[Introduction of sucrose in the diet plan of persons with type 1 diabetes: its influence in the glycemic control]

Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies

OBJECTIVE

To assess the effect of different food sources of fructose-containing sugars on glycaemic control at different levels of energy control.

DESIGN

Systematic review and meta-analysis of controlled intervention studies.

DATA SOURCES

Medine, Embase, and the Cochrane Library up to 25 April 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Controlled intervention studies of at least seven days' duration and assessing the effect of different food sources of fructose-containing sugars on glycaemic control in people with and without diabetes were included. Four study designs were prespecified on the basis of energy control: substitution studies (sugars in energy matched comparisons with other macronutrients), addition studies (excess energy from sugars added to diets), subtraction studies (energy from sugars subtracted from diets), and ad libitum studies (sugars freely replaced by other macronutrients without control for energy). Outcomes were glycated haemoglobin (HbA1c), fasting blood glucose, and fasting blood glucose insulin.

DATA EXTRACTION AND SYNTHESIS

Four independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by random effects models and overall certainty of the evidence assessed by the GRADE approach (grading of recommendations assessment, development, and evaluation).

RESULTS

155 study comparisons (n=5086) were included. Total fructose-containing sugars had no harmful effect on any outcome in substitution or subtraction studies, with a decrease seen in HbA1c in substitution studies (mean difference -0.22% (95% confidence interval to -0.35% to -0.08%), -25.9 mmol/mol (-27.3 to -24.4)), but a harmful effect was seen on fasting insulin in addition studies (4.68 pmol/L (1.40 to 7.96)) and ad libitum studies (7.24 pmol/L (0.47 to 14.00)). There was interaction by food source, with specific food sources showing beneficial effects (fruit and fruit juice) or harmful effects (sweetened milk and mixed sources) in substitution studies and harmful effects (sugars-sweetened beverages and fruit juice) in addition studies on at least one outcome. Most of the evidence was low quality.

CONCLUSIONS

Energy control and food source appear to mediate the effect of fructose-containing sugars on glycaemic control. Although most food sources of these sugars (especially fruit) do not have a harmful effect in energy matched substitutions with other macronutrients, several food sources of fructose-containing sugars (especially sugars-sweetened beverages) adding excess energy to diets have harmful effects. However, certainty in these estimates is low, and more high quality randomised controlled trials are needed.

STUDY REGISTRATION

Clinicaltrials.gov (NCT02716870).

Does sucrose intake affect antropometric variables, glycemia, lipemia and C-reactive protein in subjects with type 1 diabetes?: a controlled-trial

BACKGROUND

It is unclear if the sugar intake may affect metabolic parameters in individuals with type 1 diabetes. Therefore, the purpose of this study was to evaluate the effects of sucrose intake in glycemic, lipemic, anthropometric variables, as well as in C-reactive protein (CRP) levels in these individuals.

METHODS

Thirty-three subjects with type 1 diabetes were evaluated at baseline and 3-months after intervention. Volunteers were randomized into groups: sucrose-free (diet without sucrose) or sucrose-added (foods containing sucrose in composition). Both groups received the same macronutrient composition and used the carbohydrate counting methods. All underwent an interview and anthropometric evaluation. Blood was drawn for glycated haemoglobin, glucose, total cholesterol, HDL, and CRP measurement, and the medical charts were reviewed in all cases.

RESULTS

At baseline, anthropometric, clinical and laboratory variables did not differ between groups, except for the triglycerides. Although at baseline triglycerides levels were higher in the sucrose-added group (p = 0.01), they did not differ between groups after the intervention (p = 0.92). After 3-months, CRP was higher in the sucrose-added than in the sucrose-free group (p = 0.04), but no further differences were found between the groups, including the insulin requirements, anthropometric variables, body composition, and glycemic control. Both groups showed sugars intake above the recommendations at baseline and after intervention.

CONCLUSIONS

Sucrose intake, along with a disciplined diet, did not affect insulin requirements, anthropometric variables, body composition, lipemic and glycemic control. However, although the sucrose intakes increase CRP levels, the amount of sugar in the diet was not associated with this inflammatory marker.

[Influence of dietary glycemic index on anthropometric and biochemical parameters in patients with type 1 diabetes]

OBJECTIVE

To assess the influence of a non-pharmacological intervention, consisting of a diet low glycemic index (GI) for a period of six months on metabolic control and anthropometric parameters in patients with type 1 diabetes mellitus.

SUBJECTS AND METHODS

Ninety-six type 1 diabetic patients underwent an anthropometric, biochemical and dietary assessment before and six months after the prescription of diet based on the glycemic index.

RESULTS

After six months we observed a decrease in A1C levels (9,8 ± 2,26% vs. 9,1 ± 2.16%; p = 0,023) and increase in body weight (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04).

CONCLUSION

A low GI diet improved glycemic control in patients with DM1. Further studies with longer time of follow-up are needed to assess if patients' adherence to this kind of diet influences the maintenance of glycemic control.

Effect of the carbohydrate counting method on glycemic control in patients with type 1 diabetes

BACKGROUND

The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1) has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices. This study aimed to evaluate the influence of nutrition intervention and the use of multiple short-acting insulin according to the carbohydrate counting method on clinical and metabolic control in patients with DM1.

METHODS

Our sample consisted of 51 patients with DM1, 32 females, aged 25.3 +/- 1.55 years. A protocol of nutritional status evaluation was applied and laboratory analysis was performed at baseline and after a three-month intervention. After the analysis of the food records, a balanced diet was prescribed using the carbohydrate counting method, and short-acting insulin was prescribed based on the total amount of carbohydrate per meal (1 unit per 15 g of carbohydrate).

RESULTS

A significant decrease in A1c levels was observed from baseline to the three-month evaluation after the intervention (10.40 +/- 0.33% and 9.52 +/- 0.32%, respectively, p = 0.000). It was observed an increase in daily insulin dose after the intervention (0.99 +/- 0.65 IU/Kg and 1.05 +/- 0.05 IU/Kg, respectively, p = 0.003). No significant differences were found regarding anthropometric evaluation (BMI, waist, hip or abdominal circumferences and waist to hip ratio) after the intervention period.

CONCLUSIONS

The use of short-acting insulin based on the carbohydrate counting method after a short period of time resulted in a significant improvement of the glycemic control in patients with DM1 with no changes in body weight despite increases in the total daily insulin doses.