Overweight Individuals with T2DM | Keto Diet vs Plate Method Diet


Recently a study was conducted by Saslow LR and colleagues to study whether a very low carbohydrate ketogenic diet with lifestyle factors (intervention) or a “Create Your Plate” diet (control) recommended by the American Diabetes Association (ADA) would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes mellitus (T2DM).

This article was published in February 2017 in a very reputed journal ‘Journal of Medical Internet Research’. In 2017, the impact factor of this journal was 4.671. For those of you who don’t know what an impact factor is or have never heard of, it simply means the number of times recent articles published in that journal in a year was cited by others. If the impact factor is high, it is considered to be a highly ranked journal.

Now coming back to the study, it was a parallel-group, balanced randomization (1:1) trial. This trial was approved by the University of California, San Francisco, Institutional Review Board and registered with ClinicalTrials.gov (NCT01967992).

In this study, glycemic control, operationalized as the change in glycated hemoglobin (HbA1c) was the primary outcome.

They also assessed body weight, cholesterol, triglycerides, diabetes-related distress, subjective experiences of the diet, and physical side effects.

During the study, the participants were asked to measure urinary acetoacetate (one type of ketone bodies that can be measured in urine) test kits (KetoStix). Basically, there are three types of ketone bodies. Other two types of ketone bodies are acetone and beta-hydroxybutyrate.

The other group i.e. the control group were asked to follow “Create Your Plate” diet recommended by ADA. What does this ADA diet consist of? Well, ADA recommends a low-fat diet which includes green vegetables, lean protein sources, and limited starchy and sweet foods. Most of the doctors worldwide follow ADA guidelines and recommend this particular diet to their patients.

As mentioned earlier the investigators divided the eligible participants into two groups (intervention group and control group).

In fact, when I was diagnosed with T2DM my diabetologist also recommended a low-fat diet with a caloric restriction of 1800 calories. But he never advised me how to restrict my calories to 1800 or what should I eat.  I was totally confused.

Also, he prescribed a couple of oral antidiabetic drugs and a statin. I followed his instructions for a couple of weeks and the result was that within 2 weeks I developed side effects of the drugs. I immediately STOPPED all my medications and started following a keto diet. Finally, I was able to reverse my T2DM. Anyway, that’s a separate story.

Coming back to the study, all the parameters were measured at baseline before randomization in both the groups. Again, all the parameters were measured after 16 and 32 weeks of intervention.

So what conclusions were drawn from this study. Let me list the results of this study in bullet points for better understanding.

  • The investigators observed that there were significantly greater reductions in HbA1cthose who followed the ketogenic diet after 16 as well as 32 weeks
  • Similarly, those who were on keto diet lost more weight than those who followed conventional ADA diet (12.7 kg versus 3 kg)
  • Also, triglycerides level was much lower in the ketogenic group compared to ADA diet followers

This study showed that those who followed a ketogenic diet had several health benefits including lower HbA1c, body weight, and triglyceride levels.

There were few limitations in this study. The number of participants was very less (25 participants) and the follow-up duration of the study was not long.

Despite all limitations, the conclusion we can draw from this study is that low-carbohydrate ketogenic diet and lifestyle changes are beneficial in individuals who are overweight with T2DM.

If you have any queries or any experience to share please type in the comment box. I will try to reply to all your queries.

If you have enjoyed reading this article, I would request you to share with your friends and colleagues who are diagnosed with T2DM. I am sure by reading this article, they will be motivated that it’s not the end of the world if they are diagnosed with T2DM.

With dietary and lifestyle modifications, it is possible to reverse your T2DM.

Invokana superior to glimepiride for glycemic control, weight loss, BP


Over 52 weeks, glycemic control was improved and body weight and blood pressure were reduced with Invokana as add-on therapy to metformin in patients with type 2 diabetes, according to a presentation here.

In the randomized, double blind study, Katherine Merton, PhD, of Janssen Scientific Affairs, and colleagues evaluated data from 1,450 adults (mean age, 56.2 years) with type 2 diabetes (mean HbA1c, 7.8%; mean BMI, 31 kg/m2) on background metformin randomly assigned to Invokana (canagliflozin, Janssen) 100 mg or 300 mg or glimepiride for 52 weeks to determine the effects of the treatments on metabolic syndrome components.

Participants were further diagnosed with metabolic syndrome if they met two or more of the following criteria: triglyceride levels of at least 150 mg/dL; HDL cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women; waist circumference at least 102 cm for non-Asian men, at least 88 cm for non-Asian women, greater than 90 cm for Asian men and greater than 80 cm for Asian women; or a diagnosis of hypertension or BP-related criteria (systolic BP 130 mm Hg or diastolic BP 85 mm Hg). At week 52, changes from baseline in HbA1c, fasting plasma glucose, BP, waist circumference, body weight, BMI and lipid levels were evaluated.

Eighty-one percent of participants met the criteria for metabolic syndrome at baseline with the proportions similar across the treatment groups. Overall, 1,160 participants had data available to assess all metabolic syndrome criteria with 39.7% meeting three, 33.7% meeting four and 17.2% meeting five criteria.

At week 52, 1,132 participants with metabolic syndrome at baseline had data available to assess metabolic syndrome criteria; there were fewer participants with metabolic syndrome in the canagliflozin 100 mg (86.7%) and cangliflozin 300 mg (85.8%) groups compared with the glimepiride group (92.7%).

HbA1c reduction was greater with canagliflozin 300 mg (-0.9%) compared with canagliflozin 100 mg and glimepiride, which both reduced HbA1c by 0.8%.

Both canagliflozin doses resulted in reductions in fasting plasma glucose, systolic BP, diastolic BP, waist circumference, body weight and BMI compared with glimepiride.

LDL cholesterol and HDL cholesterol were increased with both doses of canagliflozin compared with glimepiride. Triglyceride reduction was greater with canagliflozin 100 mg compared with glimepiride whereas levels were similar between glimepiride and canagliflozin 300 mg.

“Canagliflozin improved all components of [metabolic syndrome] including glycemic control, BP, and weight loss compared with glimepiride over 52 weeks in patients with type 2 diabetes Merton said. “These findings support the use of canagliflozin versus glimepiride in patients who had type 2 diabetes and metabolic syndrome compnents.” – by Amber Cox

Even Well-Controlled Type 1 Diabetes Associated with Increased Mortality Risk


Patients with type 1 diabetes who have good glycemic control still have about twice the mortality risk as the general population, according to a case-control study in the New England Journal of Medicine.

Using Swedish registries, researchers matched 34,000 adults with type 1 diabetes to roughly 170,000 adults without type 1 diabetes (mean age, 36). All patients with diabetes were at elevated risk for all-cause mortality, even those with well-controlled mean glycated hemoglobin levels (5.4% for patients with hemoglobin A1c levels of 6.9% or below vs. 2.9% mortality rate for controls during 8 years’ follow-up). In that same period, mortality increased with increasing levels of glycated hemoglobin (12% for HbA1c of 9.7% or higher).

There were similar trends in cardiovascular and diabetes mortality, which accounted for much of the excess overall mortality risk.

Tight glycemic control failed to benefit pediatric ICU patients.


Tight glycemic control in critically ill children had no significant effect on the number of days alive and free from mechanical ventilation, according to researchers.

Children admitted to the pediatric ICU (aged ≤16 years) who were expected to require mechanical ventilation and vasoactive drugs for at least 12 hours were randomly assigned to tight glycemic control with a target blood glucose range of 72 mg/dL to 126 mg/dL or conventional glycemic control with a target level less than 216 mg/dL.

Besides assessing the number of days alive and free from mechanical ventilation at 30 days after random assignment, the Control of Hyperglycemia in Pediatric Intensive Care (ChiP) trial researchers examined the costs of hospital and community health services.

Of 1,369 patients at 13 centers in England, 694 were assigned to tight glycemic control and 675 to conventional glycemic control. Of those, 60% had undergone cardiac surgery, according to researchers.

Data indicate that the mean between-group difference in the number of days patients were alive and free from mechanical ventilation at 30 days was 0.36 days (95% CI, –0.42 to 1.14).

In addition, severe hypoglycemia was observed in children in the tight glycemic control group compared with those in the conventional glycemic control group (7.3% vs. 1.5%, P<.001).

The mean 12-month costs were less in the tight glycemic control group compared with the conventional glycemic control group (cost per patient difference of –$4,815; 95% CI, –$10,298 to –$668), according to data. The cardiac surgery subgroup costs were similar in each group. However, in the subgroup that did not undergo cardiac surgery, the mean cost was less in the tight glycemic controlgroup compared with the conventional glycemic control group (–$13,120; 95% CI, −$24,682 to −$1,559), researchers wrote.

In an accompanying editorial, Michael S.D. Agus, MD, of Boston Children’s Hospital and Harvard Medical School, wrote that the trial was well designed but would require further study.

“Although the improved 1-year health care outcomes in the non–cardiac-surgery patients is compelling, it remains impossible to determine best practice for the child who requires critical care for reasons other than cardiac surgery or burns until either a meta-analysis of several trials is performed on an individual-data level or until data from an ongoing large, multicenter trial are accrued,” Agus wrote.

Source: Endocrine Today.

Routine diabetes education in UK improved glycemic control, QOL .


When delivered through routine health care in the United Kingdom, diabetes education led to long-term glycemic control and improved quality of life in adults with type 1 diabetes.

Researchers from the UK National Institute for Health Research Dose Adjustment for Normal Eating (NIHR DAFNE) study group examined 262 patients with type 1 diabetes before and after evaluation of the DAFNE program.

DAFNE consisted of a 5-day course with a follow-up booster session at 6 weeks. The diabetes educators promoted carbohydrate counting, dose adjustments and other management techniques.

HbA1c data were collected from routine records up to 8 weeks before and 6 and 12 months after the course of the program, the researchers wrote. Before enrollment, patients (average age, 40 years) completed the Diabetes-Specific Quality of Life Scale (DSQOLS) and again at 3, 6 and 12 months after the course. The researchers said there were no differences between men and women in the study.

According to data, the mean baseline HbA1c was 8.5% and one-quarter of patients (n=65) had an HbA1c <7.5%. Patients with an HbA1c of <7.5% were ultimately excluded from an analysis of patients with suboptimal control; further improvements would have increased the risk for severe hypoglycemia.

Upon further analysis, significant improvements were noted among HbA1c levels in patients from baseline to 6 months (P<.001), continuing through 12 months (P<.001), researchers wrote.

“Each DSQOLS subscale and total score showed significant improvements by 3 months, all of which were maintained at 6 and 12 months in the total sample,” researchers said.

Based on these findings, they said it is possible to achieve sustainable improvements in HbA1c and QOL among adults with type 1 diabetes through routine diabetes education programs.

Perspective

 

Carol Rasmussen

  • By using a structured group education format for type 1 diabetes patients, researchers found positive outcomes. The format was to provide intensive insulin therapy with flexible food choices. By teaching freedom in choosing foods without restrictions and flexible dosing, overall quality of life (QOL) will be improved. The goal was to decrease HbA1c and increase QOL. As this program is included as part of the routine diabetes care provided, it should decrease medical costs by doing group education and support. Having this education separate from the individual clinic appointments gave additional attention to their diabetes and other concerns. The HbA1c in this study decreased in relation to improved QOL.

The paradigm for diabetes care in type 1 diabetes patients has long been individual visits and care. The group setting was used more in the type 2 diabetes population. In the clinical setting, this will impact education, in teaching to a group rather than individually a support focus will be created. The format and intense education worked well in their population, which was mainly well educated and motivated. Time will tell how it works in the less educated and motivated population.

This research and following programs bear close watching to evaluate further successes or concerns. Myself, I am excited about the implications for this innovative format.

    • Carol Rasmussen, MSN, APRN, CDE, FAADE
    • Family medicine nurse practitioner at the Exodus Healthcare Network in Magna, Utah
  • Source: Endocrine Today