Home / Resources / Articles / ADA 81st Symposium: Treatment for Prediabetes and Diabetes Can Be Found at a Grocery Store, Part 2 

ADA 81st Symposium: Treatment for Prediabetes and Diabetes Can Be Found at a Grocery Store, Part 2 

Aug 17, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions

Better food choices can lower the incidence of diabetes and kidney disease, and reduce the need for medications.  

Research from Universidade Federal do Rio Grande do Sul looked at associations between eating patterns and diabetic kidney disease (DKD) in patients with T2D. The cross-sectional study assessed diet by a quantitative food frequency questionnaire. Participants were included if they had T2D, lacked nutritional counseling six months before the study, age >30 years, BMI <40, and sCr <2 mg/dL. Exclusion criteria included UTI, renal disease, severe liver disease, decompensated heart failure, acute illness, and wasting syndrome. Of the 329 patients, about 34% consumed dairy products, fruits, and vegetables. The remaining ate ultra-processed foods (26%), refined carbs, processed meat, and solid fats (31%), and red meat, and sugary beverages (6%) (P<0.001). The ratio for DKD was most significant in the group that ate red meat and sugary drinks (1.29-2.89). Conversely, a lower rate of DKD was found in those who consumed ultra-processed foods (1.10-1.99), refined carbs, processed meat, and solid fats (0.8-1.52), and dairy products, fruits, and vegetables (1, reference pattern). Thus, poor food choices were associated with an increased prevalence of diabetic kidney disease in patients with T2D.  

 

Researchers from OptumLabs conducted a decentralized, single-arm prospective pilot study. They looked at glucose levels of patients with T2D who received meal delivery. Participants were enrolled if they were Level2, wore a continuous glucose monitor (CGM), had seven or more days of CGM data during the eligibility period, and had TIR <70% or GMI >7%. Meals were home-delivered for 28 days, totaling three meals per day. Each meal averaged 500 calories/meal and had <65 g carbs per plate. When including snacks, each meal maxed out at 110 g of carbohydrates. Patients who received meal delivery showed improved average time in the range of 6.5% (p=0.003), average glucose management indicator 0.18% (p=0.025), and average time above range (p=0.004) when compared to the control group. There was no difference between groups in the time below range (p=0.495). Overall, improvements quickly returned to baseline once the meal delivery stopped. Thus, further education and support coupled with meal delivery might prolong improvements in patients with T2D.  

Researchers from Virta Health examined whether telemedicine improved glycemic control in older adults with T2D, leading to a reduction in diabetes medication use. This patient population had an increased risk of mediation-related complications such as hypoglycemia or hyperglycemia. A previous one-year study on Telehealth patients <65 years found a reduced HbA1C (1.3). There was also a reduction in weight (12%), HOMA-IR (28%), and medication use (63%). This study examined the effects of Telehealth on 384 patients with T2D who were >65 years old. Participants maintained ketones between 0.5-3 mmol, consumed <30 grams carbohydrates per day, and ate moderate amounts of protein. Patients self-checked blood glucose levels and imputed the data into a phone application for healthcare providers to review. After one year: the average blood glucose decreased from 149.4 to 128.5 (p<0.0001), and the number of diabetes prescriptions decreased from 1.9 to 1.1 (P<0.0001). At the end of the trial, participants eliminated Sulfonylureas by 84% and insulin by 43%. Among the forty-six patients taking insulin, the average dose significantly decreased from 100 units to 39 units. Hypoglycemia was documented in 33% of the participants, with none requiring assistance.  

Practice Pearls: 

  • The prevalence of diabetic kidney disease was greater in patients with T2D who consumed red meat, sugary beverages, ultra-processed foods, refined carbs, processed meat, and solid fats. Conversely, the prevalence was lower with those that consumed dairy products, fruits, and vegetables.  
  • Patients with T2D saw better glycemic control when given adjunct meal delivery for 28 days. In addition, data showed improved average time in range, average glucose management indicator, and average time above range compared to the control group. 
  • Telemedicine reduced the need for diabetes medications in many elderly patients who had T2D. This finding resulted in a lower incidence of hypoglycemia among the study group.   

 

Chen, G. et al.  (2021, June). Food Is Medicine for People with Diabetes and At-Risk of Diabetes. American Diabetes Association. Copenhagen; Denmark. (Requires ADA Symposium login.) 

 

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions 

 

To see how prescribing vegetables can help patients with diabetes make better food choices, see part 1.