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NHD > Type 2 Diabetes Prevention > Flashcards

Type 2 Diabetes Prevention Flashcards

1
Q

What is the best weight loss amount to put T2D in remission?

A

15kg weight loss is optimal amount for T2D remission

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2
Q

What are the key lifestyle interventions (grade 4) to reduce risk of T2D in high risk groups?

A

Key lifestyle interventions to reduce T2D in high risk groups:
*Restrict energy intake
*Reduce total and saturated fat intake
*Increase fibre intake
*Increase physical activity

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3
Q

Which dietary patterns are associated with reducing risk of T2D?

A

Dietary patterns associated with reduced T2D risk:
*Mediterranean dieat
*DASH diet
*Vegetarian and vegan diets
*The Nordic Healthy diet
*Carbohydrate restriction (moderate)

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4
Q

Which specific foods have been shown to reduce T2D risk in general populations? (Evidence grade 2)

A

Specific foods associated with reduced T2D risk (grade 2):
*Wholegrains
*Some fruit
*Green leafy vegetables
*Yoghurt
*Cheese
*Tea
*Coffee

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5
Q

Which specific foods have been shown to INCREASE T2D risk in general populations? (grade 2)

A

Specific foods associated with INCREASED T2D risk:
*Red meat
*Processed meat
*Potatoes (fried)
*Sugary beverages
*Refined carbohydrates

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6
Q

What is the evidence grade 4 recommendation for weight loss in high risk groups? (T2D)

A

Grade 4 recommendation for weight loss in high risk groups:
*Aim for 5% weight loss

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7
Q

Which dietary pattern has an evidence grade 4 for reduced risk in general populations?

A

Dietary pattern with evidence grade 4 for reduced risk in general populations: Mediterranean diet (most researched)

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8
Q

Which dietary patterns has an evidence grade 2 for reduced risk in general populations?

A

Dietary pattern with evidence grade 2 for reduced risk in general populations: Vegan diet, Vegetarian diet, DASH diet and the Nordic Healthy diet

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9
Q

“Offer culturally tailed, multi-component lifestyle interventions to reduce the risk of T2D in ethnic minority groups” is which evidence grade?

A

This is evidence grade 3

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10
Q

Which has a higher evidence grade for T2D prevention, dietary patterns or specific foods?

A

Dietary patterns overall have a higher evidence grade than specific foods for T2D prevention

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11
Q

Can T1D be prevented?

A

At present T1D cannot be prevented.

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12
Q

What is Type 2 Diabetes?

A

Type 2 diabetes (T2D):
*Condition
*Not enough insulin is produced or it is not functioning correctly
*High blood sugar levels

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13
Q

What does insulin do?

A

*Insulin lowers blood sugar levels (glucose).
*It helps glucose enter cells so it can be utilised for energy
*Signals liver to store glucose for future use.

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14
Q

Where is insulin made?

A

Insulin is made in the beta cells of the pancreas

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15
Q

When is insulin released?

A

A low level of insulin is released continuously. However, more insulin is usuallyreleased after a meal.

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16
Q

What are the evidence based general guidelines for the prevention and management of T2D (Diabetes UK)?

A

Evidence based general guidelines for the prevention and management of T2D (Diabetes UK
* An individualised approach to diet taking into consideration the person’s personal and cultural preferences
* People eat more of certain foods such as vegetables, fruits, wholegrains, fish, nuts and pulses
* People eat less red and processed meat, refined carbohydrates and sugar sweetened beverages.

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17
Q

Which foods have no association with T2D risk?

A

Eggs, nuts and fish have no association with T2D risk

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18
Q

What percentage of weight loss is recommended to reduce T2D in high risk groups?

A

5% weight loss is recommended to reduce T2D risk in high risk groups

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19
Q

What does weight loss of 5% or more do in T2D?

A

Weight loss of 5% or more in T2D:
- Improves HbA1c
- Improves lipid profile/ cholesterol levels
- Improves total cholesterol
- Improves LDL-cholesterol
- Improves HDL-cholesterol
- Improves triglycerides
- Improves blood pressure
- Improves insulin sensitivity

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20
Q

What are the recommendations for overweight or obese people with T2D?

A

Recommendations for overweight/obese people with T2D:
- For remission: aim for 15kg as close to diagnosis as possible
- Aim for at least 5% weight loss for improved glycaemic control and reduced CVD risk. Increase energy expenditure and reduce energy intake to achieve this.

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21
Q

What is quick weight loss in relation to diagnosis associated with in T2D?

A

Quick weight loss as close to diagnosis as possible is associated with better long term weight maintenance

22
Q

Summarise the Portfolio Diet study (Glenn et al., 2023)

A

Portfolio Diet Study (Glenn et al., 2023)
- Focuses on the effect of cholesterol lowering
- Also analysed MED diet and DASH diet
- Study was conducted because: Portfolio diet lowered LDL cholesterol but not T2D
- Longitudinal prospective study: 16 years
- Nearly 150,000 participants
- Findings: All 3 diets investigated lowered T2D risk (12-22%)

23
Q

What is the Portfolio diet?

A

Portfolio diet:
- Focused on lowering cholesterol
- Plant based
- Four key ingredients: soy protein, plant sterols, tree nuts and soluble fibre.
- Encouraged to include: Veg (e.g. okra, aubergine), fruits (e.g. pears, bananas), seeds, whole grains, legumes and healthy fats.
- No foods specified to avoid.

24
Q

Which dietary pattern has the lowest evidence grade?

A

Moderate carbohydrate restriction has the lowest evidence grade.

25
Q

What percentage reduction is suggested in the reduction of T2D risk and physical activity?

A

Studies report a 25-40% reduction in the relative risk of T2D with increased physical activity

26
Q

What type of behaviour increases the risk of T2D?

A

Sedentary behaviour increases T2D risk, independent of physical activity/ exercise.

27
Q

What is the ultimate aim for T2D management?

A

The ultimate aim of T2D management and treatment is to reduce and maintain HbA1c concentration at a value below the cut-off for the definition of T2D

28
Q

What is defined as remission in T2D?

A

T2D remission is defined as: HbA1c <48
mmol/mol or 6.5% for ≥6 months

29
Q

Summarise the Plant Based diet Study (Kim et al. 2022)

A

Plant Based diet Study (Kim et al. 2022)
* To explore the prospective association between scores from three different plant-based diet indices and risk of T2D and investigated whether associations differ by demographic and lifestyle factors in the Korean population
* Cohort study
* 10030 participants – 7363 participants used
* Compared compliance rates of a “healthful plant-based diet” with risk of T2D – long term study of how many participants developed T2D within 14 years after the study.
* Greater adherence to diets high in healthy plant foods and low in unhealthy plant foods and animal foods was associated with a lower risk of incident T2D.
* Pros: Large sample size, long duration study
* Limitations: Korean population

30
Q

What attitude should be followed in regards to diets and T2D management?

A

“Any diet will do”. Dietary advice should be individualized and realistic to maximize long term success based on the foods that are enjoyed.

31
Q

How much exercise does Diabetes UK advise per week?

A

Diabetes UK advises: 150 mins per week of moderate to vigorous physical activity, over at least 3 days.

32
Q

Summarise the Esposito et al. 2015 Mediterranean diet study ()

A

Mediterranean diet & T2D systematic review with meta-analyses Esposito et al. 2015:
* 8 meta analyses and 5RCTS analysed
* Med diet associated with better glycaemic control, lower CVD risk and 49% probability of remission

33
Q

According to Feinman et al 2015, what is considered a very low, low, moderate and high carbohydrate amount?

A

Feinman et al 2015 Carbohydrate Amounts:
Very low: 20-50g/day OR >/= 10% total energy intake
Low: <130g/day OR <26% total energy intake
Moderate: 130-230 g/day OR 26-45% total energy intake
High: > 230g/day OR >45% total energy intak

34
Q

A study showed that low carb diets had a modest but statistically significant clinical improvements in the short term, what did it show in the long term? (Snorgaard et al. 2017)

A

A study showed that low carb diets had a modest but statistically significant clinical improvements in the short term, but no differences in the longer term at 12 months (Snorgaard et al. 2017)

35
Q

A low carbohydrate diet study showed reductions in which parameters?

A

A low carb diet showed reductions in HbA1c, BMI, waist circumference but no change in lipids.

36
Q

In regards to T2D remission is medication still needed?

A

The definition of T2D remission may or may not involve medication use. This depends on if it is considered to be partíal, reversal or complete.
Reversal: Metformin alone
Complete or partial does not involve the use of medication.

37
Q

Summarise the Nordic study (Laccopidan et al 2015)

A

The Nordic Healthy Diet study (Laccopidan et al 2015)

38
Q

Summarise the Nordic Healthy Diet Study (Laccopidan et al 2015))

A

Nordic Healthy Diet Study (Laccopidan et al 2015)
* Healthy Nordic diet: focus on fish, cabbage, rye bread, oatmeal, apples and pears, and root vegetables.
* Participants:50-64 years old 55060 participants. More women than men living in greater Copenhagen and Aarhus areas
* To assess the association between adherence to the healthy Nordic diet and the risk of Type 2 Diabetes with a large cohort of adults living in Denmark.
* Prospective cohort study
*Food frequency questionnaires used to gather a score of the adherence to the Nordic diet and participants were put into 3 groups based on this score.
*Each score level was compared to the rate of type 2 diabetes incidence. Statistics were used to analyse the risk of developing type 2 diabetes based on each score group.
* Risk was also analysed based on individual foods
* Intake over 12 months reported
* Findings:
- High adherence was associated with a healthier lifestyle.
- Adherence to the Nordic index was associated with a lower risk of type 2 diabetes in both men and women.
- Oatmeal and root vegetables they were the ones associated with lower risk.
- Men significant associations were found with rye bread and cabbage
- High fibre content of food likely to be significant due to slowing of digestion and absorption, as well as affecting insulin sensitivity
Improved blood lipids and blood cholesterol

Strengths:
Large cohort study
Confounding factors excluded: alcohol and smoking
Length of time
Validated food frequency questionnaire

Limitations:
More women than men
Diet only assessed at baseline
Only adults aged 50-64 years
Different amount of questions for each food group which could affect score (6 for cabbage, 23 for fish, 1 for oatmeal, rye bread)
Didn’t include rapeseed oil which is key component

39
Q

Which mineral and micronutrient might be protective against T2D?

A

Magnesium might be protective against T2D. So might Vit D but more research is needed

40
Q

DIET + PHYSICAL ACTIVITY + SUSTAINED WEIGHT LOSS, decreased T2D risk by what percentage?

A

DIET + PHYSICAL ACTIVITY + SUSTAINED WEIGHT LOSS, decreased T2D risk by 50%

41
Q

Being _________ increases T2D risk

A

Being sedentary increases T2D risk

42
Q

What type of diets might be effective for weight loss?

A

Very low energy diets and total diet replacements might be effective for weight loss

43
Q

Overweight/obese T2D recommendations

A

Overweight/obese T2D recommendations
For remission: 15kg weight loss
For glycaemic control and to lower CVD risk: 5% weight loss via reduced calorie intake and increased energy expenditure

44
Q

What does evidence indicate about diet, exercise and weight loss?

A

There is conflicting evidence for diet and exercise leading to greater weight loss

45
Q

What does exercise do?

A

Exercise increases blood glucose control and reduces the risk of CVD

46
Q

What did Tay et al. 2018 find about low carb and high carb diets in relation to weight loss?

A

Tay et al 2018 didn’t find much different in weight loss between low carb and high carb diets but medication reduction was statistically significant in low carbohydrate group

47
Q

Does glycaemic index make a big difference in T2D?

A

Glycaemic index is statistically significant but not clinically

48
Q

Virta Study: Ketogenic diet

A

Virta Study: Ketogenic diet
* <30g/day CHO aim for ketosis
* Reduction in: weight, medication, TAGS, BP (no difference at 2 years)
* Increase in HDL & LDL(particle size) ( no difference at 2 years)

49
Q

Lin et al 2011 600kcal diet

A

Lin et al 2011 600kcal diet
* 15% weight loss in 8 weeks
* reduced pancreatic fat
* improved beta cell function

50
Q

Increase of what macronutrient has no effect on T2D diagnosis and treatment?

A

Increase of PUFAs have no effect on T2D diagnosis and treatment

NHD (15 decks)

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