Low Glycemic Index Diets in the Treatment of Diabetes Mellitus - Literature review Example

LOW GLYCEMIC INDEX DIETS IN THE TREATMENT OF DIABETES MELLITUS By Introduction Normalization of blood glucose levelsis critical in Diabetes mellitus management in that when kept under check, it reduces the complications, progression, and development of the disorder. The nature of a patient’s nutrition is a significant factor to consider in the management of diabetes since foods (mainly carbohydrates) greatly impact on the level of blood glucose which in turn affects the secretion of insulin. As such nutrition, determined by diet, is a main area of study in the control and management of diabetes. However, it is an overly controversial topic in that there are multiple different recommendations in existence regarding the use of diets with low Glycemic index (GI) in its treatment. In the light of the ensuing controversy, the need for more research into the study is evident; thus this literature review. In this review, different sources are analyzed with regards to the authors’examinations on the effects of dietary (glycemic factors) in the treatment of diabetes mellitus.Majority of the reviewed studies indicate that indeed, the glycemic index is a major consideration in diabetes mellitus management. Overview Diabetes mellitus refers to a collection of metabolic disorders that are associated with defects in insulin action, insulin secretion, or both. They are characterized by the presence of high blood sugar levels over a long span period. The effect of insulin defect arises when the pancreas cannot produce sufficient insulin, or if cells in the body fail to respond to the produced insulin. When this happens, three types of diabetes are imminent; type 1 diabetes due to insufficient secretion of insulin, type 2 diabetes due to cell resistance to insulin, and gestational diabetes which is experienced when expectant mothers develop high levels of blood glucose. If the disorders go unnoticed, they develop into complications such as nonketotic hyperosmolar coma or diabetic ketoacidiosis in the short term. Long term complications such as kidney failure, cardiovascular disease, eye damage, stroke, or foot ulcers may develop if the disorders are not treated in time. Literature Review Brand-Miller, Hayne, Petocz, and Colagiuri (2003, p. 2261) conducted studies aimed at answering the query whether low glycemic index diets significantly improved glycemic control in diabetes patients as compared to high glycemic index diets. There were 203 type 1 and 153 type 2 diabetes patients. The evaluation was to be done depending on the levels of fructosamine and HbA1c levels before and after the tests for a period of 12 weeks. The low-GI foods used were high in carbohydrates such as oats, peas, beans, barley, bulgur, and pasta amongst others. High GI foods used were foods with minimal carbohydrate content such as white bread, potato, rice, and breakfast cereals. The results showed that the group that was on low-GIfoods showed lower levels of HbA1c (0.4% lower) and fructosamine (0.2mmol/l lower) as compared to those on high GI foods. As such, the studies showed that low-GI diets have significant [clinical] benefits in diabetes mellitus treatment and management. Similarly, Moses, Barker, Winter, Petocz, & Brand-Miller (2009, p.996) sought to determine the efficacy of the medical advice that a low-glycemic index diet is effective in treating expectant women with diabetes by improving pregnancy outcomes. The study was conducted owing to the controversial debate surrounding the advice. The test featured 63 expectant women of ages 18 to 40 years who had no prior diagnosis of gestational diabetes, and were able to follow an established protocol. The idea was to determine which group between one placed under low-GI diet and one placed under higher glycemic index would require insulin without compromising their pregnancy. The conclusions drawn showed that 29% (9 of 31) of the women assigned the low-GI diet required insulin. On the other hand, 59% (19 of 32) of the women assigned higher GI diet required insulin. From this, it was evident that a low-GI diet reduced the need for expectant women with diabetes to use insulin by half. According to Miles (2008, p.1), the debate regarding the role of glycemic index as treatment for diabetes is far-fetched, and that a common ground has never been achieved. Prior to the American Diabetes Association’s assertion that a low-fat, high-carbohydrate diet was best for the diabetic, a high-fat, low-carbohydrate diet was recommended for the same. The new assertion was made as a means of understanding lipid and glucose control rather than advocating for weight loss in diabetic patients. The glycemic index is a framework for ranking carbohydrate foods as per their impact on postprandial glucose levels (concentrations). Miles adds that while low-GI diets have been proven to produce less hyperinsulinemia and postprandial hyperglycemia, their role in treating or preventing diabetes mellitus remains unverified. Concisely, studies provided in his article show that the differences observed between patients assigned to low and high GI diets is transient (lasts for a short time) thus not sufficient to be branded as potential treatment. Thomas and Elizabeth (2009, p.2) investigated whether nutritional factors affect blood glucose levels. 402 diabetic participants who had not initiated optimal diabetes control methods were tested to reveal any significant effects of low glycemic load or low glycemic index on their diabetes. Some had type 1 diabetes and others type 2 and were evaluated for between I month to a year. The findings indicated that; fewer low-GI diet participants reported more than 15 hyperglycemic episodes monthly and that the level of HbA1c was lower in the low-GI group. Thomas and Elizabeth (2) explain that different carbohydrates have varying levels of effect on blood glucose levels and as such, maintaining a diet low in glycemic index reduced insulin release. As such, they concluded that there was bound to be clinical significance in terms of improvement in diabetic patients who were assigned low-GI diets, and that low-GI was an effective means of controlling diabetes mellitus. In Asia, similar studies were conducted on 71 Malaysian women as reported by Shyam, et. al (2013, p.12) to investigate the role of low-GI diets on body weight and glucose tolerance. The studies ran for 6 months and required the participants to have had previous histories of gestational diabetes. The women were split into two groups of conventional healthy dietary recommendation and low glycemic Index. The first group was randomized with energy restricted, refined and low in fat sugars and high fiber diets. The low-GI group was receiving a diet that reduced GI constantly. After the testing period, their glucose tolerance was measured in addition to BMI, waist-to-hip ratio, and body weight. The Low-GI group recorded significant improvements in all these aspects as compared to the conventional healthy dietary group. The indication was that lowering the glycemic index improves glucose tolerance and body weight reduction which in turn keeps gestational diabetes mellitus under control while reducing the risks of contracting the same. Wood and Fernandez (2009, p.179) agree with Miles’ (2008) statement that the issue of treating diabetes mellitus by reducing high GI foods can be traced way back into ancient times. They reveal that as early as 1893, carbohydrate-restricted diets were used to control diabetes, although the direct intention was to control chronic metabolic disease risk factors and obesity. They however state that the contemporary concept of recommending low carbohydrate diets is to reduce the risks as well as the effects of existing type 2 diabetes (metabolic syndrome and insulin resistance). In several trials they conducted by restricting carbohydrate use to constitute about 10 to 15% of total energy intake, several observations were made: first, there was a reduction in plasma triglycerides by about 40 to 70 percent. Again, there was an increase in HDL cholesterol, reduction in waist circumference, and most importantly reduced plasma glucose. Collectively, these findings indicated a relationship between low-GI diet and reduced type 2 diabetes mellitus. Westman, Yancy, Mavropoulo, Marquart& McDuffie (2008, p.5) researched the hypothesis that a low carbohydrate diet would translate to better glycemic control in diabetic persons. They had 84 volunteers from the same community who were obese and had type 2 diabetes for the research. They were grouped into two bunches in which one was randomized with a low-glycemic, reduced-calorie diet (500 kcal per day) while the other was randomized with a low-carbohydrate, ketogenic diet ( Read More