Prevalence Of Diabetes, Medical Nutritional Therapy
Review Articles
Nutrition Therapy for Diabetes
Patricia Savino Lloreda, ND.1
Summary
Medical nutritional therapy (MNT) is essential for the management of diabetic patients and must be done in conjunction with the health team.In which the patient receives education to control their blood glucose, the administration of insulin or hypoglycemic agents, recommendations for eating habits, management of the diabetic foot, prevention of complications, etc.
The change towards a A healthy lifestyle will help the patient achieve the ideal weight, improve blood biochemical parameters, reduce cardiovascular risk, improve general conditions and help ensure that exercise is planned according to their physical condition and individual state of health.
A varied and balanced diet, without extremes, contributes to the patient’s well-being.Weight control is essential for the proper management of both diabetes and cardiovascular risk, since positive results have not been demonstrated when diabetes is managed exclusively with medications.
Enteral nutrition by tube must follow the principles of the oral diet, taking into account that there are alterations of the gastrointestinal system inherent to the disease and not related to the tolerance of enteral nutrition by tube.Currently, bariatric surgery is considered an aggressive but successful alternative for the control and management of diabetes.
Keywords: Medical nutritional therapy , insulin, specialized enteral formulas, diabetes, bariatric surgery, fructo-oligosaccharides.
Abstract
Medical nutrition therapy (MNT) is essential for management of the diabetic patient.This task should be undertaken by the health care team through providing patient education on topics such as control of blood glucose levels, administration of insulin and/or oral hypoglycemiants, nutrition habits, diabetic foot management, and prevention of complications.
Adoption of a healthy lifestyle should help the patient achieve her/his ideal weight, improve biochemical parameters of the patient’s blood, reduce cardiovascular risk, improve the patient’s general condition, and contribute to planning exercise in according to his/her physical condition and individual health status.
The diabetic patient will benefit from a balanced and varied diet which avoids extremes and contributes to the patient’s overall well-being.Weight control is essential since neither diabetes nor cardiovascular risks can be managed exclusively with drugs, as have been shown numerous studies.
Enteral tube feeding should follow the same nutritional principles as does oral feeding, but it is important to take into account that there are gastrointestinal alterations inherent to diabetes which are not necessarily caused by patients' tolerance to the formula.Currently bariatric surgery is considered to be an aggressive but successful option for management and control of diabetes.
Key words: Medical nutrition therapy;insulin;oral hypoglycemicants;specialized enteral formulas;gestational diabetes;cardiovascular risk;obesity;bariatric surgery;fructooligosaccharides.
Introduction
Diabetes is a condition that is known since 1500 BC Apparently, the first reference is found in an Egyptian papyrus, where a rare disease was mentioned that caused rapid weight loss accompanied by frequent urination.
The Greek physician Aretaeus ( 30-90 AD) was the one who gave it the name “diabetes” meaning liquid that passes through a siphon and was the one who characterized the disease with symptoms of polydipsia, polyuria and significant weight loss.
Later, Galen (130-200 AD) theorized about the disease saying that it was secondary to a kidney condition.The era of “uroscopy” led to one of the most common ways to identify the disease.The color, smell and sediment of the urine were examined in order to establish what was wrong with the patient.Some doctors even tested urine and this is where its second name “mellitus” originates, which means honey in Latin.
The availability of different tests to detect glycosuria at the beginning of the century XIX made it easier to identify the presence of diabetes in the individual.However, even at this time the cause was still not found.Until during the Franco-Prussian War, the French doctor Bouchardat identified that caloric restriction helped these patients, and therefore implemented this behavior as part of the treatment.
The islets of Langerhans and diabetes
At the same time, Paul Langerhans had described the composition of the pancreas and identified the islets, whose function until then was unknown.(1,2) In 1920, Moses Barron made the connection between the islets of Langerhans and diabetes.Later, Frederick G. Banting performed several experiments, related the pancreas to diabetes, and discovered insulin.
He and his colleagues received the Nobel Prize in Physiology or Medicine for this discovery. 1923.(3) Knowledge and treatment of the disease have grown slowly, since it was not until the beginning of the 20th century when great advances in science and medicine made it possible to detect an exponential increase in proven facts for treatment. of diabetes and determine effective strategies for its prevention and control.
Having been able to deepen our understanding of the disease has made it possible to assess the nutritional medical treatment of diabetes mellitus on a daily basis.Both doctors and patients have understood the importance of diet in the management of the disease, considering it decisive for maintaining the ideal weight, for the regulation of blood glucose levels and for the prevention of various complications such as cardiovascular, neurological, renal or ophthalmological.
(Read Also: Medical Nutritional Therapy)
Epidemiology
The number of people with diabetes has grown dramatically, due to different causes, such as: population growth, aging, urbanization, increased prevalence of obesity and physical inactivity.
Non-communicable diseases related to nutrition They derive from the process of food transition, both due to a high consumption of refined foods and products of animal origin, and due to the increased consumption of saturated fats.All of these factors play a fundamental role in the obesity epidemic and in the development of diseases such as diabetes, cardiovascular disease and metabolic syndrome.(4)
The increased prevalence of type 2 diabetes 2 is closely linked to obesity.
The nutritional transition affects developing countries, producing a double burden of disease by generating overweight and malnutrition in the same family nucleus.(5) This diet is accompanied of a sedentary life and a greater availability of empty calories.The increased prevalence of type 2 diabetes is closely linked to obesity.
About 90% of cases of type 2 diabetes are attributable to excess weight.According to the January 2011 report from the WHO(6), there are nearly 220 million people in the world who have glucose intolerance, caused mainly by obesity and associated with metabolic syndrome.More than 80% of deaths from diabetes occur in low- and middle-income countries and in 2004, it was estimated that 3.4 million people died due to high blood glucose levels.This number is expected to increase to 420 million people by 2025.(7)
The average incidence of diabetes in Latin America and the Caribbean
According to Hossain,(8) who cites Wild,(9) the average incidence of diabetes in Latin America and the Caribbean is 13.3%, and an increase of 148% is expected by 2030, for a total of 33%.This is reflected in the high incidence of overweight and obesity, as well as diabetes.
The prevalence of diabetes in Mexico
The prevalence of diabetes in Mexico is 8 % in people over 20 years old, and exceeds 20% in people over 50 years old.The leading cause of mortality in this country is diabetes, for both men and women, with figures of 11.3% and 16.3%, respectively.
In addition, it is the main cause of medical care in outpatient consultation, one of the main causes of hospitalization and the disease that generates the highest percentage of spending by public institutions (around 20%).Diabetes increases the risk of dying from various conditions, such as heart disease, cerebrovascular disease, and kidney failure.Also, it is the main cause of lower limb amputation of non-traumatic origin and the main cause of blindness.
Prevalence of diabetes
In the case of Colombia, according to According to information from the Pan American Health Organization, there is a prevalence of diabetes of 8.2% and mortality in 1994 was 9.3% for men and 13.4% for women, with an average of 11.4%.
Diseases of the circulatory system occupied first place as a cause of death in the general population in 2002, with 27.3% of all deaths, and according to DANE, among them, the cause The most common cause of mortality was myocardial ischemia (52.3 per 100,000).Secondly, cerebrovascular disease (31.1 per 100,000) and, thirdly, systemic arterial hypertension (12.7 per 100,000).(10-12)
Unfortunately, the majority of Latin American and Caribbean countries do not carry out epidemiological surveillance of diabetes in adults.The information that exists on the Prevalence of Diabetes disease is very limited.
Prevalence of diabetes mellitus 2
According to a recently published article by Dr. Aschner, the prevalence of Diabetes mellitus 2 ranges between 4% and 8%, depending on the age range of the population studied and is among the first five causes of death in Colombia and its morbidity is considerable.(13)
The Diabetes Control and Complications Trial (DCCT) was a landmark study conducted between 1983 and 1993, which from its inception was designed to explore whether intensive glucose control can delay or even prevent related complications. with diabetes.
In this study, intensive control meant maintaining HbA1C at levels of 6 or even lower.
Before the DCCT, several studies had been conducted that confirmed the hypothesis that low glucose levels reduced the risk of complications, but there was no long-term study to conclusively prove it.
This study, carried out in 29 medical centers in North America, included 1,141 volunteers with type 1 diabetes and ages between 13 and 39 years.The results of 10 years of research showed that when blood glucose levels were maintained in a more or less normal range, the onset and progression of eye, kidney and neurological damage caused by diabetes could be delayed.
Even later it was stated that any effect of lowering blood glucose levels was beneficial, even if the patient had a history of poor blood glucose control.(14)
In 1993 , when the DCCT concluded, the researchers continued studying more than 90% of the participants, and called it Epidemiology of Diabetes Intervention and Complications (EDIC).
It aimed to evaluate the incidence and predictions of cardiovascular disease.Such as heart attack, stroke, need for coronary surgery, as well as diabetic complications related to the eyes, kidneys and nerves.They also examined the cost-effectiveness of intensive glucose control and its impact on quality of life.The EDIC will continue until 2016.(15)
The results found in the DCCT and intensive glycemic control showed a reduced risk of:
- Eye disease: 76%
- Kidney pathologies: 50%
- Neurological pathologies: 60%.
The results found in the EDIC and intensive glycemic control generated a risk reduction:
- In any cardiovascular disease event of 42%
- In non-fatal heart attack, infarction or death from cardiovascular causes of 57%.
The most frequent complication that occurred with intensive control of blood glucose in the DCCT was the risk of hypoglycemia.The ACCORD describes the five-year results, with an average of 3.7 years of intensive glycemic reduction in mortality and key cardiovascular events.(18)
The results showed that when Compared with standard therapy, intensive treatment for 3.7 years, whose objective was to maintain glycated hemoglobin at values less than 6%, reduced non-fatal myocardial infarctions for 5 years, but increased mortality for 5 years.
Due to these results, this strategy cannot be recommended for high-risk patients with advanced type 2 diabetes and even more so because the reasons for the high mortality in the group that received this type of treatment are not clear.According to Dluhy,(19) the results of these studies in no way detract from the importance of complying with the treatment guidelines for diabetic patients and even less underestimate the importance of glycemic control.
The Physicians caring for diabetic patients should emphasize that patients stop smoking.They receive recommendations about their diet and exercise, control their blood pressure, in addition to being prescribed aspirin and statins.Cefalu(20) mentions that another important data is the weight gain that was found in the ACCORD, since more than 27% of the patients reported an increase of 10 kg in weight.
This is not It can be considered a trivial point, since it is very different to achieve glycemic control with an aggressive medication strategy than to achieve it through lifestyle changes, through diet and exercise.
Author
1 Patricia Savino Lloreda, ND.Graduate in Nutrition and Dietetics, Pontificia Universidad Javeriana,
Bogotá , Colombia.Master of Business Administration in Health Care.
Colorado Technical University, Colorado Springs, CO, USA
Correspondence: patricia.savino@gmail. com
Received: March 2011
Accepted for publication: April 2011
RMNC 2011;2(1): 20-33.
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