabetic condition it also helps to provide relief in various other disorders that are the side effects of diabetes. Since it is a natural remedy for the prevention and control of diabetes, so there is no chance to get any side effects from it. Along with unbalancing the sugar level in body, it also affects the health of various other organs as well. It helps in producing the cells that can absorb glucose for the functioning of liver, fat tissues and muscles. The constituent of Bitter melon helps to control and regulate the formation of beta cells so that the further activities of insulin production and producing the insulin receptors can be done properly. Also, the components of Bitter melon helps to reduce the side effect symptoms of the diabetes which helps to improve the overall health of a diabetic patient.
First is to tolerate the level of glucose to some extent and the other way is to stimulate the activity of insulin hormones. The regular intake of Bitter melon helps to maintain the balance between the formation and absorption of glucose and thus the glucose level is maintained in the blood. Regular intake of Bitter melon supplements helps to bring about improvements, in these health disorders. My belief, as with most health conditions, is that we bring this on with our lifestyle choices. The fiber alone from these foods can also have a stabilizing effect on your blood sugar levels.
You don’t need to do hours of aerobics, but just 30 or so minutes a day of brisk walking, biking or weight lifting can assist your body in maintaining health blood sugar levels.
Processing takes out the good in most cases and often times companies “fortify” the foods to put back what they just processed out. Gymnema has been shown to improve the ability of insulin to lower blood sugar levels in both Type I and Type II diabetes. 1988) found a significant positive association between total fat intake and microalbuminuria. No association between energy adjusted MUFA and energy adjusted PUFA and microalbuminuria was found. The results of the post hoc analyses should be interpreted carefully, since it is a retrospective analysis which can generate hypotheses but not prove them.
CarbohydratesThe ‘Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes’ (DNSG EASD) guidelines for persons with type 1 and type 2 diabetes (Table 4) recommend that the most appropriate intake of carbohydrates consists of vegetables, legumes, fruits, wholegrain foods and naturally occurring foods rich in fiber.
Recommendation was only achieved in 0.4% of the type 1 diabetic population (Toeller M et al. Alcohol has favourable effects on HDL-cholesterol, inflammation and inhibition of platelet aggregation (Beulens et al.
In addition, participants will be advised not to take any other new treatments for the management of type 2 diabetes during this study.
The statistical analysis, using STATA will be carried out on an intention to treat basis and that will subject to the availability of data at follow up (after 90 days) as well as at entry level for individual patients.
R Brown, et al2000Promoting physical activity in rural communities: walking trail access, use and effects. W Sokol, D Hallett, 2003Personal persistence, identity development, and suicide: a study of Native and Non- native North American adolescents. L Schmid, 2003Health and Community Design: The Impact of the Built Environment on Physical Activity. J Barrera, et al2005The Chronic Illness Resources Survey: cross-validation and sensitivity to intervention. W Terry, et al1984Effects of labelling on income, work and social function among hypertensive employees.
The pH in your system is affected by the unhealthy modern lifestyle which many people practice. Since only a small number of people have access to scientific labs I have added some sources that can help you make the right choice.
It shows its effect within few weeks but it is advised to continue the course till one year to get permanent results.
Diabetes badly affects the kidney and immune system of the body that help to remove waste materials from the body and fighting with the foreign materials that can b harmful for a healthy body. Bitter melon supplements can be taken as dietary supplements to prevent yourself from the diabetes.


Whether you have issues with Hypo- (low) or Hyper- (high) glycemia, proper diet, activity and supplementation can assist you in addressing this issue. Recent research has shown that people with blood sugar control usually have low blood levels of these three key minerals. It protects not only against the dysfunction that causes diabetes, but also against the damage caused by the disease. Cinnamon (yes, the spice) extract is known to improve blood sugar levels and lipid levels in those with Type II diabetes. If you can get these two aspects under control, supplementing or taking prescribed medications will not be necessary in most cases. Toeller2[1] Division of Human Nutrition, Wageningen University, Wageningen, Netherlands[2] Department of Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University Duesseldorf, Germany1. 2009) found an increased risk of CVD in type 1 diabetic patients eating high amounts of fat and saturated fat. Data from the EURODIAB Prospective Complication Study on saturated fatty acid intake measured at baseline by 3-day food diaries and presented by each center is given in Figure 2. All participants will be contacted again after 90 days (3-months) to give their blood sample for HbA1c testing, their weight will be taken and BMI will be calculated. It is good to point out that people can find different sources arguing about certain foods and their alkalizing or acidic properties.
Thus, you get unwanted series of diseases in the body which affects your overall health and you find it difficult to live happily in your routine life. Research from the 1900s showed that Chromium-rich Brewer’s yeast was helpful in restoring blood sugar levels. L-carnitine is a popular dietary supplement because it has been shown to produce many health benefits, one of which is control blood sugar. The extract of Maitake (Sx Fraction) has also been shown to be extremely helpful for those with interest in blood sugar control. The choice is yours, but in the meantime, you now have some tools to assist your body in overcoming your blood sugar issues.
People who ate at least seven portions of fruit and vegetables each day were 42 per cent less likely to die from any cause over the course of the study. IntroductionDiabetes mellitus is with 220.000 deaths per year the eighth leading cause of death in high income countries (World Health Organization (WHO) 2008). They found that excess fat intake may contribute to hyperfiltration in type 1 diabetic patients. AlcoholIn cross-sectional analyses of the EURODIAB Prospective Complications Study (Beulens et al. Carbohydrates were negatively correlated with CHD risk factors (higher total cholesterol, LDL cholesterol, obesity, poorer glycaemic control). Cross-sectional data of the EURODIAB Complications Study showed an inverse association between fiber and LDL cholesterol and a positive association between fiber and HDL cholesterol.
Data from the EURODIAB Prospective Complication Study on fiber intake measured at baseline by 3-day food diaries and presented by each center is given in Figure 1. The even lower saturated fatty acid recommendation of <7% total energy of the ADA was not achieved by any of the centers (Figure 2). Because of this favourable effects we expect a beneficial effect on CVD, however to date no association was found between alcohol and CVD in type 1 diabetes patients (Bishop et al. Current research shows that chromium supplementation with doses as high as 1000mcg per day has been helpful at improving glucose tolerance in those with Type II diabetes. L-Carnitine improves insulin sensitivity, increases glucose storage, and optimizes carbohydrate metabolism. Furthermore higher intakes of fat and protein were associated with greater odds of coronary artery calcium (CAC), which is a strong predictor for coronary events approximating CVD risk. All centers indicated in Figure 2 exceed the recommendation of <7% saturated fat of the total energy intake.
Study population and randomizationInitially 325 patients with type 2 diabetes will be invited to pre-randomized interview, out of which only 210 patients will be included in the actual trial.
You can rely on Bitter melon supplements as it is now clinically proved that Bitter melon is the the best supplement to stay away from diabetes.
Magnesium consumption has shown to improve insulin production in those with Type II Diabetes. Worldwide approximately 285 million people had the disease in 2010 and this number will increase till 438 million in 2030 (World Diabetes Foundation (WDF) 2010).
2004) a progression of nephropathy with greater saturated fatty acid (SFA) consumption and lesser polyunsaturated fatty acid consumption (PUFA) was demonstrated.
The opposite was true for carbohydrate intake, higher intake was associated with a reduced odds of CAC.In conclusion a higher intake of total fat as well as saturated fat is positively correlated with CVD or CVD risk factors (atherosclerosis and CAC in these studies) and a higher intake of carbohydrate is negatively correlated with CVD or CVD risk factors.
Type 1 diabetic patients from Italy had the lowest intake of saturated fatty acids, but this intake was still too high (Figure 2).
For the purpose of this trial, it is expected that out of the 325 patients, 93 patients will not meet the inclusion criteria and 22 patients might refuse to participate in the trial. Data analysis methodIn this study, the thematic analysis of data will be adopted for analysing the data because the method was developed to meet the needs of investigating the experiences, meanings and the reality of the participants (Braun and Clarke, 2006). One study reported an association between lifestyle risk factors (including alcohol) and atherosclerosis, which is often the underlying cause of CVD (Bishop et al.
Furthermore dietary fiber is independently related to a lower risk for CVD in type 1 diabetic women. Keeping in mind that these samples are clinic based and not population based and that these figures may not exactly reflect the current nutritional intake, however it gives an indication of the status on fiber intake.
Also the association between alcohol and diabetic nephropathy and diabetic retinopathy was only observed in cross-sectional studies.
In that case, two hundred and ten (210) patients will agree to participate and will be required to sign informed consent documents at the clinic where they usually visit for their usual medical care for diabetes. The method also allows the study to adopt the element from constructionist notions – to investigate the ways in which events, realities, meanings, experiences are the effects of a range of discourses operating within a society. Most people haven’t heard of this mineral yet research has shown that it helps improve glucose control in as little as 6 weeks. 1992) examined whether alcohol consumption was associated with type 1 diabetic retinopathy. Since all these studies were cross-sectional, they could only look at the intake of certain nutrients and the prevalence of CVD or CVD risk factors at a certain time point. There were only a few studies examining the effect of MUFA or PUFA on chronic complications in type 1 diabetic patients.
Therefore, 105 patients will be randomized to intervention group (Physical Activity and Diet) and 105 to the control group (usual medical care). Diabetes also has a great economic impact on the individual, nation healthcare system and economy (International Diabetes Federation (IDF) 2010). Eight studies reported an association between physical activity and CVD risk factors (Kriska AM et al. They could not conclude if these are related to each other and if the nutrients are responsible for the lower or higher prevalence of CVD.
Unfortunately, this positive effect of fiber on CVD and CVD risk factors was only found in cross-sectional studies. Physical activityThere are no specific guidelines concerning physical activity for type 1 diabetic patients. Sample size estimationThe study sample size was determined based on the assumption of the estimation of Standard Deviation (SD). They found that dietary n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) are inversely associated with the degree but not with the incidence of albuminuria in type 1 diabetes (Lee CC et al. These conclusions are based on post-hoc analyses and a cross-sectional study respectively and should therefore be interpreted carefully.
This RCT trial will not be double-blinded as the participants receiving the education on lifestyle modifications in the community and healthcare clinics would know that they are on the active intervention. Therefore, the study design was selected to detect an effect size of 0.5 SD lowering of HbA1c. 2010).In conclusion these prospective studies are consistent with the cross-sectional studies about the detrimental effect of saturated fat on type 1 diabetic nephropathy.
1991) examined the relationship between physical activity and the occurrence of retinopathy in type 1 diabetic patients. Randomized controlled trialsTwo randomized controlled trials reported an association between macronutrients and CVD (Table 2), but demonstrated conflicting conclusions. Further research in prospective studies or randomized controlled trials is needed to ascertain the role of fiber in CVD.
However, it was shown that the guidelines for type 2 diabetic patients are also applicable for type 1 diabetic patients.
Once the randomization phase is completed, all patients will be instructed to follow-up the usual medical care for their diabetes for the duration of the 90 days trial. It was assumed that 10% patients might be lost to follow-up in control group over the period of three months and only 5 % patients will be lost to follow-up in intervention group.
In type 1 diabetes the body does not produce insulin (American Diabetes Association (ADA) 2010).The disease has a strong genetic component, inherited mainly through the HLA complex but the exact cause is unknown.
They found no association between physical activity (sports and leisure physical activity) and occurrence of retinopathy.4. DNSG EASD do not recommend a low carbohydrate diet for type 1 and type 2 diabetic patients (Table 4).
Several randomized controlled trials (Table 3) showed that physical activity (endurance sports; on average 2 times a week 60 minutes) improves physical fitness as well as endothelial function in type 1 diabetic patients (Lehmann R et al.
The patients will not be allowed to adjust their usual medications and follow their previous prescriptions recommended by their doctors. This assumption was based on impact of education and advice on lifestyle behavioural modifications to patients and overall popularity of this approach among the diabetic patients in sub-continent to manage their glycemic control. Most likely there is an environmental trigger in genetically susceptible people that causes an immune reaction. Diet, lifestyle and cardiovascular diseaseEight studies reported an association between macronutrients and CVD in type 1 diabetic patients. 2009), the authors concluded that a diet lower in carbohydrate and higher in MUFA might be preferable to a diet higher in carbohydrate and lower in MUFA for type 1 diabetic patients.
2009) to recommend a diet higher in MUFA and lower in carbohydrate for nonobese type 1 diabetic individuals to reduce CVD risk factors is doubtful. In addition, each patient will be asked to go for blood test for HbA1c on day 1 and then return to give blood sample after 90 days. The body's white blood cells mistakenly attack the insulin-producing pancreatic ?-cells (U.S. This was solely based on the positive effect on triglyceride (TG) levels and plasminogen activator inhibitor 1 levels (PAI-1) in the first diet. It is more acceptable to avoid too much foods high in fast available carbohydrates, foods high in fat and cholesterol. Their conclusion is based on PAI-1 and VLDL levels, which are not such a good predictors for atherosclerosis (and by extension CVD) as TG levels are.
In addition, participants will be advised not to take any other new treatments for the management of type 2 diabetes during the trial periods. The sample size (N) for each group was =105; therefore, the total, N=210 patients were recruited to participate in both the groups. When I ate more liberal carbs-about 100 g a day, my HA!C was still only 5.3 and my trigs were at 70.
A significant decrease in PAI-1 was found after 6 months in the lower carbohydrate and higher MUFA diet. An earlier quote (Helgeson 2006) expressed this precisely: ‘families of adolescents with diabetes may be more concerned that the sugar in candy is going to translate into high blood glucose levels today than that the fat in potato chips will translate into cardiovascular disease in 10 years’.
Furthermore, the small study population of 30 subjects limits the power of their conclusions.
Especially the improvement in endothelial function is important since endothelial dysfunction is an early sign of atherosclerosis, which is often the underlying cause of CVD. Those patients randomized to usual medical care (control group) will be instructed to take their normal medicines and follow-up with their doctor as per their normal schedule. In order to make accurate recommendations concerning MUFA and PUFA intake for type 1 diabetic patients more research with more participants (preferably in a prospective study) is needed. Also a positive effect on lipid related cardiovascular risk factors was found in one study (Lehmann R et al. A lower level of PAI-1 means less inhibition and more degradation of blood clots, which means a lower chance of developing atherosclerosis. At that time, a questionnaire will be sent via e-mail to participants in intervention group to assess the progress of the physical activity and diet intervention and to control group to assess the progress of the treatment with normal medical care only. Minimizing the bias It is possible that the outcome measures associated with physical activity and diet interventions will be subject to bias particularly when treatment will be in progress or just afterwards.
I don't see how you can say anything until we know both those numbers.Please give us the numbers.
The main difference between usual medical care alone for the patients and usual medical care with physical activity and dietary interventions will occur after 3 months period of trial. The point is not whether or not the individuals were *counting* calories, but how many were consumed.3Cindy C5 days ago Here is the study. This ‘food’ trigger explains why type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages (Sadauskaite-Kuehne V et al. In the other diet group there was an increase in TG levels, also this increase was not significant.
Although the evidence is gained from randomized controlled trials, the conditions of these trials are really disappointing. Measurement The factors which will be measured in this study are the physical activity of participants (an intervention), hemoglobin (HbA1c – primary outcome variable), blood pressure and weight (secondary outcome) whereas the body mass index (BMI) is a calculated variable. In order to reduce the bias, the questionnaire will be sent to patients at home or via e-mail to minimize any chance that their answers might be affected by actual or perceived influence by medical practitioners at clinic. MacronutrientsData on the relationship between macronutrients and incident CVD is lacking in patients with type 1 diabetes. 2010) found that dietary n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) are inversely associated with the degree but not with the incidence of albuminuria in type 1 diabetes. The linear regression analysis will be performed after three months between HbA1c and on the blood glucose results to see the reliability of measurement data and to observe any relationship between the two variables. This involves acute complications, like hyperglycaemia and hypoglycaemia which can lead to a coma, but also chronic complications (National Institute for Public Health and the Environment (RIVM) 2007). Physical activity is a key component of lifestyle modification that can help individuals prevent or control type 2 diabetes. Discussions The results of this randomized controlled trial will support the research question that lifestyle interventions (physical activity and diet) with usual medical care for type 2 diabetes is more effective than the usual medical care alone. The numbers you've posted are well normal are they not?Thanks for the study.1 comment removed6gbl5 days ago The improvement of LCD over CRD in this study was BARELY MEASURABLE. Chronic complications can be subdivided into macrovascular and microvascular complications. Physical activityThere were no prospective studies on physical activity and type 1 diabetic nephropathy. It decreases lipopolysaccharide-induced nuclear factor-kB (NF-kB ) activation and monocyte chemoattractant protein (MCP)-1 expression in human renal tubular cells (Lee CC et al.
It is considered that diet is probably more important in the initial phases of weight loss, incorporating exercise as part of a weight loss regimen helps maintain weight and prevent weight regain (Klein et al. The higher % age of lost to follow up throughout this trial (Figure 2) in those patients with usual medical care (10%) than in those in intervention group (5%) suggests greater satisfaction with physical activity and dietary education and advice. Cardiovascular disease is the major macrovascular complication and includes mainly myocardial infarction and stroke (American Diabetes Association (ADA) 2010).
Cross-sectional studies on fat and fiber in relation to CVDIn more detail, one cross-sectional study (Overby NC et al.
The difference at 3 months follow up is the mean change in HbA1c levels for the intervention group minus the mean change of HbA1c for the control group.
The risk for cardiovascular disease, is 4-8 times higher for people with type 1 diabetes (Soedamah-Muthu SS et al. 1991) found the lowest occurrence of diabetic nephropathy in people being 7+ hours a week physically active (sports and leisure physical activity).3.


2006) found a higher than recommended percentage of energy intake from fat and saturated fat among type 1 diabetic patients compared with healthy same-age control subjects and a lower than recommended intake of fiber. Mainly because of the higher atherosclerotic risk due to more and bigger very low-density lipoprotein (VLDL) particles in the last diet. In this study, the message will be given to participants to do 30 minutes of moderate physical activity daily (approximately 8000 step count) and it may offer greater benefits to these patients in managing their diabetes (Wright and Royson, 1996).For measurement of physical activity, the method of step count using pedometer will be used as it has been demonstrated to have a superior validity of step counts over a questionnaire approach in predicting health markers such as BMI and waist circumference (Ewald et al.
I thought I had diabetes 35 years ago, but a glucose tolerance test showed my blood sugar not going up too high, but dropping down from fasting 80 to 60, with headaches, shaking and weakness, and trace of sugar in urine.
Diet, lifestyle and retinopathyOnly two studies reported results for the association between macronutrients and type 1 diabetic retinopathy. They conclude that this higher intake of energy from saturated fat and this lower intake of energy from dietary fiber, vegetables and fruits could increase the risk of atherosclerosis, which is often the underlying cause of CVD. Furthermore the TG levels did not significantly differ between the two diets in this study.In conclusion, these trials show that the effect of carbohydrate or MUFA on cardiovascular disease risk factors in type 1 diabetic patients is still not elucidated.
I tried to maintain a healthy diet, low sugar, low fat, and very lean meats., with fruits and vegetables. The major microvascular complications are diabetic nephropathy, diabetic neuropathy and diabetic retinopathy (American Diabetes Association (ADA) 2010). Furthermore two studies reported an association between alcohol consumption and diabetic retinopathy and one study reported an association between physical activity and diabetic retinopathy.
Another study (Helgeson 2006) reported a higher than recommended percentage of energy intake from fat and saturated fat among type 1 diabetic patients, but they did not study associations with CVD or CVD risk factors. There are no firm recommendations regarding protein intake for type 1 diabetic patients with incipient nephropathy. The participants will be given pedometer for a week for the measurement of physical activities (step counts).
At 3 months follow-up, the patients would show significantly greater improvement and lower values of HbA1c by 1%.
An intake of 10-20% of total energy is recommended for patients with no evidence of nephropathy (Table 4). These participants will be instructed to wear the pedometer on a waist belt, either side and wear it from the early morning till they go to bed in the night. This would support the hypothesis 1 that the lifestyle interventions (physical activity and diet) in patients with poorly controlled diabetes will lead to reduction of 1% hemoglobin (HbA1c) in 90 days trial. Also eating every 2 hours did not help- I was hungry all the time, weak, still felt like I had to empty my bladder all the time, and hurt all the time. Their conclusions are based on PAI-1 and VLDL levels, which are not such a good predictors for atherosclerosis (and by extension CVD) as TG levels are. The recommendation for protein intake is most important for patients with diabetic nephropathy.
So the studies are in agreement with the guidelines but more research in better performed randomized controlled trials is needed to confirm this positive effect of physical activity on CVD in type 1 diabetic patients.
The participants will record the start and end time for each day wearing the pedometer and in the evening record the step count showing on the display without resetting the counter. Furthermore, a negative association between carbohydrates and dietary fiber with retinopathy progression and risk factors was found.
Furthermore none of these randomized controlled trials examined the potential positive effect of dietary fiber on CVD or the potential negative effect of saturated fat found in cross-sectional studies. Microalbuminuria can be seen as an early marker of diabetic kidney disease (Hovind P 2004). Table 2 shows the baseline characteristics of participants in intervention and control group.
Testing Hypothesis 2 (Secondary outcome variable)The hypothesis 2 will be supported if we can provide evidence that the type 2 diabetic patients after the 90 days trial would reduce 5% weight and consequently the BMI as compared to the these values at baseline.
The polynomial regression analysis will be used to generate the reference range models as these models do not make assumptions about linearity of step count with age (Wright and Royson, 1996). The 25-year cumulative incidences of any visual impairment and severe visual impairment are 13% and 3%, respectively.
Despite the high calories I was consuming from the fat( I checked Fitday), I lost about 20 lbs, mostly around my waist, and gained muscle. The changes in BMI from the base line values will determine the level of reduction in weight and BMI based on physical activity, diet and exercise.16. Ethical consideration The scientific validity of the study is a fundamental ethical protection and this study has a scientific merit and clinical value as it aims at using the socio-ecological approach to self-management of type 2 diabetes and will help diabetic patients to control their hemoglobin (HbA1c) and help them to understand the importance of physical activity and healthy diet and to enjoy a healthy lifestyle.All the patients will be provided clear instruction about the study and informed consent will be obtained and ethical clearance will be taken from a legal authority before conducting this study. Finally the high incidence of lower extremity amputations also stresses how serious the complications of type 1 diabetes are. Finally, the main contribution of this trial is to provide health professionals (diabetes care providers) and patients with type 2 diabetes an insight into the ways in which diabetes is viewed and managed in that region of Pakistan which will help them in the self-management and treatment of type 2 diabetes.17. The overall 25-year incidence of lower extremity amputations is 10.1% in 943 American type 1 diabetic patients (Sahakyan K et al. Conclusion It has been demonstrated in this study that the level of HbA1c (primary outcome) will reduce by 1% in the patients of poorly controlled type 2 diabetes after the 90 days trial of physical activity and dietary interventions and hence will support the hypothesis and the research question.
I am sure there are some people out there that can burn carbs and sugar well, but I do not think I was ever one of them.
This study will enhance the relationship between the medical practitioner and the patients of diabetes and will improve the health care system in that region of the country in managing and treating the patients with chronic disease such as diabetes.
These complications account for the major morbidity and mortality associated with type 1 diabetes, so it is very important to treat them (Daneman D 2006).In type 1 diabetes, special attention is paid to balancing the insulin dose with episodes of activity and the quantity and timing of food intake to prevent acute episodes of hypoglycaemia and hyperglycaemia (Franz MJ et al. A hypothesis is that excessive protein intake causes renal vasodilatation and glomerular excessive perfusion leading to a raised glomerular transcapillary hydraulic pressure gradient ending in proteinuria and glomerular damage, conversely, will prevent kidney damage (Percheron C et al. However, this could also be due to the kind of study (cross-sectional) and the fact that markers for CVD were used instead of CVD as endpoint. This is important because these acute complications can lead to a coma, but also because a high blood glucose concentration (glycosylated hemoglobin (HbA1c) ? 7%) in people with diabetes increases the risk for macrovascular as well as microvascular complications.
So, indeed protein restriction is beneficial for type 1 diabetic patients with established nephropathy. Other risk factors for these chronic complications are smoking, obesity, physical inactivity, high blood pressure and high cholesterol levels. Physical activityOf the eight studies that reported an association between physical activity and CVD there were five cross-sectional studies (Kriska AM et al. However, we have to mention that although this beneficial effect of a restricted protein intake was found in randomized controlled trials, the sample size of these trials were really small (maximum of 82 people). Also people with a longer history of diabetes have a higher risk (National Institute for Public Health and the Environment (RIVM) 2007). Furthermore it is important to realise that the microvascular complications lie on the pathway between diabetes and cardiovascular disease.
Nephropathy for example is an important risk factor for cardiovascular disease in people with type 1 diabetes (Jensen T et al.
1987).Recent studies have shown that people with type 1 diabetes eat a more atherosclerosis-prone diet.
This includes a high intake of energy from saturated fat and a low intake of fiber, fruits and vegetables, which could increase the risk of the development of atherosclerosis.
Further studies with a larger sample size are needed to find a cutoff point for protein intake which would still have a positive effect on diabetic nephropathy and its feasibility. It has been demonstrated that 80%-90% of type 2 diabetes and coronary heart disease cases can be prevented by healthy lifestyle behavior with a focus on healthy diet and exercise.(Stampfer et al. The studies will be discussed in the following paragraphs by study design.One study (Kriska AM et al.
1991) examined the relationship between physical activity and the occurrence of CVD in type 1 diabetic patients.
2004) These studies suggest that there could be a potential role for diet in type 1 diabetes to reduce the risk of cardiovascular disease. They found the lowest occurrence of CVD in people being 4-7 hours a week physical active (sports and leisure physical activity). There are more studies suggesting that diet (including alcohol) can play an important role in treating the complications of diabetes (Franz MJ et al. The other four cross-sectional studies examined an association between physical activity and CVD risk factors.
Several studies have reviewed nutritional recommendations for people with diabetes (Franz MJ et al. 2007) found that increased frequency of regular physical activity was associated with lower TG levels.
Furthermore they are general and not always specific for the different type of complications. 2007) found besides the positive association with TG levels also a positive significant association between regular physical activity and HDL cholesterol levels. An overview of the relationship between diet (including alcohol) and complications in type 1 diabetic patients is lacking. Also the effect of lifestyle (including physical activity and dietary patterns) on complications is still not elucidated for type 1 diabetic patients.
Lack of physical activity together with an atherogenic diet could enhance development of complications especially in high risk type 1 diabetic patients.In the following paragraphs of this bookchapter the literature on associations between diet (including alcohol) and lifestyle and chronic complications in type 1 diabetic patients will be summarized.
Impaired endothelial function is considered as an early sign of atherosclerosis, which is often the underlying cause of CVD. Since ‘diet’ and ‘lifestyle’ are broad terms the focus will be on macronutrients (carbohydrates (including fiber), proteins and fats (including cholesterol), alcohol, physical activity and dietary patterns.
2009) a significant inverse association between physical activity and CAC, a marker of coronary artery atherosclerosis, was demonstrated. In the final paragraphs all recommendations on diet and lifestyle in patients with type 1 diabetes will be put in perspective with the current literature.2. In conclusion all these studies found a beneficial effect of physical activity on cardiovascular risk factors. Diet, lifestyle and nephropathyEighteen studies reported an association between macronutrients and type 1 diabetic nephropathy. However, since all these studies were cross-sectional, they could only look at physical activity and the prevalence of CVD or CVD risk factors at a certain time point. They could not conclude if these are related to each other and if physical activity was responsible for the lower prevalence of CVD.The three trials reporting an association between physical activity and cardiovascular disease risk factors (Table 3) were consistent in their conclusions. The other five focussed on other dietary macronutrients such as fat, cholesterol or carbohydrate in relation with nephropathy. There were also three studies that reported results for protein as well as carbohydrate or fats and nephropathy. Furthermore one study reported an association between alcohol consumption and nephropathy in type 1 diabetic patients and one study reported an association between physical activity and nephropathy in type 1 diabetic patients.
2011) examined the association between physical activity and brachial artery flow-mediated dilation (FMD). Endothelial dysfunction is reflected by an impaired FMD response and is an early sign of atherosclerosis.
ProteinOf the thirteen studies that reported an association between protein and nephropathy there were three cross-sectional studies (Toeller M et al. An increase in FMD was found in type 1 diabetic patients following an exercise training program (endurance sports; on average 2 times a week 60 minutes, Table 3).
2002) examined the impact of physical activity on lipid related cardiovascular risk factors (LDL cholesterol, HDL cholesterol and TG).
They both found a decrease in LDL cholesterol levels in the training group, but only in one of these (Lehmann R et al. These will be discussed in the following paragraphs by study design.The three cross-sectional studies were not consistent in their conclusions on the effect of protein on diabetic nephropathy. 2000) failed to show a significant relationship between dietary protein intake and markers of early nephropathy, other than creatinine clearance. 1997) found a significant relationship between dietary protein intake and urinary albumin excretion rate (AER).
The relation between physical fitness and CVD was not examined.In conclusion the three trials show that physical activity improves physical fitness as well as endothelial function in type 1 diabetic patients. A higher AER was particularly found in people consuming more than 20% of their dietary food energy as protein. A positive effect on lipid related cardiovascular risk factors was only found in one study (Lehmann R et al. Dietary patternsTwo cross-sectional studies reported an association between dietary patterns, in this case the ‘Dietary Approaches to Stop Hypertension’ (DASH) diet, and CVD risk factors (Gunther ALB et al.
2001) total protein intake was not associated with the presence of microalbuminuria, but a diet including a high amount of fish protein seemed to decrease the risk. Furthermore they could not confirm an association between a high total animal protein intake and having microalbuminuria. No cross-sectional or prospective studies were found examining the effect of a Mediterranean diet or a Western diet on CVD in type 1 diabetic patients. 1991) found in their cohort study that a predominantly vegetarian diet (low in animal protein) may have an important beneficial effect on diabetic nephropathy without the need for a heavily restricted total protein intake.
2008) reported an association between adherence to the DASH diet and hypertension in type 1 diabetic patients. But they were not able to determine if the reduction in total protein intake rather than the reduction in the fraction of animal origin was primarily responsible for the fall in the fractional albumin clearance. They did not investigate a possible association between the DASH diet and CVD, but used hypertension as the main risk factor for CVD.
1998) cohort study showed that a low protein diet has a protective effect on the residual renal function in type 1 diabetic patients.In conclusion, these studies were not consistent in their conclusions on the effect of protein restriction on type 1 diabetic nephropathy.
2011) reported a possible association between the DASH diet and other CVD risk factors (total cholesterol, LDL cholesterol, HDL cholesterol, TG, LDL particle density, apolipoprotein B, body mass index (BMI), waist circumference, and adipocytokines) than blood pressure.
In one of these four this decline was greater in the low protein diet group than in the usual protein diet group, but this difference was not significant (Hansen HP et al. Unfortunately there were no studies found examining the effect of dietary patterns on CVD events.5. Current recommendations on diet and lifestyle in patients with type 1 diabetes put in perspective Overall, fiber and saturated fat intake play an important role in type 1 diabetic patients, with a beneficial and detrimental effect on the chronic complications respectively. Many researchers have shown the inappropriate intake of these nutrients in patients with type 1 diabetes.
Among these 2 studies, one (Brouhard BH & LaGrone L 1990) found a decline that was significantly greater in the usual protein group. Also moderate alcohol intake and physical activity may have beneficial effects in type 1 diabetic patients. Another study showed a decline in GFR in the low protein diet group, but did not directly compare this with the usual protein group (Dullaart RP et al. Most of the findings are consistent with the guidelines for type 1 diabetic patients (Table 4).The main limitations are the lack of prospective studies on diet and lifestyle in type 1 diabetics, lack of randomized controlled trials and the limited number of studies on dietary cholesterol, protein, carbohydrates, fat, fiber and no cardiovascular morbidity data.
The available studies, with their limitations, all indicate that diet and lifestyle play an important role in preventing chronic complications of type 1 diabetes. 1994) reported an increase in GFR during the low protein diet, but this increase was not significant.
The rates of decline in both iothalamate and creatinine clearence were significantly slower in the patients in the study-diet group than in those in the control-diet group. In three of these five trials there was a decline in albuminuria in the low protein diet group as well as in the usual protein diet group (Dullaart RP et al.
Two of these three showed a significant greater decline in albuminuria in the low protein diet group than in the usual protein diet group (Dullaart RP et al. One of these (Brouhard BH& LaGrone L 1990) found a significant difference between the diet groups. 1988) type 1 diabetic patients with microalbuminuria consumed a significantly smaller percentage of total energy as carbohydrate compared with patients with normal albumin excretion.



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