Tag Archives: #type2diabetes

Altering Mealtimes Could Prevent Development of Type 2 Diabetes – New Study Set to Investigate (Food / Medicine)

An innovative new study is set to examine if changing our mealtimes to earlier or later in the day could reduce the risk of developing Type 2 diabetes.

Led by Dr Denise Robertson, Professor Jonathan Johnston and post graduate researcher Shantel Lynch from the University of Surrey, the study, outlined in the journal Nutrition Bulletin, will investigate if changing the time we eat during the day could reduce risk factors such as obesity and cholesterol levels that are typically associated with the development of Type 2 diabetes. The team of researchers will also for the first time investigate, via a series of interviews with participants and their friends and family, the impact of such changes on home life, work/social commitments and whether co-habitants of those who make such modifications are influenced to alter their own meal timings/eating habits as a result.

During the unique 10-week study, 51 participants aged between 18- 65 years old who have been identified as having an increased/moderate/high risk of developing Type 2 diabetes will be split into three groups. The first, a control group, will be asked to make no changes to their eating habits; the second group will be required to restrict their eating times during the day to between 7am- 3pm; and the third group will limit their eating time to between 12-8pm.

Participants will regularly attend the Surrey Clinical Investigations Unit to monitor their blood pressure, waist and hip circumferences and provide blood and urine samples. A registered dietitian will also use specialist eye-tracking equipment to analyse participants’ eye gaze direction to identify and monitor any changes to food preferences over the course of the intervention. Previous research has shown that eye gaze direction is a strong signal of attention and preference behaviours.

Researchers will examine in detail results gathered from such visits to determine if changing the time meals are consumed to earlier or later in the day could reduce risk factors associated with Type 2 diabetes.

Senior scientist of the study Dr Denise Robertson, Reader in Nutritional Physiology at the University of Surrey, said: “Type 2 diabetes is a growing problem in the UK, with over three million people diagnosed and 12.3 million people at potential risk of developing the condition, which can increase the likelihood of developing serious problems with our eyes, heart and nervous system.

“Public health initiatives are often rolled out with a focus on prevention, but these have had limited success. We need to adopt different approaches in preventing this condition. A simple solution to this could be altering when we eat our meals, lessening the risk factors associated with the development of Type 2 diabetes.”

PGR student and registered dietitian Shantel Lynch said: “Treating Type 2 diabetes and its associated complications places a tremendous strain on the NHS. To ease such strain there needs to be more of a focus on prevention and tackling the areas, which are often lifestyle choices, that lead to the development of the condition.

“The possible benefits of altering mealtimes, such as weight loss, have become increasingly topical in nutrition-related research. However, there are still many unanswered questions and we hope to contribute to this field of research while finding out whether time-restricted feeding may help to reduce the risk of developing long-term illnesses like Type 2 diabetes, and how feasible it is to follow this diet in real life.”

Jonathan Johnston, Professor of Chronobiology and Integrative Physiology at the University of Surrey, said: “Changing our mealtimes limits our energy intake to a set number of hours in the day, which leads to an extension of the daily fast that generally happens overnight. This study will help us understand what time of day is optimal to eat to reduce our chances of developing Type 2 diabetes.

“We will also for the first time be investigating the impact of time-restricted feeding on individuals’ work, social and home life to understand the obstacles people encounter in adapting to new mealtimes, which may affect their ability to stick to the schedule.”

Reference: Lynch, S., Johnston, J.D. and Robertson, M.D. (2021), Early versus late time‐restricted feeding in adults at increased risk of developing type 2 diabetes: Is there an optimal time to eat for metabolic health?. Nutr Bull. https://doi.org/10.1111/nbu.12479 https://onlinelibrary.wiley.com/doi/10.1111/nbu.12479

Provided by University of Surrey

Short Term Low Carbohydrate Diet Linked to Remission of Type 2 Diabetes (Food)

But further trials are needed to determine longer term effects, say researchers.

Patients with type 2 diabetes who follow a strict low carbohydrate diet for six months may experience greater rates of remission compared with other recommended diets without adverse effects, suggests a study published by The BMJ today.

The researchers acknowledge that most benefits diminished at 12 months, but say doctors might consider short term strict low carbohydrate diets for managing type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed.

Type 2 diabetes is the most common form of diabetes worldwide and diet is recognised as an essential part of treatment. But uncertainty remains about which diet to choose and previous studies have reported mixed results.

To address this evidence gap, a team of international researchers set out to assess the effectiveness and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes, compared with (mostly low fat) control diets.

Their findings are based on analysis of published and unpublished data from 23 randomised trials involving 1,357 participants.

LCDs were defined as less than 26% daily calories from carbohydrates and VLCDs were defined as less than 10% daily calories from carbohydrates for at least 12 weeks in adults (average age 47 to 67 years) with type 2 diabetes.

Outcomes were reported at six and 12 months and included remission of diabetes (reduced blood sugar levels with or without the use of diabetes medication), weight loss, adverse events and health related quality of life.

Although the trials were designed differently, and were of varying quality, the researchers were able to allow for this in their analysis.

Based on low to moderate certainty evidence, the researchers found that patients on LCDs achieved higher diabetes remission rates at six months compared with patients on control diets, without adverse events.

For example, based on moderate certainty evidence from 8 trials with 264 participants, those following a LCD experienced, on average, a 32% absolute risk reduction (28 fewer cases per 100 followed) in diabetes remission at 6 months.

LCDs also increased weight loss, reduced medication use, and improved body fat (triglyceride) concentrations at six months.

However, most of these benefits diminished at 12 months, a finding consistent with previous reviews, and some evidence showed worsening of quality of life and cholesterol levels at 12 months.

This study used robust methods to increase the precision and overall certainty of the effect estimates. But the authors acknowledge some limitations, such as the ongoing debate around what constitutes remission of diabetes, and uncertainty over the longer term effectiveness and safety of LCDs.

They also stress that their results are based on moderate to low certainty evidence.

As such, they suggest clinicians “might consider short term LCDs for management of type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed.”

“Future long term, well designed, calorie controlled randomised trials are needed to determine the effects of LCD on sustained weight loss and remission of diabetes, as well as cardiovascular mortality and major morbidity,” they conclude.

Reference: Joshua Z Goldenberg, Andrew Day,  Grant D Brinkworth, Junko Sato,  Satoru Yamada, Tommy Jönsson, Jennifer Beardsley, Jeffrey A Johnson,  Lehana Thabane,  Bradley C Johnston,  “Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data”, BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4743 https://www.bmj.com/content/372/bmj.m4743

Provided by BMJ

Wrinkled ‘super pea’ Could Be Added To Foods To Reduce Diabetes Risk (Food)

A type of wrinkled ‘super pea’ may help control blood sugar levels and could reduce the risk of type 2 diabetes, suggests a new study.

A type of wrinkled ‘super pea’ may help control blood sugar levels and could reduce the risk of type 2 diabetes, suggests a new study.

This image shows wrinkled peas ©The John Innes Centre.

The research, from scientists at Imperial College London, the John Innes Centre, Quadram Institute Bioscience and University of Glasgow, suggests incorporating the peas into foods, in the form of whole pea seeds or flour, may help tackle the global type 2 diabetes epidemic.

The work, published in the journal Nature Food and funded by the BBSRC, focused on a naturally occurring type of pea. Unlike regular (smooth) peas, they contain higher amounts of ‘resistant starch’, which takes longer for the body to break down.

The study reveals that compared to eating smooth peas, wrinkled peas prevented ‘sugar spikes’ – where blood sugar levels rise sharply after a meal. The same effect was seen when consuming flour made from wrinkled peas incorporated in a mixed meal.

According to the researchers, this could be important as frequent, large sugar spikes are thought to increase the risk of diabetes. They add that flour from their ‘super peas’ could potentially be used in commonly consumed processed foods which, if eaten over the long term, could prevent these sugar spikes.

Dr Katerina Petropoulou, first author of the research from the Centre for Translational and Nutrition Food Research at Imperial College London, said: “Despite national campaigns to promote healthy eating, type 2 diabetes diagnosis rates continue to rise. An alternative dietary strategy to maintain normal blood glucose rates among the population is to improve the composition of commonly consumed foods. There is much evidence that diets rich in a type of carbohydrate called resistant starch have a positive impact on controlling blood glucose levels, and hence reduce susceptibility to type 2 diabetes.”

The peas used in the research are similar to the frozen peas you can buy in the supermarket. They are also the same as those used by the famous scientist Gregor Mendel in the 1800s, to show how dominant and recessive genetic traits can be passed on through selective breeding.

However, in these latest experiments, researchers used larger, mature versions of those typically found in the freezer aisle. This is because larger, mature peas contain more so-called ‘resistant starch’. The high amount of resistant starch is due to the way the starch is made in the cell, and the fact that the cells themselves are more resistant to digestion.

This image shows regular (smooth) peas. ©The John Innes Centre.

Starch is a compound that the body breaks down to release sugar, but resistant starch is broken down more slowly, so that sugar is released more slowly into the blood stream, resulting in a more stable increase rather than in a spike.

In the latest study, the researchers used a type of ‘super pea’ – wrinkled peas with a naturally occurring genetic mutation, or variant, that produces a greater amount of resistant starch, but a lower overall carbohydrate content.

Over a series of experiments, the team gave healthy volunteers a mixed meal including 50 grams of wrinkled peas, and in a series of control experiments gave them regular ‘smooth’ peas. Working with the University of Glasgow, researchers also added a tracer molecule to the peas, so that they could trace how they were absorbed and digested by the human gastrointestinal tract.

They repeated the experiments using flour made from wrinkled peas or control peas. To further investigate the impact of long-term consumption they recruited 25 volunteers and asked them to consume pea hummus and mushy peas (made from wrinkled or control peas) for a period of 4 weeks.

Professor Gary Frost, lead author of the study and head of Imperial’s Centre for Translational and Nutrition Food Research, said: “The ‘super pea’ contains a naturally-occurring variant gene that means they are high in resistant starches. These starches are not completely digested in the upper parts of the digestive tract and are available for fermentation by bacteria in the colon.”

Previous research from the same group has suggested that, as these bacteria ferment the starch, they produce compounds called short chain fatty acids. These compounds in turn help boost the function of cells that produce insulin, which helps control blood sugar.

Further tests using a mimic of the human gut, carried out by researchers at Quadram Institute Bioscience, showed that the way that the peas were prepared and cooked affected how quickly they were digested. Researchers also showed that there were significant benefits to our gut microbiota because of the fermentation process taking place there.

Professor Pete Wilde of the Quadram Institute said: “This study has shown us that by preparing these peas in certain ways we can further reduce blood sugar spikes, opening up new possibilities for making healthier foods using controlled food processing techniques.”

The researchers are now planning further trials involving volunteers with early stage type 2 diabetes. This will also involve a major pea breeding programme with help from industry partners to develop more ‘super peas’ with the resistant starch. They will also explore the genetic background of commonly consumed pulses (beans) to see if similar genetic variation in other crops shows the same positive effects on health.

Professor Claire Domoney of the John Innes Centre in Norfolk said: “This research has emphasized the value of developing the pea lines used in this study, which could be compared meaningfully and involved many years of breeding. It also demonstrates how plant genetics can be used effectively across many disciplines to study the impact of food on human health.”

The study authors point out that it is not only peas which have the resistant starch mutation. Other research is focusing on breeding the mutation into staple crops, such as rice and wheat. With modern genomic tools there is the potential for discovery or generation of the mutation across a range of seed and grain crops – which make up many of the carbohydrate-rich foods we consume.

Professor Domoney added: “Longer term it could become policy to include resistant starch in food. We have precedents for this kind of intervention, such as iron being added to bread to tackle anemia. It could potentially be policy that food should contain a certain amount of resistant starch to tackle type 2 diabetes and other metabolic illnesses.”

Professor Melanie Welham, BBSRC’s Executive Chair, said “By investing in plant research, such as this collaboration between Imperial College, the Quadram Institute and the John Innes Centre, new solutions that help address the health problems affecting many people across the country are being developed. Long term benefits come from long term investments that equip our research base to tackle new and emerging challenges.”

Provided by Imperial College London

Improved Survival After Obesity Operation In Patients With Previous Myocardial Infarction (Medicine)

Researchers at Karolinska Institutet and Danderyd Hospital in Sweden have studied the risk of additional myocardial infarctions and early death in severely obese patients who undergo metabolic surgery following a myocardial event. The registry study covering 1,018 individuals shows a lower risk of additional myocardial infarctions and improved survival that cannot be simply attributed to the loss of weight. The study is published in the journal Circulation.

©gettyimages

According to the WHO and the Body Mass Index measurement it devised, there are currently two billion people who are overweight today, 650 million of whom are classified as obese, with a body mass index (BMI) greater than 30 kg/m2.

Severe obesity (in this study defined as BMI greater than 35 kg/m2) increases the risk of several health problems, including type 2 diabetes, hypertension, cardiovascular disease and cancer.

People who lose weight can improve their health and it has previously been shown that after metabolic surgery, diabetes and hypertensions go into a period of remission in which the symptoms disappear, at least temporarily.

In the current study, researchers at Karolinska Institutet, Orebro University and Uppsala University examined the risk of additional myocardial infarction and early death in people with severe obesity and a previous infarction who subsequently underwent metabolic surgery.

By cross-referencing the quality registries SOReg (Scandinavian Obesity Surgery Registry) and SWEDHEART (for people who have suffered myocardial infarction) between 1995 and 2018, the researchers were able to identify severely obese individuals who underwent a gastric bypass or gastric sleeve procedure as a treatment for their obesity after suffering a myocardial infarction.

A gastric bypass involves disconnecting much of the stomach and part of the small intestine; a gastric sleeve involves removing most of the stomach to leave a tube-like structure that leads food into the intestines.

The group of 509 individuals who underwent surgery was matched with people of the same gender, age and BMI, and who had suffered a myocardial infarction in the same year but not undergone metabolic surgery.

“We found that individuals operated on for their obesity were at a much lower risk of suffering another myocardial infarction, of death and of developing heart failure,” says the study’s first author Erik Naslund, professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet and consultant surgeon at Danderyd Hospital. “These data suggest that severely obese people who suffer a myocardial infarction should be offered metabolic surgery for their obesity as a secondary prevention.”

According to the researchers, it is unlikely the weight loss is the only reason for the study’s observed correlation between metabolic surgery and a lower risk of cardiopathic events, such as stroke, myocardial infarction or early death.

One theory is that metabolic surgery per se has a positive impact on cardiometabolic risk factors, which is to say physiological conditions that increase the risk of cardiovascular disease.

“Many of the patients who underwent metabolic surgery in this study had clinical remission of type 2 diabetes, hypertension and dyslipidemia (high blood lipids). An earlier study, Look AHEAD, demonstrated that long, intensive non-surgical lifestyle intervention in patients with type 2 diabetes resulted in weight loss of 6 per cent, but did not lower the risk of myocardial infarction.”

Before the results of the study can become part of clinical praxis, more research is needed in which severely obese people who have suffered myocardial infarction are randomly assigned to either surgery or to regular post-infarction care.

References: “Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity: a nationwide cohort study”. Erik Naslund, Erik Stenberg, Robin Hofmann, Johan Ottosson, Magnus Sundbom, Richard Marsk, Per Svensson, Karolina Szummer, and Tomas Jernberg. Circulation, online 26 October 2020, doi: 10.1161/CIRCULATIONAHA.120.048585 link: http://dx.doi.org/10.1161/CIRCULATIONAHA.120.048585

Provided by Karolinska Institute

People With Type 2 Diabetes Need Not Avoid Eating Potatoes Based On Glycemic Index (Medicine)

New study findings show that people with type 2 diabetes can better maintain overnight glycemic control when high Glycemic Index (GI) potatoes are included in an evening meal versus low GI basmati rice.

Schematic of study protocol. Four trial conditions (evening meals consisting of boiled potato, roasted potato, boiled then cooled potato and basmati rice) were completed in a randomized order separated by a 9-day washout. Interstitial glucose was measured continuously throughout each trial condition (from Day −3 through to Day 2) via a continuous glucose monitoring system (CGMS).

People with type 2 Diabetes (T2D) are frequently told to avoid eating potatoes, and other high Glycemic Index (GI) foods, because of the longstanding perception that these foods make it difficult to control blood sugar levels. This is especially problematic during the night when blood sugar tends to spike — a phenomenon that has been associated with cardiovascular disease and endothelial disfunction. However, for the first time, a rigorously controlled clinical trial, including 24 adults with T2D, demonstrates that GI is not an accurate surrogate for an individual’s glycemic response (GR) to a food consumed as part of an evening meal. Specifically, the findings published in Clinical Nutrition show that participants had a better ‘nocturnal’ GR when they ate a mixed meal with skinless white potatoes compared to an isoenergetic and macronutrient-matched mixed meal that included a low GI carbohydrate food — basmati rice.

“Despite its frequent use among nutrition researchers, GI is not an appropriate tool for understanding how a meal impacts glycemic control; it is a very specific measurement for foods consumed in isolation, typically conducted under controlled laboratory conditions,” says Dr. Brooke Devlin, PhD, the primary investigator, at Australian Catholic University in Melbourne. “It’s rare that people eat foods in isolation, and findings from this study demonstrate how other factors, such as the time of day or food pairings, need to be considered when investigating the GR of mixed meals in individuals with T2D.”

Participants were provided the same breakfast and lunch, but they were randomly assigned to one of four dinners, each including either skinless white potatoes (test meal) prepared in three different ways (boiled, roasted, boiled then cooled then reheated) or basmati rice (control meal). Participants repeated the experiment, with a 9-day break in between each trial, to cycle through all test meals and the control. In addition to having blood samples collected regularly (both immediately after the meal and again every 30 minutes, for 2 hours), participants also wore a continuous glucose monitor overnight to track changes in blood sugar levels while sleeping.

There were no differences between meals in glucose response following the dinner that contained any of the potato dishes or basmati rice. Moreover, participants’ overnight GR was more favorable after eating the evening meal that included any of the high GI potato side dishes compared to low GI basmati rice.

“These findings are contrary to that of observational research and traditional dietary guidance that has led some to believe potatoes are not an appropriate food choice for people with T2D,” added Devlin. “Our study shows high GI foods, like potatoes, can be consumed as part of a healthy evening meal without negatively affecting GR — and while delivering key nutrients in relatively few calories, which is essential for people with T2D.”

This study followed a rigorous methodology by using a randomized crossover design and measuring glucose levels both immediately post-meal and overnight to obtain a better picture of the potatoes’ impact on GR. However, the researchers noted a few limitations: study participants’ baseline GR was assessed for only one evening meal, the dinner provided was larger than what is typically recommended for people with T2D (but in line with Australian eating patterns, at 40 percent of an individual’s total energy intake), and the potatoes’ impact on long-term glycemic control was not assessed.

Despite such limitations, the researchers concluded that “potatoes are a vegetable that is sustainable, affordable and nutrient-dense, and thus, they can play an important role in modern diets irrespective of metabolic health status.”

References: Brooke L. Devlin, Evelyn B. Parr, Bridget E. Radford, and John A. Hawley, “”Lower nocturnal blood glucose response to a potato-based mixed evening meal compared to rice in individuals with type 2 diabetes,” Clinical Nutrition, 2020. doi: https://doi.org/10.1016/j.clnu.2020.09.049.

Provided by Food minds LLC