Effects of total and green vegetable intakes on glycated hemoglobin A1c and triglycerides in elderly patients with type 2 diabetes mellitus: The Japanese Elderly Intervention Trial

Objective: De-intensification of diabetes treatment is recommended in elderly patients with tight glycemic control at high risk of hypoglycemia. However, rates of de-intensification in endocrine practice are unknown. We conducted a retrospective study to evaluate the rate of de-intensification of antidiabetic treatment in elderly patients with type 2 diabetes mellitus (T2DM) and tight glycemic control. Methods: All patients with ≥2 clinic visits over a 1-year period at a major academic diabetes center were included. De-intensification of diabetes treatment was defined as a decrease or discontinuation of any antidiabetic drug without adding another drug, or a reduction in the total daily dose of insulin or a sulfonylurea drug with or without adding a drug without risk of hypoglycemia. Results: Out of 3,186 unique patients, 492 were ≥65 years old with T2DM and hemoglobin A1c (HbA1c) <7.5% (<58 mmol/mol). We found 308 patients treated with a sulfonylurea drug or insulin, 102 of whom had hypoglycemia as per physician note. Among these 102 patients, 38 (37%) were advised to de-intensify therapy. In a subgroup analysis of patients ≥75 years old with HbA1c <7% (<53 mmol/mol), we found that out of 23 patients treated with a sulfonylurea drug or insulin and reporting hypoglycemia, 11 (43%) were advised de-intensification of therapy. There were no significant predictors of de-intensification of treatment. Conclusion: Our study suggests that de-intensification of antidiabetic medications is uncommon in elderly patients with T2DM. Strategies may need to be developed to prevent the potential harm of overtreatment in this population. Abbreviations: ADA = American Diabetes Association; CGM = continuous glucose monitoring; HbA1c = hemoglobin A1c; T2DM = type 2 diabetes mellitus; UKPDS = United Kingdom Prospective Diabetes Study

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Dietary pattern and mortality in Japanese elderly patients with type 2 diabetes mellitus: Does a vegetable- and fish-rich diet improve mortality? An explanatory study

Geriatrics and Gerontology International ◽

10.1111/j.1447-0594.2011.00813.x ◽

2012 ◽

Vol 12 ◽

pp. 59-67 ◽

Cited By ~ 24

Author(s):

Satoshi Iimuro ◽

Yukio Yoshimura ◽

Hiroyuki Umegaki ◽

Takashi Sakurai ◽

Atsushi Araki ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Elderly Patients ◽

Dietary Pattern ◽

Japanese Elderly

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Effect of Dietary Intervention Using Low-Carbohydrate Diet to Manage Newly Diagnosed Type 2 Diabetes Mellitus in TUTH Hospital, Nepal

Nepalese Medical Journal ◽

10.3126/nmj.v4i1.34710 ◽

2021 ◽

Vol 4 (1) ◽

pp. 419-423

Author(s):

Aarem Karkee ◽

Samir Singh ◽

Pradeep Krishna Shrestha ◽

Nani Shova Shakya ◽

Sadiksha Shrestha ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Hemoglobin A1c ◽

Glycated Hemoglobin ◽

Newly Diagnosed ◽

Carbohydrate Diet ◽

Low Carbohydrate Diet ◽

Low Carbohydrate

Introduction: Low-carbohydrate diet is effective in improving blood glucose parameters, glycated hemoglobin A1c, weight, and waist circumference. The effectiveness of this diet is well accepted in America and the United Kingdom but in Nepal due to many preexisted misbeliefs regarding carbohydrates, we still have a carbohydrate-based diet for type 2 diabetes mellitus.Material and Methods: Fifty-four newly diagnosed type 2 diabetes mellitus without any treatment were selected for solely low-carbohydrate diet intervention (<130g carbohydrate) in the endocrinology unit of Tribhuvan University Teaching Hospital, Kathmandu from March to August 2019. Antidiabetic medications were not used. Individualized diet plans and repeated counseling were given and followed for 3 months. Blood glucose (fasting and postprandial),glycated hemoglobin A1c, weight, and waist circumference were compared at entry and 3 months. Statistical analysis was done using SPSS version 21.Results: The mean ± SD age was 44.77 ± 10.32. The mean body weight decreased by 4.52 ± 1.79 kg (p<0.001), mean waist circumference decreased by 7.85±0.72 cm (p<0.001), mean fasting blood glucose decreased from 10.44±3.52 mmol/L to 6.18±1.02 mmol/L (p<0.001), mean postprandial blood glucose decreased from 16.76±8.26 mmol/L to 8.26±1.66 mmol/L (p<0.001) and mean glycated hemoglobin A1c decreased by 2.38 ± 1.49 % (p<0.001) after 3months of low-carbohydrate diet intervention.Conclusions: The use of a low-carbohydrate diet may effectively produce glycemic control and decrease glycated hemoglobin A1c without medication in newly diagnosed type 2 diabetes mellitus. Additionally, this diet may also help to lower weight and waist circumference in newly diagnosed type 2 diabetes mellitus.

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