Scientific Basis for Information on Diabetes Treatment
Limiting Salt Intake
Probably, when some people hear the word diabetes, they think of restricting sugar.
In order to manage blood sugar levels, salt intake is sometimes restricted, but is there any evidence for this management or approach? The following is the result of a research paper.
What is the study?
From a Cochrane review in 2010.
Thirteen studies (254 people) were selected, these included 75 people with type 1 diabetes and 158 people with type 2 diabetes.
The median decrease in urinary sodium was
203 mmol/24 hours (11.9 g/day) for type 1 diabetes, and
The median decrease in urinary sodium was 203 mmol/24 hours (11.9 g/day) for type 1 diabetes and 125 mmol/24 hours (7.3 g/day) for type 2 diabetes.
The median duration of salt restriction was 1 week for both type 1 and type 2 diabetes. Blood pressure was reduced in both type 1 and type 2 diabetes mellitus.
In type 1 diabetes (56 patients), salt restriction reduced blood pressure by -7.11 / -3.13 mm Hg (systolic / diastolic). (95% CI: systolic blood pressure (SBP) -9.13 to -5.10; diastolic blood pressure (DBP) -4.28 to -1.98)
In type 2 diabetes (56 patients), salt restriction reduced BP by -6.90 / -2.87 mm Hg. (95% CI: SBP -9.84 to -3.95; DBP -4.39 to -1.35)
Blood pressure was substantially lower in normotensive patients.
Conclusions.
Although the study is not extensive, this meta-analysis shows a significant reduction in blood pressure with salt restriction as well as with monotherapy. All diabetic patients should consider reducing their salt intake to at least less than 5-6 g/day in line with current recommendations for the general population, and may consider lowering their salt intake to lower levels, although further research is needed.
Parenting RJ, He FJ, MacGregor GA. Modification of dietary salt intake for the prevention and treatment of diabetic kidney disease Cochrane Database of Systematic Reviews 2010, No. 12. Number: CD006763 DOI: 10.1002 / 14651858.CD006763.pub2.
Psychological Interventions to Relieve Distress in Diabetes
I have heard that the treatment of type 2 diabetes is often painful.
It is easy to imagine how difficult it is to manage food, control blood sugar levels, and treat complications from other diseases. I would like to introduce the evidence of psychological interventions for these pains. The following is an introduction to the evidence.
The study
We identified 30 RCTs with 9177 participants.
The median duration of the interventions was 6 months (ranging from 1 week to 24 months) and the median follow-up was 12 months (ranging from 0 to 12 months).
A meta-analysis of all psychological interventions combined with usual care did not show a robust impact on DRD. There was a small beneficial effect on self-efficacy and HbA1c at mid-term follow-up (6 to 12 months).
No diabetes-related complications or socioeconomic effects were reported in the selected trials.
Conclusion.
The low-quality evidence showed that none of the psychological interventions improved DRD more than usual care. Low quality evidence can be used to improve self-efficacy and HbA1c after psychological interventions. This means that there is uncertainty about the impact of psychological interventions on these outcomes. However, psychological interventions will probably have no substantial adverse events compared to usual care. More high-quality research is needed in non-U.S. and non-European settings, and in low- and middle-income countries, using emotion-focused programs.
Chew BH, Vos RC, Metzendorf MI, Scholten RJPM, Rutten GEHM. psychological interventions for diabetes-related distress in adults with type 2 diabetes. cochrane Database of Systematic Reviews 2017, Issue 9. art. . No.: CD011469. doi: 10.1002 / 14651858.CD011469.pub2.
Phototherapy to treat foot ulcers in diabetics
Study Description
Eight studies with 316 participants met the selection criteria.
Most of the included studies were single-center studies conducted in clinics or hospitals with sample sizes ranging from 14 to 84. We did not identify any studies that reported valid data until wound healing was complete.
A meta-analysis of four studies that included 116 participants showed that participants receiving phototherapy had a higher percentage of wounds that healed completely during follow-up compared to those not receiving phototherapy/placebo.
Four studies reported changes in ulcer size, but they were not combined, primarily due to high heterogeneity. In general, after 2-4 weeks of treatment, phototherapy may significantly reduce ulcer size, but the small sample size suggested that the quality of evidence was low due to an unclear risk of bias in the original study.
Conclusion.
This systematic review of randomized trials suggested that phototherapy may reduce wound size in diabetic patients by increasing the proportion of wounds that healed completely during follow-up when compared to no phototherapy/placebo, but there was no evidence that phototherapy improved quality of life. There was no evidence that phototherapy improved quality of life. The small sample size and methodological flaws in the original study resulted in a low quality of evidence and reduced confidence in these results. Large, well-designed, randomized controlled trials are needed to confirm whether phototherapy can be an effective option for treating foot ulcers in diabetic patients.
Wang HT, Yuan JQ, Zhang B, Dong ML, Mao C, Hu D. Phototherapy for treating foot ulcers in diabetic patients.Cochrane Database of Systematic Reviews 2017, Issue 6. art. No.: CD011979. doi: 10.1002 / 14651858.CD011979.pub2.
Probiotics to Prevent Gestational Diabetes
Gestational diabetes mellitus is a disease in which the mother develops hyperglycemia after 13 weeks of pregnancy.GDM is different from type 2 diabetes in that blood glucose levels are normal before pregnancy and usually return to normal after pregnancy, but there is a potential for an increased risk of developing type 2 diabetes later in life. Women with gestational diabetes are at increased risk for proteinuria in the urine (preeclampsia), high blood pressure during delivery and cesarean section, and infants are more likely to be born larger in weeks.
Probiotics are "good" bacteria, usually taken in the form of capsules or drinks, that add to the bacteria in our gut, but also keep us healthy by regulating our immune system and protecting us from disease-causing bacteria. It is believed that probiotics can alter a person's metabolism and may play a role in preventing gestational diabetes.
Research has shown that.
Low-quality evidence from six trials does not clearly identify the effect of probiotics on the risk of GDM. And the high quality evidence suggests that probiotics may increase the risk of preeclampsia. Thus, there is now evidence that there may be little observed benefit to widespread use of probiotics during pregnancy, and that they cause harm. There are eight ongoing studies that may help to better define the effects of probiotics. Further investigation of the relationship between probiotics and preeclampsia is also stated to be important.
Davidson SJ, Barrett HL, Price SA, Callaway LK, Dekker Nitert M. Probiotics for preventing gestational diabetes. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No.: CD009951. DOI: 10.1002/14651858.CD009951.pub3.
Chinese Herbal Medicine for the Treatment of Diabetic Complications
Study details
49 randomized trials with 3639 participants were included.
All trials were conducted and published in China. Thirty-eight different herbal medicines were tested, including four single herbs, eight traditional Chinese patent medicines, and 26 self-formulated Chinese herbal combination formulas.
General improvement in symptoms and changes in nerve conduction velocity were reported.
Conclusion
Based on this systematic review, there is no evidence to support the objective efficacy and safety of Chinese herbal medicines for diabetic peripheral neuropathy. Properly designed randomized placebo-controlled trials with objective outcome measures have not been conducted.
Chen W, Zhang Y, Li X, Yang G, Li JP. Chinese herbal medicine for diabetic peripheral neuropathy. Cochrane Database of Systematic Reviews 2013, Issue 10. art. No.: CD007796. doi: 10.1002 / 14651858.CD007796.pub3.
Management of diabetes mellitus in pregnancy
Study Description
A total of 12 studies (944) were included in this update of the review, in which women
Type 1 diabetes: 660 women
Type 2 diabetes: 113 women
Type 1 or 2 (unspecified): 171 women were included.
Continuous glucose monitoring (CGM) versus intermittent glucose monitoring (4 studies, 609 women)
CGM may reduce gestational hypertension.
This did not lead to a clear reduction in preeclampsia.
CGM appears to reduce neonatal hypoglycemia.
No neurosensory disturbances have been reported.
Other methods of glucose monitoring
The following five comparisons, between
Self-monitoring versus different types of self-monitoring (two studies, 43 women)
Self-monitoring at home versus hospitalization (1 study, 100 women)
Preprandial and postprandial glucose monitoring (1 study, 61 women)
Automated telemedicine monitoring versus conventional systems (3 studies, 84 women)
Constant CGM versus intermittent CGM (1 study, 25 women)
It is unclear whether any of the interventions affect the grade outcomes (hypertensive disorders of pregnancy, cesarean section, age at conception) were found to be very low. There was not enough evidence to assess the combined perinatal and neonatal mortality and morbidity.
No other important outcomes such as neurosensory impairment were reported in these comparisons.
Conclusion.
Two new studies (406 women) have been incorporated into one of the comparisons in this update. Evidence suggests that CGM compared with intermittent glucose monitoring may reduce hypertensive disorders of pregnancy, but this did not lead to a clear reduction in preeclampsia, so this result should be viewed with caution. There was no evidence of differences in the other main results of this comparison. The evidence base for the effectiveness of the other monitoring techniques analyzed in the other five comparisons is weak and based on a single study containing primarily very low quality evidence. Additional evidence from large, well-designed randomized trials is needed to inform the choice of other glucose monitoring techniques and to confirm the effectiveness of CGM.
Jones LV, Ray A, Moy FM, Buckley BS. Technology to monitor blood glucose levels during pregnancy in women with existing diabetes. Cochrane Database of Systematic Reviews 2019, No. 5. Number: CD009613. doi: 10.1002 / 14651858.CD009613.pub4.
