RSSDI TEXTBOOK OF DIABETES MELLITUS PDF
Download full-text PDF e textbook of Secondary Diabetes by Podolsky and of Diabetes Mellitus, diabetes is classi ed into four broad. xx RSSDI Textbook of Diabetes Mellitus. SECTION 3: DIAGNOSIS AND CLASSIFICATION. 8. Definition, Diagnosis and Classification. Navigation Menu. Journal IJDDC · Current News Letter · News Letter ( ) · News Letter Archives · RSSDI - Text Book of Diabetes Mellitus · Others.
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This is a huge book - and I mean huge! Place it on your lap and you'll be looking for your popliteal pulses. A third edition, it has 1, pages and is written by. Diabetes mellitus is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin. rssdi textbook of diabetes mellitus pdf free download. Click the button below to get the available options to download the free human.
The Indian type 2 diabetes risk score also helps identify those at risk of macrovascular disease and neuropathy CURES J Assoc Physicians India ;—3. Diabetes Technol Ther. Management of hyperglycemia in type 2 diabetes, a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes.
Random blood glucose: a robust risk factor for type 2 diabetes. Performance of a random glucose case-finding strategy to detect undiagnosed diabetes. American Journal of Preventive Medicine. Random blood glucose screening at a public health station encouraged high risk subjects to make lifestyle changes. International Journal of Clinical Practice.
Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. Conversion of gestational diabetes mellitus to future type 2 diabetes mellitus and the predictive value of HbA1c in an Indian cohort.
Diabet Med. Effect of iron deficiency anemia and iron supplementation on A1C levels—implications for diagnosis of prediabetes and diabetes mellitus in Asian Indians. Clinica Chimica Acta.
Haemoglobin A1c as a screening tool for type 2 diabetes and prediabetes in populations of Swedish and Middle-East ancestry. Primary Care Diabetes. Diagnostic performance of HbA1c for diabetes in Arab vs. Diabetic Medicine. Effect of ethnicity on HbA1c levels in individuals without diabetes: systematic review and meta-analysis.
PLOS One. Diabetologia ;54 12 —7. Diabetes in Asia. The Lancet. Risk of noninsulin dependent diabetes mellitus conferred by obesity and central adiposity in different ethnic groups: a comparative analysis between Asian Indians, Mexican Americans and Whites. Diabetes Res Clin Pract ;36 2 —5. Insulin resistance in patients of Asian Indian and European origin with non-insulin dependent diabetes. Horm Metab Res ;19 2 —5.
Prevalence of diabetes and pre-diabetes and assessments of their risk factors in urban slums of Bangalore. Journal of family medicine and primary care. Prevalence of prediabetes and its associated risk factors among rural adults in Tamil Nadu. Archives of Medicine and Health Sciences. Risk factors of diabetes in North Indians with metabolic syndrome. Awareness and approach towards diagnosis and treatment of diabetes type 2 and its complication among general practioners of western Vadodara.
Int J Diabetes Dev Ctries. Prevention of type 2 diabetes and its complications in developing countries: a review.
Int J Behav Med. International Journal of Diabetes in Developing Countries. Screening for diabetes using Indian diabetes risk score. International Journal of Advances in Medicine. Validation of simplified Indian diabetes risk scores for screening undiagnosed diabetes in an urban setting of haryana. Assessment of diabetes risk in an adult population using Indian Diabetes Risk Score in an urban resettlement colony of Delhi.
Journal of the Association of Physicians of India. Validation of Indian diabetic risk score in diagnosing type 2 diabetes mellitus against high fasting blood sugar levels among adult population of central India. Biomed J. The study was done for a period of three months from January to March Data analysis was done in SPSS software version Results: Among the diabetic patients, Conclusions: This study reveals that the diabetic populations are at higher risk of developing cardiovascular diseases.
Hence awareness about the risk should be created and appropriate intervention at early stages should be implemented at primary health care level.
Belgium: About Diabetes; cited Accessed on 7 February RSSDI textbook of diabetes mellitus. JP Medical Ltd; Park K. Bhanot Publishers; Oxford textbook of public health.
Sixth edition. New York: Oxford University Press; World Health Organization. On the basis of expert opinion of the panel, general population should be evaluated for the risk of diabetes by their healthcare provider on annual basis beginning at age Yearly or more frequent testing should be considered in individuals if the initial screen test results are in the prediabetes range or present with one or more risk factors that may predispose to development of diabetes.
The panel opine that screening programs should be linked with healthcare system and ongoing national prevention programs that will facilitate effective and easy identification of people at high risk of developing diabetes and its complications.
Paramedical personnel can play a key role as facilitator in imparting basic self-management skills to patients with diabetes and those at risk of diabetes. They can be actively involved in engaging people with diabetes or at risk of diabetes in implementing diet and lifestyle changes, behavioral changes, weight management, prepregnancy counselling, and other preventive education.
Nurses or other trained workers in primary care settings and in hospital outpatient settings can:. It has been observed that Indians are more prone to diabetes at a younger age and at a lower BMI compared to their western counterparts [21, 22]. In a cross-sectional study on slum dwellers in Bangalore, prevalence of diabetes and prediabetes was identified as Moreover, female gender, increasing age, overweight and obesity, sedentary lifestyle, tobacco consumption, and diet habits were strongly associated with prevalence of diabetes and prediabetes.
Similarly, in a cross-sectional study in Tamil Nadu, prevalence of diabetes and prediabetes was identified as A study on north Indian subjects proposed severity of IR and family history of diabetes as determinants of diminished beta-cell function leading to diabetes in MS . Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, A1C, low and high density lipoprotein HDL cholesterol, and physical inactivity.
Despite the escalating burden, the current evidence on the prevention of T2DM and its complications in India still remain scanty. Though the general practitioners in India are well aware of symptoms and complications of T2DM, they are oblivious regarding the use of standard screening tests resulting in significant delay in diagnosis and treatment .
Considering significant resource constraints together with awareness levels of patients and physicians, there is a need for prevention strategies that are culturally relevant and cost-effective . Following section covers evidence from India studies on various strategies that are helpful in detecting and minimizing the risk of development of diabetes and its associated complications.
Ramachandran are found to be useful for identifying undiagnosed patients with diabetes in India. Use of these tools could make screening programs more cost-effective [7, 8]. However, there are a lot of false positive and false negative results with these non-invasive screening tools and currently the panel does not recommend using these tools for diagnosis of diabetes or prediabetes, in the absence of the gold standard tests based on blood glucose testing outlined above.
It is also found by some researchers that identifying the presence of multiple risk factors could be used as a simple measure of identifying people at high risk of diabetes . The panel suggest that individuals with diabetes or at risk of developing diabetes should be advised on lifestyle changes and implementing strategies focusing on diet, exercise, and weight loss to prevent the risk of progression and thus complications of diabetes . In patients in whom metformin is contraindicated, AGIs such as acarbose or voglibose may be used, as they confer lesser side effects compared to other OADs.
Another systematic review and meta-analysis show that physical activity in prediabetes subjects improves oral glucose tolerance, FPG and A1C levels, and maximum oxygen uptake and body composition . Results indicate that physical activity promotion and participation slow down the progression of disease and decrease the morbidity and mortality associated with T2DM. Similar results were observed in a systematic review and meta-analysis of 10 articles which determined that the pooled relative risks for T2DM were 1.
Mobile phone messaging was found to be an inexpensive and most effective alternative way to deliver educational and motivational advice and support towards lifestyle modification in high-risk individuals . Dietary interventions such as high-carbohydrate low-fat diet , fiber-rich , and protein-rich diet [66, 67] were found to have definite role in prevention of diabetes.
Evidence from the CURES and Prevention Awareness Counselling and Evaluation PACE diabetes project suggests that awareness and knowledge regarding diabetes is inadequate among patients in India and implementation of educational programs at massive level can greatly improve the awareness on diabetes and its associated CVD [69, 70]. Moreover, mass awareness and screening programs through community empowerment were found to effectively prevent and control diabetes and its complications such as foot amputations .
A clear and transparent decision should be made about whether or not to endorse a screening strategy. If the decision is in favor of screening, this should be supported by local protocols and guidelines and public and healthcare professional education campaigns.
Early detection and treatment of type 2 diabetes reduce cardiovascular morbidity and mortality: Unnikrishnan R, Mohan V. Why screening for type 2 diabetes is necessary even in poor resource settings.
J Diabetes Complications. Systematic literature review of the health economic implications of early detection by screening populations at risk for type 2 diabetes. Current medical research and opinion.
American Diabetes Association. Promoting health and reducing disparities in populations. Standards of Medical Care in Diabetes Diabetes Care ; Majra JP, Verma R.
Opportunistic screening for random blood glucose level among adults attending a rural tertiary care centre in Haryana during world health day observation activity. Opportunistic screening for diabetes mellitus among adults attending a primary health center in Puducherry.
Derivation and validation of diabetes risk score for urban Asian Indians. Diabetes Res Clin Pract. A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects. J Assoc Physicians India. The Indian type 2 diabetes risk score also helps identify those at risk of macrovascular disease and neuropathy CURES J Assoc Physicians India ; Diabetes Technol Ther.
Random blood glucose: Performance of a random glucose case-finding strategy to detect undiagnosed diabetes. American Journal of Preventive Medicine.
Random blood glucose screening at a public health station encouraged high risk subjects to make lifestyle changes. International Journal of Clinical Practice. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: Conversion of gestational diabetes mellitus to future type 2 diabetes mellitus and the predictive value of HbA1c in an Indian cohort.
RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017
Effect of iron deficiency anemia and iron supplementation on A1C levels—implications for diagnosis of prediabetes and diabetes mellitus in Asian Indians. Clinica Chimica Acta. Haemoglobin A1c as a screening tool for type 2 diabetes and prediabetes in populations of Swedish and Middle-East ancestry.
Primary Care Diabetes. Diagnostic performance of HbA1c for diabetes in Arab vs. European populations: Diabetic Medicine. Effect of ethnicity on HbA1c levels in individuals without diabetes: Diabetologia ;54 Diabetes in Asia. The Lancet. Insulin resistance in patients of Asian Indian and European origin with non-insulin dependent diabetes. Horm Metab Res ;19 2: Incidence of diabetes and prediabetes and predictors of progression among Asian Indians: Prevalence of diabetes and pre-diabetes and assessments of their risk factors in urban slums of Bangalore.
Journal of family medicine and primary care. Prevalence of prediabetes and its associated risk factors among rural adults in Tamil Nadu. Archives of Medicine and Health Sciences. Prevalence and risk factors of diabetes in a large community-based study in North India: Risk factors of diabetes in North Indians with metabolic syndrome.
Awareness and approach towards diagnosis and treatment of diabetes type 2 and its complication among general practioners of western Vadodara. Int J Diabetes Dev Ctries. Prevention of type 2 diabetes and its complications in developing countries: Int J Behav Med. International Journal of Diabetes in Developing Countries. Screening for diabetes using Indian diabetes risk score. International Journal of Advances in Medicine. Validation of simplified Indian diabetes risk scores for screening undiagnosed diabetes in an urban setting of haryana.
Assessment of diabetes risk in an adult population using Indian Diabetes Risk Score in an urban resettlement colony of Delhi.
Journal of the Association of Physicians of India. Validation of Indian diabetic risk score in diagnosing type 2 diabetes mellitus against high fasting blood sugar levels among adult population of central India. Biomed J. Baseline characteristics of participants in the Kerala Diabetes Prevention Program: A new non-invasive technology to screen for dysglycaemia including diabetes. Detection of microvascular complications of type 2 diabetes by EZSCAN and its comparison with standard screening methods.
Based Med. A new tool to detect kidney disease in Chinese type 2 diabetes patients: Pedobarography in diagnosis and clinical application. Acta Informatica Medica. Plantar pressure as a risk assessment tool for diabetic foot ulceration in Egyptian patients with diabetes. Clinical medicine insights. Endocrinology and diabetes. Quick and simple evaluation of sudomotor function for screening of diabetic neuropathy. ISRN endocrinology. Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients.
Journal of Diabetes Investigation. Pedobarography—a novel screening tool for diabetic peripheral neuropathy? Eur Rev Med Pharmacol Sci.
Useful screening tools for preventing foot problems of diabetics in rural areas: BMC Public Health. A pragmatic and scalable strategy using mobile technology to promote sustained lifestyle changes to prevent type 2 diabetes in India—outcome of screening.
Chaturvedi N. The burden of diabetes and its complications: Detection and early lifestyle intervention in those at risk of type 2 diabetes. Eur Med J;2: Cost-effectiveness of the interventions in the primary prevention of diabetes among Asian Indians: Efficacy of primary prevention interventions when fasting and postglucose dysglycemia coexist: Prevention of type 2 diabetes by lifestyle intervention: Effect of physical activity intervention in prediabetes: Journal of Physical Activity and Health.
Quantity and quality of sleep and incidence of type 2 diabetes: Determinants of shortened, disrupted, and mistimed sleep and associated metabolic health consequences in healthy humans. Sleep duration and risk of type 2 diabetes: A community-based diabetes prevention and management education program in a rural village in India. Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: Lancet Diabetes Endocrinol. Ahuja MMS.
North Indian food practice and dietary fibre. Effect of fibre diet guar on cholesterol, blood glucose and body weight. Low carbohydrate or high carbohydrate: The effect of modified pulse-carbohydrate diet on weight and HbA1c in type 2 diabetic patients. Lifestyle interventions to stem the tide of type 2 diabetes. Springer International Publishing. Increased awareness about diabetes and its complications in a whole city: Prevention awareness counselling and evaluation PACE diabetes project: The cut-off points for overweight and obesity in Indian T2DM patients are as follows:.
Maintaining healthy lifestyle is recommended for management of metabolic syndrome. This includes:. Overweight and obese people with T2DM should be initiated on exercise therapy, prescribing a combination of aerobic and muscle strengthening activities. Restrictive procedures: Experimental procedures: Comprehensive lifestyle changes including dietary modification, exercise, behavioral management, pharmacotherapy and bariatric surgery are the most effective interventions for weight management in T2DM patients.
Obesity is a highly prevalent metabolic disorder that is often associated with T2DM [1, 2]. In India, the prevalence of obesity is rising at an alarming rate, especially affecting urban population [2, 6]. Furthermore, female gender, hypertension, diabetes, higher socioeconomic status, physical inactivity, and urban residence were significantly associated with GO, AO, and CO, in Indian populations .
High AO contributes significantly to metabolic alterations such as IR, dysglycemia, and dyslipidemia [12—16, 17]. Obesity-induced IR may cause T2DM by increasing the allostatic load on the pancreas which eventually leads to failure of pancreas.
In light of increasing prevalence of obesity in both developed and developing countries and a higher risk for developing IR, dyslipidemia, dysglycemia, and a higher CV risk at lower levels of BMI in Indians, a consensus meeting was convened in New Delhi in published in to redefine the cut-offs for BMI and WC for diagnosing overweight and obesity in Indian population [21, 22].
According to this consensus statement, a BMI of 18— The following local factors were considered when framing recommendations for obesity that were reviewed in Indian context: Indian Diabetes Risk Score is a simple technique for screening of diabetes, which uses four risk factors: Several studies have highlighted the importance of IDRS in the screening of diabetes in Indian population [23—26].
In a cross-sectional study comparison of IDRS and Framingham Risk Score FRS by obesity and lipid abnormality status in women of Asian Indian origin hinted that IDRS can predict CV and diabetes risk more effectively than FRS and serve as simple and cost-effective tool for a primary care physician to identify at risk individuals for diabetes and cardiovascular diseases .
Lifestyle interventions including diet therapy, physical activity, and behavioral and psychosocial strategies have shown positive health outcomes in obese T2DM patients . Similarly, a randomized controlled trial RCT including Asian Indians report that lifestyle intervention with less education lost a model-predicted 3.
Moreover, a population-based cross-sectional study with 15, participants report that an additive interaction exists between poor sleep quality, AO, and family history of diabetes in relation to IFG . The diet therapy for obese T2DM patients should be based on the criteria of decreased energy intake and increased energy expenditure to produce the negative energy balance.
This includes low-calorie diet and diet with caloric restriction and with varying combination of macronutrients . Behavioral therapy includes modifiable factors such as eating patterns and exercise habits that can have significant impact on the management of obesity. A review in Indian scenario suggested that slow eating techniques along with stimulus control not distracted by television, books, or other materials have positive effect on weight loss .
Other important components of behavioral therapy embrace self-monitoring, goal setting, and stimulus or cue control. Such strategies help in setting up realistic goals, guide patients in identifying stimulus that lead to excessive nutrient intake, and eliminate them accordingly .
A recent systematic review and meta-analysis report that diet and physical exercise resulted in significant improvement of body weight in south Asian adults but had no effect on BMI and WC. Furthermore, no alteration in these parameters was observed in south Asian children . Body weight has been shown to be inversely associated with physical activity .
Subjects with low physical activity have threefold greater risk of major weight gain in men and almost a fourfold in women [38, 39]. Moreover, this association was stronger for women than for men and for obese compared to normal weight or overweight individuals . Furthermore, slow and prolonged exercise is associated with fatty acid oxidation with beneficial effects on body weight [41, 42].
Therefore, the panel opined that prescribing a combination of aerobic and resistance training exercises in individuals with T2DM can improve metabolic control while reducing obesity and its related complications.
Though lifestyle modifications are effective in preventing diabetes relapse or remission , they often fail requiring initiation of pharmacotherapy. Metformin is the first choice drug with some evidence for weight loss [45, 46]. Orlistat tetrahydrolipstatin , a lipase inhibitor, is the only approved agent for weight loss in India. It causes modest weight loss by blocking fat absorption from gut and when used in combination with lifestyle changes was found to be effective in prevention of diabetes [10, 55].
Evidence from several studies suggests that bariatric surgery provides durable glycemic control compared with intensive medical therapy [57—60].
In addition, a systematic review and meta-analysis of RCTs report that RYGB surgery is superior to medical treatment for short- to medium-term remission of T2DM and improvement of metabolic condition and CV risk factors . Bariatric surgery is an effective option for severely obese patients with poorly controlled T2DM and weight loss due to gastric bypass surgery is associated with good glycemic control .
Gulati S, Misra A. Abdominal obesity and type 2 diabetes in Asian Indians: European Journal of Clinical Nutrition. National Heart, Lung and Blood Institute. Clinical practice guidelines. The Indian Journal of Medical Research. Asia Pacific perspective: Redefining obesity and its treatment. Health Communications Australia; Misra A, Khurana L.
Obesity and the metabolic syndrome in developing countries. Obesity is becoming synonym for diabetes in rural areas of India also—an alarming situation. Int J Biol Med Res. The metabolic syndrome in South Asians: Metab Syndr Relat Disord. Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity. Int J Obes Lond. Serum immunoreactive insulin responses to a glucose load in Asian Indian and European type 2 non-insulin-dependent diabetic patients and control subjects.
Diabetologia ;29 4: Misra A and Khurana L. Cutoff values for normal anthropometric variables in Asian Indian adults. Ramachandran A. Indian J Med Res. Kaur J. A comprehensive review on metabolic syndrome. Cardiology research and practice.
Available on: PH46 Assessing body mass index and waist circumference thresholds for intervening to prevent ill health and premature death among adults from black, Asian and other minority ethnic groups in the UK Sugar intake, obesity, and diabetes in India.
Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. Misra A, Shrivastava U. Obesity and dyslipidemia in South Asians.
Bhagat M, Ghosh A. Comparison of Framingham Risk Score and Indian diabetes risk score by obesity status and lipids abnormality in women of Asian Indian origin: Santiniketan women study. Hagobian TA, Phelan S. Lifestyle interventions to reduce obesity and diabetes. American Journal of Lifestyle Medicine. Body size and shape changes and the risk of diabetes in the diabetes prevention program.
Wing RR et al. Long term effects of a lifestyle intervention on weight and CV risk factors in individuals with type 2 diabetes: Archives of internal medicine. Lifestyle intervention in obese patients with type 2 diabetes: Interaction of poor sleep quality, family history of type 2 diabetes, and abdominal obesity on impaired fasting glucose: Sahu R.
K, Prashar D. Current treatment strategies for obesity including Indian scenario. Free full text articles from Asian J Pharm. Effects of a behavioural weight loss program stressing calorie restriction versus calorie plus fat restriction in obese individuals with NIDDM or a family history of diabetes. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement.
Health Technol Assess. Diet and physical activity interventions to prevent or treat obesity in South Asian children and adults: Associations between diet, physical activity and body fat distribution: Recreational physical activity and ten-year weight change in a US national cohort. The role of exercise and physical activity in weight loss and maintenance.
RSSDI Textbook of Diabetes Mellitus
Progress in Cardiovascular Diseases. Effects of physical activity intensity, frequency, and activity type on y weight change in middle-aged men and women. Exercise improves fat metabolism in muscle but does not increase h fat oxidation.
Exercise and Sport Sciences Reviews. Neither high- nor low-intensity exercise promotes whole-body conservation of protein during severe dietary restrictions. Int J Obes. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: Diabetes remission after nonsurgical intensive lifestyle intervention in obese patients with type 2 diabetes. Journal of Diabetes Research. Lee A, Morley JE. Metformin decreases food consumption and induces weight loss in subjects with obesity with type II non-insulin-dependent diabetes.
Obes Res. Hendricks EJ.
Off-label drugs for weight management. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. Bray GA et al.
Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. The Effect of glucagon-like peptide 1 receptor agonists on weight loss in type 2 diabetes: Efficacy and safety of sodium glucose co-transport-2 inhibitors in type 2 diabetes: Diabetes Obes Metab. Indian journal of endocrinology and metabolism.
The glucose-lowering efficacy of sitagliptin in obese Japanese patients with type 2 diabetes. Internal Medicine.
Impact of baseline body mass index status on glucose lowering and weight change during sitagliptin treatment for type 2 diabetics.
Diabetes Research and Clinical Practice. Indian Journal of Endocrinology and Metabolism. Effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus: Obesity Reviews. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. Bariatric surgery versus intensive medical therapy in obese patients with diabetes.
Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. New England Journal of Medicine. Roux-en-Y gastric bypass versus medical treatment for type 2 diabetes mellitus in obese patients: Effect of sleeve gastrectomy and gastric bypass on diabetic control in Indore, India. Saudi J Obesity ;2: An observational longitudinal study of the impact of sleeve gastrectomy on glycemic control in type 2 diabetes mellitus.
Roux-en-Y gastric bypass stands the test of time: Surgery for Obesity and Related Diseases. Predictors of remission of T2DM and metabolic effects after laparoscopic Roux-en-Y gastric bypass in obese Indian diabetics—a 5-year study. Obesity surgery. A healthy Indian Mediterranean diet pattern is recommended due to its protective role in high-risk individuals with T2DM.
RSSDI Textbook of Diabetes Mellitus
High-carbohydrate diets with relatively large proportion of unrefined carbohydrate and fiber-rich foods such as pulses, legumes, unprocessed vegetables, and fruits are recommended. Millets and brown rice are preferred to polished white rice. Low-carbohydrate ketogenic diet is preferred than low-caloric diet in patients with T2DM.
Diet containing carbohydrates may be monitored by carbohydrate counting, glycemic index, glycemic load, exchanges, or experience-based estimation. Diet containing high proportion of fat and monounsaturated fats like sunflower oil significantly increases the risk of metabolic syndrome MS ; therefore, they are not recommended in obese T2DM patients. Use of trans fatty acids TFAs should be avoided in high-risk individuals. Combining foods with high and low glycemic indices, such as adding fiber-rich foods to a meal or snack, improves the glycemic and lipaemic profiles.
More leafy vegetables, vegetable salads, fruits, nuts, whole grains, coarse grains, sprouted grams, spices, and other foods rich in fiber and antioxidants.
Alcohol, excess sugar, industrial trans fat, saturated fats, and foods that are refined, processed, salt-rich, cholesterol-rich and deep-fried, polished rice, high fructose corn syrup HFCS. Provide access to a dietician nutritionist or other healthcare professionals trained in nutrition, at or around the time of diagnosis offering an initial consultation and during follow-up sessions as required, preferably individually or in groups. Advice on reducing energy intake and control of foods with high amounts of added refined sugars, fats, and alcohol.
Provide advice on the use of foods in the prevention and management of hypoglycemia where appropriate. Nutritional counselling may be provided by any healthcare personnel, with training in nutrition therapy, but not necessarily an accredited dietician nutritionist.
Nutritional and diet therapy remains an integral part of diabetes management. The primary goal of the diet therapy is to improve health by providing calories for normal growth and development while achieving and maintaining optimal glycemia and normalizing dyslipidaemia .
Evidence from epidemiological and experimental studies focusing on nutritional intervention in the prevention of T2DM suggests that intake of foods with more non-starch polysaccharides and omega-3 fatty acids with low glycemic index GI may play a protective role, whereas excess intake of saturated fats and TFAs may contribute to the increased risk . In people who are accustomed to consuming sugar sweetened foods, ADA recommends the use of non-nutritive sweeteners in moderate amounts as they have the potential to reduce overall calorie and carbohydrate intake .
However, the exact nature of diet appropriate for patients with T2DM still remains a matter of debate due to lack of tools and strategies that help to decide on healthy eating patterns to minimize the burden of disease . In addition, attitudes, cultural differences, and religious and social beliefs and imbalances in dietary patterns pose significant barriers in effective prevention and management of T2DM .
The panel endorse most of the IDF recommendations on diet therapy with a few modifications based on the local factors that were reviewed in Indian context including high prevalence of both obesity and undernutrition, poor access to healthy food choices, and inadequate physical activity in some.
Several parameters like carbohydrate counting, glycemic index GI , glycemic load GL , exchanges, or experience-based estimation can be used for monitoring of carbohydrate content in food, which may be useful in diet management for T2DM patients .
The most beneficial metabolic profile is provided by a high-carbohydrate low-fat diet, and the worst metabolic profile results from low-carbohydrate high-fat diets. High-carbohydrate diabetes diets are effective when relatively large amounts of unrefined carbohydrate and fiber are included such as legumes, unprocessed vegetables, and fruits.
Such a diet is particularly beneficial in patients with impaired glucose tolerance, diabetes, and obesity. A recent review suggests that high-carbohydrate diets are at least as effective as low-carbohydrate diets, associated with significant weight loss and a reduction in plasma glucose, A1C, and low density lipoprotein-cholesterol LDL-C levels in patients with T2DM. Evidence suggests that in patients with diabetes, weight loss achieved due to intake of low-carbohydrate diets is linked to duration of the diet restriction and reduced energy intake but not with restriction of carbohydrates alone.
Therefore, obese diabetes patients should consider switching to a diet reduced in calories and fat to reduce the incidence of T2DM and myocardial infarction [14, 15]. Asian Indians increasingly tend to consume high-carbohydrate diet in the form of refined grain.
Individuals who consumed refined grains were more likely to have metabolic syndrome odds ratio [OR], 7. In another study that examined the association of dietary carbohydrates and glycemic load with the risk of T2DM among urban adult Asian Indian population, consumption of refined grain OR 5. Refined cereals contributed to the bulk of the energy This suggests that these aberrant dietary patterns among urban South Indians contribute to the diabetes risk in this population .
Evidence suggests that improving the carbohydrate quality of the diet by replacing the common cereal staple white rice with brown rice could have beneficial effects on reducing the risk of diabetes and related complications.
As Indians consume relatively more carbohydrates, it is very difficult to alter the amount of carbohydrate in their diets. Therefore, substituting brown rice in place of white rice can be an acceptable option and may reduce the risk of T2DM .
Sugar and sugar-sweetened beverages have been found to increase the glycemic load. Mohan et al. Recent studies report that the intake of total sugar Dal, roti, rice, and curry are the typical examples of Indian mixed diets that are unique from basic or less-mixed diets of Westerners, Black Africans, and other Asians.
Different carbohydrate foods mixed with cereals exhibit GIs intermediate between the GI of each food individually. Within-individual variations in GI and insulinaemic indices of cereal-pulse mixtures are attributable to viscosity of food, high un-absorbable carbohydrate content, or delayed gastric emptying .
Evidence suggests that replacing high GI diets with low GI diets combined with grams and pulses as staple will ensure satiety and adequate calories. Combining acarbose with such modified diet was associated with significant decline in postprandial blood glucose in T2DM patients with secondary failure with OADs . Similarly, use of thepla wheat flour, Bengal gram flour, and oil was associated with lower hyperglycemic and hyperinsulinemia effect in T2DM patients.
Enhanced insulin secretion by pulses gram flour is attributed to lower GI of mixed diets in non-insulin dependent diabetes patients . In a systematic review of dietary patterns in India, it was identified that diet rich in rice and pulses was associated with lower risk of diabetes whereas diet rich in sweets and snacks was associated with high risk .
Consumption of legumes may be beneficial in T2DM prevention in older adults at high cardiovascular risk .
Another study evaluating the risk of MS with type of vegetables oils used for cooking among Asian Indians suggests that the prevalence of MS was higher among sunflower oil users They appear as a good dietary composition as per global standards. But the undeniable increase in the incidence of obesity, diabetes, and cardiovascular diseases in India draws the focus on a balance between fats, carbohydrates, and proteins, rather than an emphasis on individual macronutrients.
Fiber-rich diet has got a definite role in the treatment of diabetes mellitus, obesity, and hypercholesterolemia or hyperlipidemia . The beneficial effects of fiber-rich food in diabetes patients may be attributed to slow release of the absorbed glucose into the blood circulation resulting in decreased insulin secretion .
Diabetes patients on high carbohydrate and fiber diets are found to have lower postprandial glycemia and serum insulin concentration. In obese diabetes patients, diet rich in fiber is particularly useful as it increases satiety, reduces the food intake, and also shows blood glucose reducing effect as is manifested by diminished GI.
Evidence suggests that high fiber diet, particularly of the soluble type, significantly improves glycemic control, decreases hyperinsulinemia, and lowers plasma lipid concentrations in patients with T2DM [37, 38]. Nonetheless, a meta-analysis of 17 prospective cohort studies did not find any direct correlation between dietary fiber intake and risk of T2DM . A recent systematic review reports that the overall mean weighted salt intake was This calls for urgent steps to decrease salt consumption of the population at high risk .
Moreover, the study concludes that excessive salt intake has a greater impact on the prevalence of hypertension in urban than rural regions .Risk factors of diabetes in North Indians with metabolic syndrome. IDF diabetes atlas—7th edition Diabetes education should be focused towards the assessment of change in behavior of people and promote self-management in person with T2DM.
Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: There is lack of knowledge attitude practice studies to determine the gaps in knowledge among diabetics and physicians in the areas of individual diabetes care in India.
Any disease that causes extensive damage to the pancreas may lead to diabetes for example, chronic pancreatitis and cystic fibrosis.
Read all details Description Diabetes mellitus is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.
Your cart is empty. Similarly, in a cross-sectional study in Tamil Nadu, prevalence of diabetes and prediabetes was identified as