The Use of Low Glycaemic Index Diets in the Treatment of Diabetes Mellitus - Literature review Example

The use of low glycaemic index diets in diabetes mellitus treatment Lecturer Introduction Diabetes mellitus isa metabolic condition that results due to an insulin secretion defect, insulin action or both actions (American Diabetes Association 2012, 65). As a result of the disorder, chronic hyperglycemia of fat, protein and carbohydrate disturbances results. Long-term complications that result from a poorly controlled diabetes mellitus entail nephropathy, neuropathy, retinopathy, as well as an increased cardiovascular disease risk. The incidence of diabetes mellitus is on the rise (Drouin 2013, 68). The condition results when the pancreas lacks to produce enough insulin for maintaining the normal blood sugars or when the cells fail to respond to insulin properly (Zhang et al. 2010). The number of individuals suffering from diabetes is increasing and by 2030, the number of patients suffering from the chronic condition is expected to increase to three hundred and sixty million patients worldwide (American Diabetes Association 2012, 64). It is a major world threat as the annual health care expenditures for patients with diabetes is 11.5 percent of all the health care expenditure (Drouin et al. 2013, 68). According to Drouin et al. (2009), the condition has been associated with significant mortality and morbidity accounting for 7 to 9 percent of all deaths resulting from all comorbidities thus; it has become a top health care priority. The literature review focuses on the use of low glycemic index diets in diabetes mellitus treatment. Diabetes management intervention The main reason for diabetes control is normalizing and stabilizing the levels of blood glucose, as glucose control has been linked to a decline of complications associated with the disorder. Common treatment remedies for diabetes include diet and weight control as well as physical activity. If the blood glucose levels remain relatively, high diabetes tables can be administered and in other cases, insulin injections and islets cell transplants are required (Kashikar & Tejaswita 2011, 23). According to Zhang et al. (2010), nutritional factors are key in affecting the blood glucose levels. Despite of the research conducted, there is no any recommended way for optimal diabetes dietary strategy. According to Thomas & Elliott (2009), the improvement in glycemic control that can be achieved through dietary interventions is fundamental in decreasing the diabetic complications, improving life among the affected, minimizing the expenses associated with diabetic medications, as well as increasing their life expectancy. There are different carbohydrates each with different effects on the body’s blood glucose. They are grouped with respect to the effects they have on glucose levels by the use of the glycemic index (Kendall et al. 2006, 54). Low index containing foods such as oats and beans contribute a gradual supply of glucose in the body resulting in a better glycemic control. High glycemic index containing foods include white bread, potatoes, and cereals that need to be avoided by individuals suffering from diabetes mellitus (Brand-Miller, et al, 2263). The low glycemic index foods are thus essential to increasing insulin sensitivity as they minimize the fluctuations in the blood glucose levels and as well reduce insulin secretion over the day (Radulian et al. 2009, 5). A glycemic load is a representation of the total glycemic results of food consumed and is evaluated through multiplication of the GI with the grams of starch in the food (Thomas & Elliott 2010, 801). Glycemic index (GI) Glycemic index (GI) is the assessment of the carbohydrate-containing foods quality based on their abilities of raising the blood glucose levels. Individuals suffering from diabetes utilize the GI to be a guideline in determining the type of food to consume (Balzer 2012, 287). The index is essential as it helps in the classification of carbohydrates food in regards to their potential abilities of raising the sugar levels in the blood. Foods containing a great glycemic index often lead to a raised level of blood sugar faster and higher as compared to the low-value glycemic index foods. In decreasing the glycemic response to an individual’s dietary intake, the low glycemic index carbohydrate foods are usually exchanged for the higher carbohydrate glycemic foods (Rizkalla et al. 2002, 260). According to research studies of trials of diabetes management, substituting high glycemic carbohydrate foods with low glycemic carbohydrate foods has proven to show great improvements in glycemic level control in two weeks to a period six months in individuals suffering from diabetes mellitus. This dietary strategy is also essential as reduces the chances of cardiovascular risk factors (Wolever et al. 2008, 1614). According to Balzer et al. (2012), the nutrition substitution improves the postprandial glycemia as well as enhances sensitivity C-reactive protein among the individuals. The utilization of low glycemic index diet is important in sustaining improvements in the glycemic control as compared to high glycemic index diet. Educating the individual on the utilization of glycemic index in diabetes management is important and recommended but it needs to be based on the person’s interest and ability. Some of the advantages associated with the utilization of the low value glycemic index food include their ability of lowering the blood sugar levels and as a result will reduce the need for taking diabetes medications (Radulian et al. 2009, 5). The low glycemic foods are also essential as they help in regulating the blood sugar levels throughout the day as they release it slowly reducing the risk of insulin resistance on the individual. As well, they help in controlling appetite and delaying the cues of hunger that helps in weight management thus are considered be very beneficial (Larsen et al. 2011, 233). However, despite the benefits, some potential problems are associated with the use of low glycemic index foods as the diet may not be a balanced combination of the various components of food for the diet to have a low glycemic index value. Moreover, glycemic control only applies to food only containing carbohydrates. Diabetes glycemic control does not take into consideration how the food has been prepared and what components and substances are being consumed such as the nutrient value of the food as food can contain a low GI value but be saturated by fat and sugar thus not healthy for consumption (Brennan 2005, 566). The main goal of diabetes management is the restoration of the normal blood glucose levels (Rizkalla et al. 2002, 255). There has been controversy on how the GI helps in the control of diabetes. Wolever et al. (1994) stated that glycaemic control is essential in lessening the risks associated with diabetic complications as well as improving the quality of care. A lesser GI diet has been proven as an ultimate remedy for diabetic individuals improving the pregnancy outcomes of diabetic pregnant women especially when used during the first trimester of pregnancy (Louie et al. 2013, 259). Thus, it is a treatment option that can be undertaken among pregnant women with diabetes but, the safety in regards to the treatment results as well as the associated pregnancy outcomes has not been established (Louie et al. 2013, 261). Shyam et al. (2013) conducted a research study with an aim of determining whether the prescription of low GI foods among pregnant individuals suffering from gestational diabetes mellitus will decline insulin supplementation with no compromisation of the outcomes. Gestational diabetes mellitus pregnant women were either assigned to receive a high or low GI diet. From the outcomes out of the participants selected to receive a low GI foods, only 29 percent required further supplementation of insulin. However, from the group receiving a high GI foods sixty percent required further insulin treatment. The conclusion was that use of lower GI diet for pregnant women suffering from gestational diabetes mellitus is an achievable success in care of individuals suffering from diabetes (Shyam et al. 2013, 68). The use of glycemic index load in meal planning for the diabetic individuals has fueled many concerns. According to the Cochrane review, there is limited quality of information regarding the efficacy of diet alone in diabetes mellitus management. Brand-Miller, et al. (2003) states that low GI diets exerted a small but quite a significant result in glycemic management (P < 0.03). The glycaemic effect of the carbohydrates in foods is more crucial than what content of food it contains in GI control. The diabetes association in UK has stated that management of GI is crucial and important in diabetes mellitus care (Wood & Fernandez 2009, 182). It is a challenge for a patient to follow the glycemic index of foods on their own, but consultation with a dietitian will help. Majority of the foods are not packed and ranked based on their glycemic index, as packed foods do not list their glycemic index ranking on their labels. It then becomes hard to estimate the real glycemic index contained in the different food types. There are some basic principles of the low glycemic index diet. These entails educating the diabetic patients to choose the high fiber food products that include legumes, vegetables, fruits and whole grain as well as choosing raw and fresh foods over the processed and canned food (Balzer 2012, 296). The glycemic index diet is a good measure that deserves consideration among the individuals suffering from diabetes mellitus (Mann et al. 2004, 387). Conclusion Diabetes mellitus is a metabolic condition that results due to an insulin secretion defect, insulin action or both actions resulting in chronic hyperglycemia of fat, protein and carbohydrate disturbances (American Diabetes Association 2012, 65). The objective of diabetes management is to help in normalizing and stabilizing the body’s glucose amounts, as glucose adjustment is essential to enhance the reduction of diabetes incidences (Thomas & Elliott 2009, 801). GI definition is an assessment of the amount of starch contained in food based on their sheer abilities of raising the blood glucose levels. Individuals suffering from diabetes utilize the GI to be a guideline in food selection. The index is essential as it helps in the classification of carbohydrates foods in regards to their potential abilities of raising the sugar levels in the blood. Foods with a g high quantity of GI raises sugar levels more quickly and highly as compared to the low-value food of glycemic index. Replacing higher glycemic carbohydrate foods with low-value carbohydrate foods has proved to show significant improvements in the glycaemic control among diabetic mellitus patients (Rizkalla et al. 2002, 260). The utilization of glycaemic control is fundamental in decreasing the incidences of diabetic, improving the patients living standards, minimizing the expenses associated with diabetic medications as well as increasing their life expectancy. It is important for the individuals suffering from diabetes mellitus to receive food counseling from dietitians. Nutrition therapy is essential in reducing glycated levels of hemoglobin by 1-2 percent, and when combined with other diabetes care components it improves the metabolic and clinical care outcomes of diabetes mellitus. Specific foods and patterns have been proven effective in the management of diabetes mellitus (Balzer 2012, 294). This is by replacing the high glycemic index starch foods with low carbohydrate glycemic index foods in meals. References American diabetes association, 2012. Diagnosis and classification of diabetes mellitus. Diabetes care, 35 Suppl 1, pp.64–71. Balzer, B.W.R. et al., 2012. Low glycaemic index dietary interventions in youth with cystic fibrosis: A systematic review and discussion of the clinical implications. Nutrients, 4, pp.286–296. Brand-Miller, J. et al., 2003. Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care, 26, pp.2261–2267. Brennan, C.S., 2005. Dietary fibre, glycaemic response, and diabetes. Molecular Nutrition and Food Research, 49, pp.560–570. Drouin, P. et al., 2013. Diagnosis and classification of diabetes mellitus. Diabetes care, 36 Suppl 1, pp.S67–74. Drouin, P. et al., 2009. Diagnosis and classification of diabetes mellitus. Diabetes care, 32 Suppl 1, pp.S62–7. Kashikar, V.S. & Tejaswita, K., 2011. Indigenous remedies for diabetes mellitus. International Journal of Pharmacy and Pharmaceutical Sciences, 3, pp.22–29. Kendall, C.W.C. et al., 2006. The glycemic index: methodology and use. Nestle Nutrition workshop series. Clinical & performance programme, 11, pp.43–53; discussion 53–56. Larsen, R.N. et al., 2011. The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: A 12 month randomised controlled trial. Diabetologia, 54, pp.731–740. Louie, J.C.Y. et al., 2013. Higher glycemic load diet is associated with poorer nutrient intake in women with gestational diabetes mellitus. Nutrition Research, 33, pp.259–265. Mann, J.I. et al., 2004. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutrition, metabolism, and cardiovascular diseases : NMCD, 14, pp.373–394. Radulian, G. et al., 2009. Metabolic effects of low glycaemic index diets. Nutrition journal, 8, p.5. Rizkalla, S.W., Bellisle, F. & Slama, G., 2002. Health benefits of low glycaemic index foods, such as pulses, in diabetic patients and healthy individuals. The British journal of nutrition, 88 Suppl 3, pp.S255–S262. Shyam, S. et al., 2013. Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial. Nutrition journal, 12, p.68. Sievenpiper, J.L. et al., 2009. Effect of non-oil-seed pulses on glycaemic control: A systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia, 52, pp.1479–1495. Thomas, D. & Elliott, E.J., 2009. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database of Systematic Reviews. Thomas, D.E. & Elliott, E.J., 2010. The use of low-glycaemic index diets in diabetes control. The British journal of nutrition, 104, pp.797–802. Wolever, T.M. et al., 1994. Glycaemic index of 102 complex carbohydrate foods in patients with diabetes. Nutrition Research, 14, pp.651–669. Wolever, T.M.S. et al., 2008. Low glycaemic index diet and disposition index in type 2 diabetes (the Canadian trial of Carbohydrates in Diabetes): A randomised controlled trial. Diabetologia, 51, pp.1607–1615. Wood, R.J. & Fernandez, M.L., 2009. Carbohydrate-restricted versus low-glycemic-index diets for the treatment of insulin resistance and metabolic syndrome. Nutrition Reviews, 67, pp.179–183. Zhang, P. et al., 2010. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, pp.293–301. Read More