Glycemic index and diabetes pdf
File Name: glycemic index and diabetes .zip
Glycemic load is a smidge more useful than glycemic index when it comes to choosing healthy, diabetes-friendly foods. Have you ever eaten a snack in hopes of curing your afternoon slump only to feel up and then down again? By using an easy formula no major arithmetic required!
What is the glycaemic index (GI)?
HbA 1c indicates glycated hemoglobin A 1c. The mean time to dropout for those participants who did not complete the end point assessment was 5. One participant who dropped out from the high—cereal fiber diet had an antihyperglycemic medication dosage decrease and 1 participant who dropped out from the low—glycemic index diet had an antihyperglycemic medication dosage increase.
Error bars indicate SEM. The P value at the lower left of each panel indicates the comparison between high—cereal fiber diet vs a low—glycemic index diet as change from week 0 to week 24 for each measurement by intention-to-treat analysis using an analysis of covariance model.
Low—glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations. There was also an increase of high-density lipoprotein cholesterol in the low—glycemic index diet by 1.
The need for implementation of effective dietary strategies in diabetes prevention and management has been emphasized by the success of diet and lifestyle changes in preventing diabetes in high-risk patients. One dietary strategy aimed at improving both diabetes control and cardiovascular risk factors is the use of low—glycemic index diets. Our goal in this study was to assess the effect of a low—glycemic index diet in an adequately powered study of patients with type 2 diabetes controlled by oral medications with HbA 1c concentrations between 6.
At these levels, a reduction in glycemia and associated risk factors for diabetes complications are likely to be observed more clearly.
We selected a high—cereal fiber diet treatment for its suggested health benefits 8 , 9 , 23 - 25 for the comparison so that the potential value of carbohydrate foods could be emphasized equally for both high—cereal fiber and low—glycemic index interventions.
Study participants were recruited from local newspaper advertisements. Out of responses by telephone, participants were considered potentially eligible and were invited to attend an information session at the Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada, where all study clinical activity took place.
Of those participants invited, attended a screening appointment. A total of participants were ineligible and were eligible; however, 6 participants could not be contacted, 5 were unable to start the study immediately, and 48 declined to continue.
The remaining participants were randomized Figure 1. Recruitment took place between July 8, , and December 5, , with the last follow-up visit on May 22, Eligible participants were men or postmenopausal women with type 2 diabetes who were taking oral medications other than acarbose to control their diabetes, with medications stable for the previous 3 months, and who had HbA 1c values at screening between 6. Participants were accepted after surgery or myocardial infarction providing an event-free, 6-month period had elapsed before the study.
After randomization, it was found that 5 participants had not been excluded who were taking acarbose and had not subsequently been advised to stop taking acarbose, and 2 participants were not taking diabetes medications. In addition, 8 participants had changed their medications within 3 months before the start of the study and 2 women were not postmenopausal.
Furthermore, at the start of the trial, 9 participants 6 in the low—glycemic index diet and 3 in the high—cereal fiber diet did not receive the appropriate dietary advice for the treatment to which they had been randomized. This error was corrected within the first 4 weeks of the study. Nevertheless, all randomized participants were retained both for the intention-to-treat ITT and study completion analyses. The study was approved by the research ethics board of St Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada, and written consent was obtained from all participants.
Neither the dietitians who were responsible for the day-to-day running of the study nor the participants could be blinded to the treatment allocation. The technical staff involved in the analyses were blinded to treatment, as was the statistician up to and during the preliminary assessment of the primary outcome, HbA 1c.
In addition, during the study, equally strong emphasis was placed by dietitians on the potential importance of either high—cereal fiber foods or low—glycemic index foods and appropriate weekly checklists were developed for each treatment.
Participants were observed at the Clinical Nutrition and Risk Factor Modification Center at baseline, weeks 2 and 4, and thereafter at monthly intervals until the end of the 6-month period.
During the first month, participants received instructions regarding the diet to which they were allocated. Throughout the study, this advice was reinforced by the dietitians. At all center visits, participants were weighed in indoor clothing without shoes and a fasting blood sample was taken. Blood pressure was measured seated on 3 occasions at 1-minute intervals using an Omron automatic sphygmomanometer OMRON Healthcare Inc, Burlington, Ontario, Canada and the mean of the 3 measurements was taken.
In addition, participants brought with them their 7-day food record covering the week before the visit; this was discussed with the dietitian together with their checklist of low—glycemic index or high—cereal fiber food items recorded on a daily basis throughout the study.
For the last participants who were enrolled in the study, adherence was rated formally under 1 of 3 categories good, adequate but may need additional encouragement with a between-visit telephone call, or nonadherent with definite need for a telephone call between scheduled visits. During the study, participants were asked to maintain their antihyperglycemic medications constant and letters were sent to family physicians for their support in this matter.
When patients experienced symptoms of hypoglycemia with blood capillary glucose levels of less than The patients were then referred back to their family physicians so that medications could be reduced according to a predetermined protocol.
If HbA 1c increased to more than 8. Only 1 participant was withdrawn due to HbA 1c being more than 8. The participant's HbA 1c was 7. They were informed that this was not a weight-loss study but appropriate advice was given on portion size and fat intake to help them meet their body weight objectives. Participants were also provided with a checklist with either low—glycemic index or high—cereal fiber food options from different categories breakfast cereals, breads, vegetables, fruit as approximately g carbohydrate servings.
In the low—glycemic index diet, the following foods were emphasized: low—glycemic index breads including pumpernickel, rye pita, and quinoa and flaxseed and breakfast cereals including Red River Cereal [hot cereal made of bulgur and flax], large flake oatmeal, oat bran, and Bran Buds [ready-to-eat cereal made of wheat bran and psyllium fiber] , pasta, parboiled rice, beans, peas, lentils, and nuts Table 1. Six servings were prescribed for a kcal diet, 8 servings for a kcal diet, and 10 servings for a kcal diet.
Detailed advice was also given to avoid starchy foods not directly recommended as part of the treatment, including those foods advised in the alternative treatment. In both diets, participants were specifically advised to avoid foods such as pancakes, muffins, donuts, white buns, bagels, rolls, cookies, cakes, popcorn, french fries, and chips. Three servings of fruit and 5 servings of vegetables were encouraged on both treatments.
In the low—glycemic index diet, temperate fruit was the focus, including apples, pears, oranges, peaches, cherries, and berries; and in the high—cereal fiber diet, tropical fruit, such as bananas, mangos, guavas, grapes, raisins, watermelon, and cantaloupe, were emphasized.
Participants were also advised against eating fruit recommended in the alternative treatment. Checklists were completed by participants on a daily basis throughout the study and 7-day diet records were completed before each visit.
Participants were instructed on how to record using food models as examples of portion size and were asked to give actual weights or to express the amounts in terms of common measures, including cups, teaspoons, and dessert spoons.
Adherence was assessed from the 7-day diet records. The daily checklists were of value in alerting the dietitian to problems with adherence to the diet plan over the month before center attendance.
Diets were assessed for macronutrients, fatty acids, cholesterol, fiber, and glycemic index by using a computer program based on US Department of Agriculture data 29 and international glycemic index tables, 30 with white bread as the standard.
Additional measurements were made on local foods, especially specialty breads used as part of the low—glycemic index diet. Glycemic load was calculated as the product of the mean daily available carbohydrate and glycemic index divided by The original power calculation was based on a predicted HbA 1c difference between end of treatments of 0.
Our participant requirement was 67 for each treatment. However, the preliminary results of a large but at the time unpublished study that assessed the diet effect on HbA 1c suggested our effect size would be smaller than we had originally predicted. Our revised goal therefore was to detect a difference of half of an SD 0.
All analyses were performed by using SAS version 9. The first and primary analysis was an ITT analysis, which included all randomized participants, with the baseline observation carried forward, rather than the last observation, for all those who did not complete the study.
This procedure was used to recognize that these individuals would most likely have reverted to their previous diets and behavioral patterns, resulting also in a reversion to their previous level of diabetic control.
The second analysis included participants who completed the study completer analysis , and the third analysis involved participants who completed the study according to the protocol but who did not change their antihyperglycemic medications before or during the study period per-protocol analysis. The analysis of covariance model for these analyses was the basic model described above together with the main effect of interest and its diet interaction.
The time trends were estimated by using Proc GLM in SAS and the repeated statement assuming a spatial power covariance structure to control for unevenly spaced time intervals between measurements.
This is an autoregressive test assuming correlations between successive observations. A significant time trend therefore indicates a monotonic relationship between time and change in the study measurement. No time trend was observed between weeks 2 to 24 for the other measurements. Additional analyses were performed by using change in fiber, carbohydrate intake, and body weight as covariates in the analysis of covariance model Proc GLM.
Pearson product-moment correlations were calculated to examine associations of dietary fiber, glycemic index, and body weight change with other variables of interest. Partial correlations controlling for either change in body weight, fiber, or glycemic index were also undertaken to examine the independent association of fiber and glycemic index with the variables of interest.
The participant flow diagram is shown in Figure 1. Eleven participants dropped out after randomization but before their baseline visit and were therefore unaware of their treatment allocation 5 in the high—cereal fiber diet group and 6 in the low—glycemic index diet group. There were no treatment differences at baseline Table 2 , with the exception of more carbohydrate and less fat consumed before the high—cereal fiber diet compared with the low—glycemic index diet Table 3.
By the end of the study, although carbohydrate intake increased similarly on both treatments, fiber intake increased slightly more with the low—glycemic index diet The glycemic index decreased with the low—glycemic index diet from In the assessment of the last participants enrolled, the dietitians rated adherence similarly and poor in 8 of 58 participants The relative change in absolute HbA 1c units in the low—glycemic index diet compared with the high—cereal fiber diet was —0.
A treatment difference was observed in glucose of —6. Difference in body weight reduction was not significant —0. No significant interactions were observed between diet and the following factors: sex, baseline glycemic control, age, or BMI in relation to the treatment effect on HbA 1c. However, the smokers were too few to allow meaningful conclusions. Systolic and diastolic blood pressure dropped slightly in both diets, but the treatment differences did not reach significance Table 4.
For the ITT analysis, the reductions from baseline at 24 weeks were —1. There were no serious adverse events directly related to the study; however, of the 11 participants who reduced their diabetes medications, all 6 who had clear evidence of hypoglycemic symptoms or low blood glucose levels were taking low—glycemic index diets.
The further increase during the study did not therefore appear related to the intervention. In general, the completer and per-protocol analyses confirmed the ITT analysis but showed larger effect sizes and greater significance levels Figure 3. Greater reductions in HbA 1c were observed in the low—glycemic index diet —0. The results of the per-protocol analysis were similar except that the reduction in the blood glucose was no longer significant but a significantly greater reduction was observed in body weight in the low—glycemic index diet —3.
Lowering the glycemic index of the diet improved glycemic control and risk factors for coronary heart disease CHD. These data have important implications for the treatment of diabetes where the goal has been tight glycemic control to avoid complications. The reduction in HbA 1c was modest, but we think it has clinical relevance.
Our 0. Pharmacological interventions to improve glycemic control in type 2 diabetes have often failed to show a significant reduction in cardiovascular events. Low HDL-C is one of the characteristics of the dyslipidemia associated with type 2 diabetes and may be part of the reason for the increased CHD risk observed in type 2 diabetes.
Previous cross-sectional studies have noted a negative relationship between glycemic index 12 , 13 or glycemic load 14 and HDL-C.
Back to Food and diet. The glycaemic index GI is a rating system for foods containing carbohydrates. Carbohydrate foods that are broken down quickly by your body and cause a rapid increase in blood glucose have a high GI rating. High GI foods include:. Low or medium GI foods are broken down more slowly and cause a gradual rise in blood sugar levels over time. They include:.
PDF | Worldwide diabetes mellitus especially type 2 diabetes mellitus (T2DM) has become a common and rapidly growing chronic.
What is the glycaemic index (GI)?
People with diabetes often hear that they should not eat sweet foods because these can cause spikes in blood sugar. Could honey be a healthful alternative to the sugar in sweets and snacks? The pancreas secretes insulin , a hormone, to keep blood sugar at safe levels. In a person with diabetes , the body either cannot use insulin correctly or it cannot produce enough. How honey affects people with diabetes remains unclear.
Items in Shodhganga are protected by copyright, with all rights reserved, unless otherwise indicated. Shodhganga Mirror Site. Show full item record. Saradha Ramadas V. Diabetes is fast gaining the status of a potential epidemic in India and currently newlinemore than 62 million individuals diagnosed as diabetics.
We encourage you to approach these offerings as you would a buffet — review the options, maybe try a few new things and come back for what works best for you. Bon Appetit! The Glycemic Index Diet was designed to help people with diabetes control their blood sugar levels. The diet focuses on carbohydrates, with the goal of eating foods that produce a steady rise in blood sugar instead of the spike in blood sugar created by eating foods that are quickly digested. Due to the high fiber content of most foods in the glycemic index, those following the diet often feel fuller and are able to lose weight without feeling hungry.
Background: The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear. Objectives: The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes. Selection criteria: As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between and , including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies.
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