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The Influence of Nutrition and Diet Management on the Origin of Type 2 Diabetes

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Dr. Ichiro Kishimoto

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Department of Endocrinology and Diabetes, Toyooka Public Hospital, 1094 Tobera, Toyooka 668-8501, Japan
Interests: the origin of type 2 diabetes; lifestyle prevention of postprandial hyperglycemia; reactive hypoglycemia; nutrition; diet management

Special Issue Information

Dear Colleagues,

Postprandial hyperglycemia is known to precede the development of type 2 diabetes. It is mainly characterized by the insulin resistance of the skeletal muscle and by the failure of timely insulin secretion from the pancreatic β-cells. Hyperglycemia-induced hyperinsulinemia often leads to an unwanted excessive decrease in blood glucose levels, which elicits overeating and the activation of counter-insulin hormonal systems. The glycemic rollercoaster further worsens insulin resistance and the dysfunction of β-cells, creating the vicious cycle that leads to the development of diabetes, and, therefore, can be regarded as the origin of type 2 diabetes. This Special Issue focuses on the influence of nutrition and diet on postprandial hyperglycemia and/or reactive hypoglycemia, which ignites the fire of type 2 diabetes.

Dr. Ichiro Kishimoto
Guest Editor

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17 pages, 1272 KiB

Open AccessArticle

Comparing the Effectiveness of Different Dietary Educational Approaches for Carbohydrate Counting on Glycemic Control in Adults with Type 1 Diabetes: Findings from the DIET-CARB Study, a Randomized Controlled Trial

by Bettina Ewers, Martin Bæk Blond, Jens Meldgaard Bruun and Tina Vilsbøll

Nutrients 2024, 16(21), 3745; https://doi.org/10.3390/nu16213745 - 31 Oct 2024

Cited by 1 | Viewed by 1846

Abstract

Background/Objectives: Carbohydrate counting is recommended to improve glycemic control in type 1 diabetes (T1D), but the most effective educational methods are unclear. Despite its benefits, many individuals struggle with mastering carbohydrate counting, leading to inconsistent use and suboptimal glycemic outcomes. This study aimed to compare the effectiveness of two group-based programs with individual dietary counseling (standard care) for glycemic control. Methods: The trial was a randomized, controlled, open-label, parallel-group design. Adults with T1D on multiple daily insulin injections (MDIs) and with glycated hemoglobin A1c (HbA1c) 53–97 mmol/mol were randomly assigned (1:1:1) to basic (BCC), advanced carbohydrate counting (ACC), or standard care. Primary outcomes were the changes in HbA1c or mean amplitude of glycemic excursions (MAGEs) in BCC and ACC versus standard care after six months. Equivalence testing was performed to compare BCC and ACC. Results: Between November 2018 and August 2021, 63 participants were randomly assigned to BCC (N = 20), ACC (N = 21), or standard care (N = 22). After 6 months, HbA1c changed by −2 mmol/mol (95% CI −5 to 0 [−0.2%, −0.5 to 0]) in BCC, −4 mmol/mol (−6 to −1 [−0.4%, −0.6 to −0.1]) in ACC, and −3 mmol/mol (−6 to 0 [−0.3%, −0.6 to 0]) in standard care. The estimated difference in HbA1c compared to standard care was 1 mmol/mol (−3 to 5 [0.1%, −0.3 to 0.5]); p = 0.663 for BCC and −1 mmol/mol (−4 to 3 [−0.1%, −0.4 to 0.3]); p = 0.779 for ACC. For MAGEs, changes were −0.3 mmol/L (−1.5 to 0.8) in BCC, −0.0 mmol/L (−1.2 to 1.1) in ACC, and −0.7 mmol/L (−1.8 to 0.4) in standard care, with differences of 0.4 mmol/L (−1.1 to 1.9); p = 0.590 for BCC and 0.7 mmol/L (−0.8 to 2.1); p = 0.360 for ACC versus standard care. An equivalence in effect between BCC and ACC was found for HbA1c, but not for MAGEs. Conclusions: Group-based education in BCC and ACC did not demonstrate a clear advantage over individualized dietary counseling for overall glycemic control in adults with T1D. Healthcare providers should consider flexible, patient-centered strategies that allow individuals to choose the format that best suits their learning preferences when selecting the most suitable dietary educational approach. Full article

(This article belongs to the Special Issue The Influence of Nutrition and Diet Management on the Origin of Type 2 Diabetes)

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10 pages, 963 KiB

Open AccessArticle

The Contribution of Postprandial Glucose Levels to Hyperglycemia in Type 2 Diabetes Calculated from Continuous Glucose Monitoring Data: Real World Evidence from the DIALECT-2 Cohort

by Niala den Braber, Miriam M. R. Vollenbroek-Hutten, Sacha E. M. Teunissen, Milou M. Oosterwijk, Kilian D. R. Kappert and Gozewijn D. Laverman

Nutrients 2024, 16(20), 3557; https://doi.org/10.3390/nu16203557 - 20 Oct 2024

Viewed by 2165

Abstract

Background/Objectives: Traditional glycemic monitoring in type 2 diabetes is limited, whereas continuous glucose monitoring (CGM) offers better insights into glucose fluctuations. This study aimed to determine the correlations and relative contributions of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels to hyperglycemia. Methods: We utilized CGM and recorded carbohydrate intake data from lifestyle diaries of 59 patients enrolled in the Diabetes and Lifestyle Cohort Twente (DIALECT-2). Correlations between FPG and the glucose management indicator (GMI), FPG and Time Above Range (TAR), PPG and GMI, and PPG and TAR were conducted. Daily and mealtime relative contributions of PPG and FPG to glycated hemoglobin (HbA_1c) and GMI were determined, considering two ranges: on target (<7.0%, 53 mmol/mol) and not on target (≥7.0%, 53 mmol/mol). Correlations between mealtime PPG and carbohydrate consumption were examined. Results: FPG and PPG correlated with GMI (r = 0.82 and 0.41, respectively, p < 0.05). The relative contribution of PPG in patients with HbA_1c, GMI, and TAR values not on target was lower than in patients with HbA_1c, GMI, and TAR values on target. When analyzing different mealtimes, patients with target GMI values had a higher PPG (73 ± 21%) than FPG after breakfast (27 ± 21%, p < 0.001). Individuals with elevated GMI levels had lower PPG after lunch (30 ± 20%), dinner (36 ± 23%), and snacks (34 ± 23%) than FPG. PPG after breakfast positively correlated (r = 0.41, p < 0.01) with breakfast carbohydrate intake. Conclusions: Both PPG and FPG contribute to hyperglycemia, with PPG playing a larger role in patients with better glycemic control, especially after breakfast. Targeting PPG may be crucial for optimizing glucose management. Full article

(This article belongs to the Special Issue The Influence of Nutrition and Diet Management on the Origin of Type 2 Diabetes)

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