Comparative review of diets for the metabolic syndrome: implications for nonalcoholic fatty liver disease

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024.

Objective: To evaluate the adherence to nutritional recommendations in inpatient rehabilitation and the long term maintenance of dietary changes among patients with coronary heart disease. Design: Prospective cohort study. Setting: Two rehabilitation clinics in Germany. Participants: A cohort of 1206 patients undergoing inpatient rehabilitation after an acute manifestation of coronary heart disease. Main outcome measures: Self reported dietary intake before, during, and one and three years after rehabilitation measured with a semiquantitative food frequency questionnaire and summarised to a nutritional index, which was used to categorise patients as having a poor, fair, or good diet. Results: During rehabilitation the proportion of patients whose dietary intake was categorised as good increased strongly from 30% to 91%. One and three years after rehabilitation a still increased proportion of 49% and 42%, respectively, in the good category was observed. The strong increase in intake of low fat and wholemeal products that was achieved during rehabilitation was followed after rehabilitation discharge by a backslide to the intake observed before rehabilitation admission. The avoidance of unfavourable food items, such as French fries or eggs, was at least partly maintained during the follow up period. Conclusion: During inpatient rehabilitation most patients do have to make major changes in their dietary intake to comply with recommendations. Although some proportion of patients continue to adhere to dietary recommendations in the long run, further research into strategies to improve maintenance of dietary changes is needed to enhance further the long term benefits from cardiac rehabilitation.

/pdf/long-term-adherence-to-dietary-recommendations-after-3oq4o8w03f.pdf

Long term adherence to dietary recommendations after inpatient rehabilitation: prospective follow up study of patients with coronary heart disease

Objective: The purpose of this study was to determine if Hispanic Seventh-Day Adventists (SDAs), who typically eat a diet lower in fat, saturated fat and protein, and higher in complex carbohydrates and dietary fiber than the usual omnivorous diet, exhibit lower risk factors for cardiovascular disease (CVD) and Type 2 diabetes compared to Hispanic Catholic omnivores.Methods: Anthropometric characteristics, dietary intake, blood pressure, serum lipids, glucose and insulin, as well as plasma ascorbic acid and vitamin E concentrations, were measured in two groups of Hispanic study participants residing in Denver, Colorado: 74 SDA study participants (x age: 42±1.5 y) and 45 Catholic participants (x age: 44±2.2 y).Results: The SDAs reported lower dietary intakes of total fat, saturated fat and cholesterol and higher relative intakes of carbohydrate and dietary fiber compared to their Catholic counterparts. The SDAs exhibited significantly lower body mass index (BMI=27.2±0.6) and waist-to-hip ratios (WHR=0.84±0...

Risk Factors for Cardiovascular Disease and Diabetes in Two Groups of Hispanic Americans with Differing Dietary Habits

Background: The incidence of coronary artery disease (CAD) is increasing at an alarming rate, especially in developing countries, such as India. It is often advocated that a vegetarian lifestyle could reduce the burden of CAD. However, in spite of a majority of Indians being vegetarians, the incidence of CAD is highest in this population. This may be due to deficiency of vitamin B12, a micronutrient, sourced only from animal products. Methods: Herein, we assessed the effect of vitamin B12 with respect to CAD in 816 individuals (368 CAD patients and 448 controls) recruited from a tertiary care center in New Delhi, India. Results: We found that vitamin B12 levels were significantly lower in CAD patients than in controls (p<0.0001). Also, vegetarians were found to have significantly lower vitamin B12 concentrations (p=0.0001) and higher incidence of CAD (p=0.01). Interestingly, elevated homocysteine levels, a hallmark of vitamin B12 deficiency, was not associated with CAD. In contrast, cysteine levels were significantly higher in CAD patients than in controls (p=0.004). Conclusions: We believe that, when vitamin B12 is deficient, homocysteine is rapidly metabolized via the transsulfuration pathway leading to increased cysteine levels.

Vitamin B12 deficiency is associated with coronary artery disease in an Indian population.

This 28-week observational study measured adherence to and acceptability of the diet and nutrition component of an Ornish-type program among patients in a rural southern setting. Ten volunteers followed a very-low-fat (10% of energy), total vegetarian diet and participated in a program of exercise, stress management, and group support. Patients made significant dietary changes and found the diet "acceptable." Three patients consumed less than 10% of energy from fat and two additional patients consumed less than 20% of energy from fat. Eighty-five percent of the patients' meals adhered to a near vegetarian diet. Weight loss ranged from 0.1 to 11.7 kg (0.25 to 26 lb). Lipid values were unchanged. At 12 months, without the benefit of the structured program, one patient reported 100%, six reported 85%, and two reported 50% adherence to the dietary principles. We conclude that motivated patients with coronary artery disease can follow a very-low-fat, near vegetarian diet but experience difficulty without a structured program.

Adherence to very-low-fat diet by a group of cardiac rehabilitation patients in the rural southeastern United States.

OBJECTIVE
To evaluate safety and effectiveness of MiniMed™ 670G hybrid closed loop in comparison with continuous subcutaneous insulin infusion (CSII) therapy for six months, in persons with type 1 diabetes (T1D).


METHODS
Adults (aged 18-80 years), adolescents, and children (aged 2-17 years) with T1D who were using CSII therapy were enrolled and randomized (1:1) to six months of HCL intervention (N=151, mean age of 39.9±19.8 years) or CSII control (N=151, 35.7±18.4 years) without continuous glucose monitoring. Primary effectiveness endpoints included change in A1C for Group 1 (baseline A1C >8.0%), from baseline to the end of study, and difference in the end of study percentage of time spent below 70 mg/dL (%TBR<70 mg/dL) for Group 2 (baseline A1C ≤8.0%), to show superiority of HCL intervention versus control. Secondary effectiveness endpoints were change in A1C and %TBR<70 mg/dL for Group 2 and Group 1, respectively, to show non-inferiority of HCL intervention versus control. Primary safety endpoints were rates of severe hypoglycemia and diabetic ketoacidosis (DKA).


RESULTS
Change in A1C and difference in %TBR<70 mg/dL for the overall group were significantly improved, in favor of HCL intervention. In addition, a significant mean (95% CI) change in A1C was observed for both Group 1 (-0.8% [-1.1%,-0.4%], p<0.0001) and Group 2 (-0.3% [-0.5%,-0.1%], p<0.0001), in favor of HCL intervention. The same was observed for difference in %TBR<70 mg/dL for Group 1 (-2.2% [-3.6%,-0.9%]) and Group 2 (-4.9% [-6.3%,-3.6%]) (p<0.0001 for both). There was one DKA event during run-in and six severe hypoglycemic events: two during run-in and four during study (HCL: N=0 and CSII: N=4 [6.08 per 100 patient-years]).


CONCLUSIONS
This RCT demonstrate that the MiniMed 670G system safely and significantly improved A1C and %TBR<70 mg/dL with HCL intervention compared with CSII control in persons with T1D, irrespective of baseline A1C level.

Improved Glycemia with Hybrid Closed-Loop (HCL) Versus Continuous Subcutaneous Insulin Infusion (CSII) Therapy: Results from a Randomized Controlled Trial.

Background Type 1 diabetes (T1D) results from immune-mediated destruction of insulin-producing beta cells. Efforts to prevent T1D have focused on modulating immune responses and supporting beta cell health; however, heterogeneity in disease progression and responses to therapies have made these efforts difficult to translate to clinical practice, highlighting the need for precision medicine approaches to T1D prevention. Methods To understand the current state of knowledge regarding precision approaches to T1D prevention, we performed a systematic review of randomized-controlled trials from the past 25 years testing disease-modifying therapies in T1D and/or identifying features linked to treatment response, analyzing bias using a Cochrane-risk-of-bias instrument. Results We identified 75 manuscripts, 15 describing 11 prevention trials for individuals with increased risk for T1D, and 60 describing treatments aimed at preventing beta cell loss in individuals at disease onset. Seventeen agents tested, mostly immunotherapies, showed benefit compared to placebo (only two prior to T1D onset). Fifty-seven studies employed precision analyses to assess features linked to treatment response. Age, measures of beta cell function and immune phenotypes were most frequently tested. However, analyses were typically not prespecified, with inconsistent methods reporting, and tended to report positive findings. Conclusions While the quality of prevention and intervention trials was overall high, low quality of precision analyses made it difficult to draw meaningful conclusions that inform clinical practice. Thus, prespecified precision analyses should be incorporated into the design of future studies and reported in full to facilitate precision medicine approaches to T1D prevention.

/pdf/type-1-diabetes-prevention-a-systematic-review-of-studies-34hx7or6.pdf

Type 1 Diabetes Prevention: a systematic review of studies testing disease-modifying therapies and features linked to treatment response

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Adherence to very-low-fat diet by a group of cardiac rehabilitation patients in the rural southeastern United States.

Improved Glycemia with Hybrid Closed-Loop (HCL) Versus Continuous Subcutaneous Insulin Infusion (CSII) Therapy: Results from a Randomized Controlled Trial.

Type 1 Diabetes Prevention: a systematic review of studies testing disease-modifying therapies and features linked to treatment response