Diet and Lifestyle approaches for Prevention and Treatment of Type 2 Diabetes – exploring evidence of how this impacts on health outcomes

Question 1

how is the prevelance of obesity and diabetes changing?

Answer 1

both increasing

Question 2

what is the relationship between BMI and the risk of developing type 2 diabetes?

Answer 2

Question 3

how does CVD risk of someone with diabetes comapre in men and women?

Answer 3

higher risk of CVD in women with diabetes compared to men with diabetes

Question 4

what are CVD risk factors?

Answer 4

smoking, obesity, hypertension, hyperlipidemia, and insulin resistance

Question 5

does obesity increase CVD risk?

Answer 5

yes

The mechanisms by which obesity increases the risk of CVD are not yet fully understood

It is understood that people with diabetes are at increased risk of CVD and the presence of obesity increases that risk.

Obesity is a complex condition and patients are often ill‐served by simplistic “eat less move more” messages

Question 6

what is the management of obesity?

Answer 6

The causes and effects of obesity are complex and multifactorial, spanning from a societal level right down to a molecular level

Dietary intervention is crucial to the management of obesity and it is becoming better understood how nutrition can be manipulated, for example with the addition of MUFAs and PUFAs or manipulations of macronutrients to address some of the factors exacerbating obesity and CV risk

Question 7

what si the rise in obesity due to?

Answer 7

The rapid rise in obesity is likely not due to a major genetic defect, rather, lifestyle choices/changes

A plentiful supply of energy dense food and a sedentary lifestyle predisposes people to weight gain (and makes it difficult to lose weight)

Question 8

how has obesity affected diabetes?

Answer 8

Type 2 diabetes is now a bigger challenge than ever before thanks to the ‘obesogenic environment’ in which people are exposed to unhealthy foods that are cheap and readily available from childhood

Question 9

Lifestyle changes promoting the rise in diabetes, what are they?

Answer 9

Physical activity has decreased and more time is spent on screen-based and sedentary leisure activities

The unhealthy lifestyle choices we have increasingly been defaulting to all give rise to modifiable risk factors for Type 2 diabetes, which are primarily overweight and obesity (BMI of 25 or more) and a large waist circumference (abdominal obesity)

There are also several risk factors that cannot be controlled or prevented, including:

• a family history of Type 2 diabetes
• age - being older than 40 or older than 25 for some black and minority ethnic (BME) groups
• certain ethnicities

Question 10

do people that are active has less of a chance of developing type 2 diabetes?

Answer 10

People who are at least moderately active have a 30% to 40% lower risk of type 2 diabetes

Question 11

What is the influence of exercise on postprandial glucose and triacylglycerol metabolism

Answer 11

Skeletal muscle plays an important role in regulating the storage and/or oxidation of glucose and TAG during the postprandial period

Insulin plays a central role in this regulation

Reductions in peripheral insulin sensitivity leads to abnormalities in glucose and TAG metabolism and is the first detectable defect in the pathogenesis of metabolic diseases, such as type 2 diabetes

Acutely, exercise is a potent stimulus of muscle glucose and TAG uptake due to the increased energy demands of the activity, and adaptations to regular training also benefit postprandial metabolism

Question 12

what is the effect of an acoute bout of exercise on glucose metabolism?

Answer 12

A bout of endurance‐type exercise increases glucose transport into muscle

Insulin‐stimulated glucose uptake is also elevated for at least 16 hours with higher whole‐body insulin sensitivity detectable for 3 days post‐exercise

Although exercise timing should be considered, the window over which exercise exerts a glucoregulatory effect spans many meals (~3 days), and thus its effect on the first or even second eating occasion (~6 hours) must be interpreted accordingly

Exercise is widely acknowledged as a potent and non-pharmacological strategy for increasing muscle insulin sensitivity and improving postprandial glucose control

Question 13

what is the effect of regular exercise training?

Answer 13

In healthy humans, endurance-type exercise training increases insulin sensitivity allowing postprandial blood glucose to be regulated with lower insulin levels

In humans with impaired glucose tolerance, similar training can also improve oral glucose tolerance although this may be dependent on the extent of glucose intolerance at baseline and the exercise

Enhancing the efficacy of exercise? - Many individuals fail to meet physical activity recommendations, with a lack of time often cited as a barrier

Therefore, whilst exercise volume (exercise duration - exercise intensity - exercise frequency) is likely the main determinant of the magnitude of improved glycaemic responses, strategies to maximise the benefits of ANY exercise performed are of interest

Question 14

Eating too much sugar will give you type 2 diabetes - true or false?

Answer 14

Eating too much sugar will give you type 2 diabetes…..it may not !

Despite some suggestions that a diet with a large proportion of high GI carbohydrates, typically monosaccharides (i.e. simple sugars), may increase type 2 diabetes risk relative to a diet containing more complex carbohydrates, this association is not always apparent in the literature (need to consider whole diet and lifestyle factors)

Question 15

Doesn’t matter what i eat, ill get diabetes anyway - true or false?

Answer 15

Doesn’t matter what i eat….it does!

Diets with high-fibre content have been associated with reduced risk of cardiovascular and metabolic diseases

Humans ingesting 26g of dietary fibre/day have been reported to have a 22% lower risk of type 2 diabetes vs. those consuming 13 g/day

Question 16

The ____ of developing type 2 diabetes can be substantially reduced by _______ ______

_________ __________ directed at fat and calorie restriction, increased dietary fibre intake, and at achieving a minimum of 30 min of moderate exercise daily is the method of choice in reducing the incidence of type 2 diabetes

The focus should be on _______ _____ ____ and surgery and weight loss drugs may also be appropriate; the greater the reduction in weight back to a healthy BMI, the greater the impact on reducing the risk of developing diabetes

While ______________ ______ is clearly able to lower blood glucose in those with IGT and IFG, the lack of information on its impact on hard clinical outcomes makes it currently unsuitable for widespread use in those with IGT and IFG

Health systems need to develop ways of identifying those at high risk of developing diabetes, and implementing intensive _______ programs. This needs to be supported by societal changes that facilitate the pursuit of _______ ________ for everyone

Answer 16

The risk of developing type 2 diabetes can be substantially reduced by lifestyle change

Lifestyle intervention directed at fat and calorie restriction, increased dietary fibre intake, and at achieving a minimum of 30 min of moderate exercise daily is the method of choice in reducing the incidence of type 2 diabetes

The focus should be on achieving weight loss and surgery and weight loss drugs may also be appropriate; the greater the reduction in weight back to a healthy BMI, the greater the impact on reducing the risk of developing diabetes

While pharmacological therapy is clearly able to lower blood glucose in those with IGT and IFG, the lack of information on its impact on hard clinical outcomes makes it currently unsuitable for widespread use in those with IGT and IFG

Health systems need to develop ways of identifying those at high risk of developing diabetes, and implementing intensive lifestyle programs. This needs to be supported by societal changes that facilitate the pursuit of healthy lifestyles for everyone

Question 17

Dietary approaches for treatment - what are the aims of dietary advice?

Answer 17

Provide a knowledge of healthy eating

Encourage lifestyle changes in order to reduce obesity and ensure optimal weight

Maintain blood glucose and lipids as near normal as possible

Reduce the acute (short term) complications of diabetes such as hypoglycaemia and hyperglycaemia

Reduce body weight

Question 18

what is important in a diabetics diet?

Answer 18

no such thing as a diabetic diet, just a healthy diet is needed

Question 19

How do diet recommendations differ for healthy eating and Type 2 diabetes ?

Answer 19

they are very similar

Question 20

what diet is best to treat type 2 diabetes?

Answer 20

Unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss itself is the main reason behind observed improvements

A systematic review of randomised controlled trials (RCT): Only four RCT indicated the benefit of a particular dietary intervention over another in improving HbA1c levels, including the Mediterranean, vegan and low glycaemic index (GI) diets

Currently insufficient evidence to suggest that any particular diet is superior in treating overweight and obese patients with T2DM

Question 21

does weight loss help type 2 diabetes?

Answer 21

Weight loss will help - the majority of published guidelines emphasise the importance of weight loss for the 90% of those with type 2 diabetes who are overweight or obese, and of the three macronutrients (carbohydrate, fat and protein)

Carbohydrate management has also been identified as a key strategy for blood glucose control

Question 22

Weight management is a _________ for those with type 2 diabetes

A variety of weight management strategies are ________

The ideal amount of macronutrients is ________

_________ management can improve glycaemic control

A variety of dietary patterns are associated with improved outcomes and __________ advice is recommended

Answer 22

key strategy

effective

unknown

Carbohydrate

individualised

Question 23

do improvements of glycaemic control in people with type 2 diabetes affect the risk of micro and macrovascular disease?

Answer 23

There is strong evidence that improvements in glycaemic control in people with Type 2 diabetes are associated with significant reductions in risk from both microvascular and macrovascular disease

Question 24

in type 2 diabetes, you want to reduce the amount of time spent with _________ bloog glucose

Answer 24

elevated

Question 25

in healthy humans what does postprandial BG reach?

Answer 25

In healthy humans, postprandial blood glucose typically peaks at 7–8 mmol/l, a rise of only 60% above fasting concentrations and returns to fasting levels in 1–2 hours

Following a typical carbohydrate‐rich meal (~60–70 g), the ability to maintain this blood glucose concentration is challenged

This buffering of ingested glucose is achieved primarily by increasing muscle glucose uptake and thereby increasing glucose disappearance rates

The suppression of hepatic glucose output decreases endogenous appearance and together these changes offset the rise in exogenous glucose appearance seen when eating, with insulin playing a central regulatory role

Question 26

what is a good examples of a diet to be used in type 2 diabetes?

Answer 26

The Mediterranean diet (MedDiet) has been held up over the last decade as an example of a good diet that reduces the risk of CVD

Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet

A Mediterranean diet may be more effective for weight loss and improving symptoms of diabetes, when compared to a low-fat diet

Question 27

what are dietary components of MedDiet?

Answer 27

• High consumption of vegetables
• High intake of fruit and nuts
• High consumption of legumes
• High intake of cereals
• High consumption of fish and seafood
• Low intake of meat and meat products
• Low intake of dairy products
• High ratio of monounsaturated fatty acids to saturated fats
• Moderate alcohol intake

Question 28

People with type 2 diabetes are at increased risk of ………

Answer 28

CVD

Question 29

______ is a well‐established risk factor and is associated with insulin resistance, hypertension, dyslipidaemia, inflammation and cardiac dysrhythmia

Answer 29

Obesity

Question 30

weight loss improves __ risk

Answer 30

CV

Question 31

how much of an energy deficit is required to achieve weight loss

Answer 31

To achieve weight loss, an energy deficit must occur, 500–1000 kcal/day less than is required for weight maintenance is recommended

Question 32

is there a particular diet that is best?

Answer 32

successful weight reduction appears to be determined by adherence to a chosen dietary strategy that achieves energy restriction long-term, rather than by a specific diet, and this approach is recommended by most dietary guidelines

Question 33

healthy eating has been shown to improve what outcomes?

Answer 33

Healthful eating patterns have been shown to improve both glycaemic and cardiovascular outcomes and these can be combined with carbohydrate monitoring and control to maximise benefit

Question 34

what is the best way to improve glycaemic control is someone with newly diagnosed type 2 diabetes?

Answer 34

Weight loss is more effective in improving glycaemic control in those newly diagnosed with type 2 diabetes