Comparative Evaluation of a Low-Carbohydrate Diet and a Mediterranean Diet in Overweight/Obese Patients with Type 2 Diabetes Mellitus: A 16-Week Intervention Study

Association Between Body Mass Index and Glycemic Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Background

Body mass index (BMI) is a known risk factor for poor glycemic control in patients with Type 2 diabetes mellitus (T2DM). However, the extent to which BMI correlates with glycated hemoglobin (HbA1c) levels and its clinical implications require further investigation.

Objective

This study aimed to assess the relationship between BMI and HbA1c levels in T2DM patients and to explore the clinical significance of BMI management in optimizing glycemic control.

Methods

A cross-sectional study was conducted on 200 T2DM patients from Jinniu District Hospital between 2024/04/01 and 2024/10/03. BMI and HbA1c levels were recorded, and patients were categorized into normal weight (BMI < 25 kg/m²), overweight (25 ≤ BMI < 30 kg/m²), and obese (BMI ≥ 30 kg/m²). Pearson correlation analysis was used to assess the relationship between BMI and HbA1c. One-way ANOVA was employed to compare HbA1c levels across BMI categories.

Results

A significant positive correlation between BMI and HbA1c was observed (r = 0.45, P < 0.001). Obese patients had significantly higher HbA1c levels (8.5 [7.8-9.0]%) compared to overweight (7.7 [7.2-8.1]%, P < 0.01) and normal-weight patients (6.9 [6.4-7.5]%, P < 0.001). The graded relationship indicated worsening glycemic control with increasing BMI.

Conclusion

Higher BMI is associated with poorer glycemic control in T2DM patients. Obese patients, in particular, may benefit from more intensive weight management strategies to reduce HbA1c levels and prevent diabetes-related complications. These findings underscore the importance of integrating BMI reduction into diabetes management plans to improve clinical outcomes.

Therapeutic Education and Pharmacotherapeutic Follow-Up Protocol, a Useful Tool for the Improvement of Patients at Cardiovascular Risk in Community Pharmacies

The aim was to determine the influence of a complex intervention based on pharmacotherapeutic follow-up (PTF) and the application of therapeutic education (TE) protocols on the clinical and educational parameters of patients at cardiovascular risk (CVR) attending community pharmacies (CPs). A prospective, longitudinal, randomized, controlled clinical trial was conducted over 6 months in patients from four Spanish CPs, divided into control (CG) and intervention (IG) groups. CG patients received usual pharmacy care and IG patients received a PTF- and TE-based intervention. The sample consisted of 85 elderly patients. After pharmaceutical follow-up of the IG patients, the following results were observed: significant reductions in cardiovascular risk (CVR) (p < 0.005), blood pressure (BP) (p < 0.05), and sedentary lifestyle (p < 0.001), as well as an improved knowledge of CVR and cardiovascular risk factors (CVRFs) (p < 0.001). Target values for BP were achieved in 27.2% of patients and for triglycerides in 12.4% of patients. The PTF of the patients showed that 29.2% did not have the expected response to some treatments, while 25% had untreated pathologies and 10% had adverse reactions. The TE protocols related to the patients' educational needs, applied individually and in conjunction with the PTF, were able to improve their lifestyle habits, their knowledge of CVR, CVRFs, and pharmacotherapy, and their clinical parameters, and, thus, the level of development of their disease.

A multiphase very-low calorie ketogenic diet improves serum redox balance by reducing oxidative status in obese patients

The very-low calorie ketogenic diet (VLCKD) is recommended as an effective dietary approach for the management of obesity. This study investigated changes in circulating biomarkers of redox homeostasis induced by a multiphase VLCKD in obese individuals. A total of 40 obese subjects were prescribed a multiphasic VLCKD for eleven weeks. Anthropometric measurements, body composition parameters, calorimetric measures, and standard laboratory markers of glucose and lipid metabolism were evaluated at baseline (T0) and at the end of the dietary intervention (T1). Additionally, circulating markers of oxidative damage and antioxidant status were analyzed in serum and erythrocytes. Compared to T0, at T1 the multiphase VLCKD induced significant weight loss and reduction of waist circumference, with beneficial effects on body composition parameters and the glucose/lipid biochemical profile. Moreover, a decrease in serum markers of oxidative damage was reported at T1, while no changes in serum markers of antioxidant status and in erythrocyte redox markers were observed. In addition, a significant association was found between variations in anthropometric measurements, body composition, glucose metabolism parameters, and changes in circulating markers of oxidative damage. Regression models showed that variation in lipofuscin was significant predictor of changes in body mass index, fat mass, visceral adiposity, and insulin sensitivity. In conclusion, this study demonstrated that the multiphase VLCKD improves serum redox balance by reducing markers of oxidative damage in obese individuals, highlighting the interplay between adiposity, glucose metabolism, and redox homeostasis in the pathogenesis of obesity. Furthermore, these data provide a rationale for future investigations aimed at testing serum lipofuscin as a reliable redox marker in obesity.

Dysbiosis and nutrition in steatotic liver disease: addressing the unrecognized small intestinal bacterial overgrowth (SIBO) challenge

Steatotic liver disease (SLD) is characterized by hepatic fat accumulation, potentially causing major consequences such as liver decompensation. Currently, we lack medications for the treatment of SLD. Therapeutic recommendations for patients include a hypocaloric diet, weight loss, and physical activity. In particular, the Mediterranean diet is frequently recommended. However, this diet might exacerbate intestinal problems in a subset of patients with coexisting small intestinal bacterial overgrowth (SIBO). Previous studies have reported that SIBO is more predominant in patients with fatty liver than in healthy individuals. Both our research and the findings of others have highlighted a challenge related to nutritional therapy in patients with fatty liver who also suffer from SIBO inasmuch as SIBO induces several phenomena (like bloating or abdominal pain) that can adversely affect patients' quality of life and might be exacerbated by the Mediterranean diet. This may lower their adherence to the intervention. As a solution, we suggest introducing additional diagnostics (e.g., breath test) in patients with SLD who complain of SIBO-like symptoms. The next step is to modify their diets temporarily starting with several weeks of "elimination and sanitation." This would involve restricting products rich in fermentable sugars and polyols, while simultaneously treating the bacterial overgrowth. In summary, while the hypocaloric Mediterranean diet is beneficial for patients with fatty liver, those with coexisting SIBO may experience exacerbated symptoms. It is vital to consider additional diagnostics and dietary modifications for this subset of patients to address both liver and intestinal health concurrently.

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

ATP2B1 gene polymorphisms associated with resistant hypertension in the Japanese population

Single-nucleotide polymorphisms (SNP) of ATP2B1 gene are associated with essential hypertension but their association with resistant hypertension (RHT) remains unexplored. The authors examined the relationship between ATP2B1 SNPs and RHT by genotyping 12 SNPs in ATP2B1 gene of 1124 Japanese individuals with lifestyle-related diseases. Patients with RHT had inadequate blood pressure (BP) control using three antihypertensive drugs or used ≥4 antihypertensive drugs. Patients with controlled hypertension had BP controlled using ≤3 antihypertensive drugs. The association between each SNP and RHT was analyzed by logistic regression. The final cohort had 888 (79.0%) and 43 (3.8%) patients with controlled hypertension and RHT, respectively. Compared with patients homozygous for the minor allele of each SNP in ATP2B1, a significantly higher number of patients carrying the major allele at 10 SNPs exhibited RHT (most significant at rs1401982: 5.8% vs. 0.8%, p = .014; least significant at rs11105378: 5.7% vs. 0.9%, p = .035; most nonsignificant at rs12817819: 5.1% vs. 10%, p = .413). After multivariate adjustment for age, sex, systolic BP, and other confounders, the association remained significant for rs2681472 and rs1401982 (OR: 7.60, p < .05 and OR: 7.62, p = .049, respectively). Additionally, rs2681472 and rs1401982 were in linkage disequilibrium with rs11105378. This study identified two ATP2B1 SNPs associated with RHT in the Japanese population. rs1401982 was most closely associated with RHT, and major allele carriers of rs1401982 required significantly more antihypertensive medications. Analysis of ATP2B1 SNPs in patients with hypertension can help in early prediction of RHT and identification of high-risk patients who are more likely to require more antihypertensive medications.