Diabetes management

About: Diabetes management is a research topic. Over the lifetime, 6060 publications have been published within this topic receiving 164670 citations.

The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.

Abstract: Recently, the role of a low-carbohydrate diet in diabetes management has generated interest with claims being made regarding its superiority over the traditional high-carbohydrate, low-fat dietary approach. This systematic review and meta-analysis evaluated the interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes. Randomised controlled trials were searched for which included adults with type 2 diabetes aged 18 years or more. The intervention was a low-carbohydrate diet as defined by the author compared to a control group of usual care. MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, ISRCTN, ProQuest and opengrey.eu were searched. Independent experts were contacted and reference lists of selected papers were checked. Results were analysed descriptively and meta-analyses were completed to include trials that presented data at 1 year. Eighteen studies (n = 2204) were eligible for inclusion within the systematic review. The definition of a low-carbohydrate diet varied. At trial end, the descriptive analysis suggested that the low-carbohydrate intervention arm (LCIA) may promote favourable outcomes in terms of HbA1c, triglycerides and HDL cholesterol. The LCIA demonstrated reduced requirements for diabetes medication, which may have reduced the observed benefit of dietary carbohydrate restriction on HbA1c. Seven studies provided data to be included in the meta-analyses at 1 year. The meta-analyses showed statistical significance in favour of the LCIA for HbA1c (estimated effect = −0.28%, 95% CI −0.53 to −0.02, p = 0.03; χ 2 = 13.15, df = 6, p = 0.03; I 2 = 54%), HDL cholesterol (estimated effect = 0.06 mmol/L, 95% CI 0.04–0.09, p < 0.00001; χ 2 = 6.05, df = 6, p = 0.42; I 2 = 1%), triglycerides (estimated effect = −0.24 mmol/L, 95% CI −0.35 to −0.13, p < 0.0001; χ 2 = 1.88, df = 6, p = 0.93; I 2 = 0%) and systolic blood pressure (estimated effect = −2.74 mmHg, 95% CI −5.27 to −0.20, p = 0.03; χ 2 = 10.54, df = 6, p = 0.10; I 2 = 43%). Meta-analyses for weight, total cholesterol, LDL cholesterol and diastolic blood pressure did not demonstrate a statistically significant difference between interventions. Dietary adherence was an issue in most studies. A very low-carbohydrate diet (<50 g/day) seems unrealistic in this population, however, a low-carbohydrate diet (<130 g/day) appears to be achievable. Improved clinical outcomes were observed in some studies as a result of achieving a low- or moderate-carbohydrate diet. Fifteen out of 18 studies were considered high risk of bias, with performance bias being a common issue. Reducing dietary carbohydrate may produce clinical improvements in the management of type 2 diabetes. Further research is needed to understand the true effect of dietary carbohydrate restriction on HbA1c independent of medication reduction and to address known issues with adherence to this dietary intervention. Clarity is needed regarding appropriate classification of a low-carbohydrate diet.

Follow-up Intervention: Its Effect on Compliance Behavior to a Diabetes Regimen:

Abstract: This study tested the hypothesis that follow-up intervention (by telephone calls and home visit) affects compliance in patients with non-insulin-dependent diabetes mellitus (NIDDM). Sixty NIDDM patients were randomly assigned to two groups--a control group, which received the standard protocol (3-day educational program and a review session 1 month after the program); and an intervention group, which received the standard protocol as well as a series of four telephone calls and one home visit by a registered nurse over a 3-month period. Compliance to prescribed regimens was determined by analyzing three sets of data: changes in pre- to poststudy glycosylated hemoglobin (HbA1c) values; changes in pre- to poststudy weight; and frequency with which self-monitoring of blood glucose (SMBG) was practiced. Results showed that SMBG practice was significantly better for the intervention group. No significant differences were seen in poststudy HbA1c values and weight changes between the two groups. Follow-up intervention by telephone calls and home visit can enhance patient compliance to certain aspects of the prescribed diabetes management plan.

A Machine Learning Approach to Predicting Blood Glucose Levels for Diabetes Management

Abstract: Patients with diabetes must continually monitor their blood glucose levels and adjust insulin doses, striving to keep blood glucose levels as close to normal as possible. Blood glucose levels that deviate from the normal range can lead to serious short-term and long-term complications. An automatic prediction model that warned people of imminent changes in their blood glucose levels would enable them to take preventive action. In this paper, we describe a solution that uses a generic physiological model of blood glucose dynamics to generate informative features for a Support Vector Regression model that is trained on patient specific data. The new model outperforms diabetes experts at predicting blood glucose levels and could be used to anticipate almost a quarter of hypoglycemic events 30 minutes in advance. Although the corresponding precision is currently just 42%, most false alarms are in near-hypoglycemic regions and therefore patients responding to these hypoglycemia alerts would not be harmed by intervention.

Internet Psycho-Education Programs Improve Outcomes in Youth With Type 1 Diabetes

Abstract: OBJECTIVE The purpose of this study was to determine the efficacy of two internet-based psycho-educational programs designed to improve outcomes for youth with type 1 diabetes transitioning to adolescence. RESEARCH DESIGN AND METHODS The study was a multisite clinical trial of 320 youth (age 11–14 years; 37% minority; 55% female) randomized to one of two internet-based interventions: TeenCope or Managing Diabetes. Primary outcomes were HbA 1c and quality of life (QOL). Secondary outcomes included coping, self-efficacy, social competence, self-management, and family conflict. Data were collected at baseline and after 3, 6, and 12 months online. Youth were invited to cross over to the other program after 12 months, and follow-up data were collected at 18 months. Analyses were based on mixed models using intent-to-treat and per-protocol procedures. RESULTS Youth in both groups had stable QOL and minimal increases in HbA 1c levels over 12 months, but there were no significant differences between the groups in primary outcomes. After 18 months, youth who completed both programs had lower HbA 1c ( P = 0.04); higher QOL ( P = 0.02), social acceptance ( P = 0.01), and self-efficacy ( P = 0.03) and lower perceived stress ( P = 0.02) and diabetes family conflict ( P = 0.02) compared with those who completed only one program. CONCLUSIONS Internet interventions for youth with type 1 diabetes transitioning to adolescence result in improved outcomes, but completion of both programs was better than only one, suggesting that these youth need both diabetes management education and behavioral interventions. Delivering these programs via the internet represents an efficient way to reach youth and improve outcomes.