Effect Of Different Types Of Nuts On Glycemic Control In Patients With Type 2 Diabetes Mellitus

Part 1 Cognitive status of different food categories in patients with type 2 iabetes mellitus and its effect on glycosylated hemoglobinObjectives To understand cognitive status of different food categories in patients with type 2 diabetes mellitus(T2DM),and explore its effect on glycosylated hemoglobin(Hb A1c)with T2 DM patients.Methods Convenient sampling method was adopted.According to the inclusion and exclusion criteria,two hundred forty-nine patients were rescruited from 5 hospitals in Jiangsu,Shanghai and Zhejiang,and the diabetes clubs in Suzhou from October 2014 to October 2015.General Situation Questionnaire was utilized to obtain demographic data including age,sex,degree of education,et al.and clinical data including smooking,diabetes duration,family history of diabetes,et al.The Diabetes Mellitus Dietary Knowledge Scale(DDKS)was used to acquire cognitive status of different types of foods in T2 DM patients.The patients wih Hb A1 c values<6.5% and those with Hb A1 c values?6.5% were considered as the good glycemic control group and the poor glycemic control group,respectively.The factors related to glycemic control were analyzed.Results1.Cognitive status of different food categories in T2 DM patientsThe patients got the highest score in the item ?Foods that have little effect on glycemia?(3.55±1.38)and 25% of them completely answered correct.However,the patients obtained the lowest score in the item ?Foods rich in healthy fat?(1.60±1.57).Only 1.6% patients completely answered correct.2.Factors related to Hb A1 c controlThe average DDKS score of the good glycemic control group was 36.02,which was significantly higher than that of the poor glycemic control group(30.12)(P<0.001).Education level,body mass index(BMI)and clinical treatment were related to Hb A1 c control(P<0.05).The items of DDKS related to glycemic control included the items ?Preferentially chosen meat? [B=-0.618;P<0.01;95%CI(0.374-0.777)],?Preferentially chosen beans or milk? [B=-0.404;P<0.05;95%CI(0.488-0.914)],?Preferentially chosen dietary fiber? [B=-0.409;P < 0.05;95%CI(0.485-0.910)],?Preferentially chosen nuts? [B=-0.690;P<0.001;95%CI(0.357-0.704)] and ?Foods when hungry,not hypoglycemia? [B=-0.518;P<0.001;95%CI(0.450-0.789)].3.Factors associated with Hb A1 c controlAdjusting demographic data(age,gender and education level)and clinical data(BMI,smoking,DM duration,DM family history,complications,concomitant disease,and clinical treatment),the item ?Preferentially chosen nuts?(B=-0.56;P < 0.01;95CI = 0.37-0.87)still influenced Hb A1 c level.Other factors included education level,BMI and clinical treatment(P<0.05).Conclusions T2 DM patients had lower cognitive level of fat foods.Cognitive level of nuts of T2 DM patients could predict glycemic control.The nursing staff should strengthen healthy education about fat foods,especially,foods rich in healthy fat.Part 2 Effect of different types of nuts on glycemic control in patients with ype 2 diabetes mellitusObjectives To explore the effects of different types of nuts on blood glucose,blood lipids,body mass index(BMI)and inflammation in patients with type 2 diabetes mellitus(T2DM).Methods This study was a prospective,single blind and randomized controlled trial.Convenient sampling method was adopted.According to the inclusion and exclusion criteria,T2 DM patients were rescruited from the First Affiliated Hospital of Soochow University and the diabetes clubs in Suzhou from December 2015 to August 2016.Based on allocation concealment,patients were randomly assigned to peanut group(N=15)and almond group(N=17).In peanut group,male and female patients consumed peanut 60g/d and 50g/d,respectively;in almond group,male and female patients consumed almond 55g/d and 45g/d,respectively,for three months.Before the intervention,1 week was washout period.All patients received scheduled telephone visits(once/week).When patients were recruited,two groups received the education of low carbohydrate diet by one-to-one.Compliance of edible nuts,fasting plasma glucose(FPG),postprandial blood glucose,glycosylated hemoglobin(Hb A1c),the incidence of hypoglycemia,BMI,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),interleukin-6(IL-6)and urinary albumin –creatinine(ACR)were collected and compared at baseline as well as 3-month.Results During 3 months,4 cases in peanut group and 3 cases in almond group were removed respectively.Finally,there were 11 in the peanut group and 14 in the almond group.1.Compliance of edible nutsThere were no significant differences between the two groups in the frequency of consuming nuts per week and the total amount of nuts consumed during 3 months(P> 0.05).2.Effect nuts on glycemic controlFPGFPG trend of the two groups showed that FPG among first week and third week decreased significantly in almond group and then fluctuated in the level of glucose of third week.FPG firmly decreased and FPG of tenth week went minimal in peanut group.FPG before and after intervention were compared between the two groups respectively.At 3 months,the results showed that the values of FPG in two groups were lower than baseline(P<0.05).Postprandial blood glucoseDuring the intervention,the postprandial 2h blood glucose fluctuated in the two groups,and the fluctuation of postprandial 2h blood glucose in peanut group was higher than that of almond group.There were no significant changes in postprandial 2h blood glucose values before and after intervention in the two groups.Hb A1c(1)At 3 months,Hb A1 c levels of two groups decreased,but there was no significant difference between two groups(P>0.05).The comparison of the mean difference of Hb A1 c levels before and after intervention between the two groups showed that the level of Hb A1 c in almond group was significantly lower than that of the peanut group(P<0.05).(2)At 3 months,the level of Hb A1 c in Almond group was significantly lower than that at baseline(P<0.01).However,there was no significant change in the level of Hb A1 c before and after intervention in peanut group(P>0.05).(3)The intention-to-treat analysis showed that the results were consistent with these of the prior analysis.The incidence of hypoglycemiaThere were 2 patients(18.2%)who suffered hypoglycemia in peanut group and no patients experienced it in almond group among 3 months before intervention.During the 3 months intervention,the incidence of hypoglycemia was not found in the peanut group,but 1 patient(7.1%)occurred in the almond group.There were all no significant differences.3.Effect nuts on BMI and blood lipidThere were no significant differences between the two groups and the mean differences before and after intervention between the two groups about BMI and blood lipid index(P>0.05).Compared with baseline,BMI in almond group significantly decreased(P<0.01),but there was no difference in BMI of the peanut group(P>0.05).4.Effect nuts on IL-6After 3 months intervention,there was no significant difference in IL-6 between the two groups(P>0.05).The mean differences before and after intervention between the two groups were compared.The result showed that the mean difference of IL-6 in peanut group was significantly greater than that of almond group(P<0.05).5.Effect nuts on ACRThere were no significant differences between the two groups and the mean differences before and after intervention between the two groups about ACR(P>0.05).ConclusionsTwo different types of nuts can improve FPG.And consuming almonds can be conducive to stability of long-term blood glucose and improve BMI of T2 DM patients.Therefore,it is recommended that obese patients with unstable blood glucose can moderately consume almonds.Peanuts are good for the patients with the poor FPG and high expression of inflammatory factors.These can be used as adjuvant therapy for T2 DM patients.