Korean J Nutr.  2010 Feb;43(1):46-56. 10.4163/kjn.2010.43.1.46.

Effects of Low Glycemic Index Nutrition Education on the Blood Glucose Control in Patients with Type 2 Diabetes Mellitus

• Kim MJ
• Kwon S
• Ly SY

• KMID: 2267963
• DOI: http://doi.org/10.4163/kjn.2010.43.1.46

Abstract

This study was intended to assess the effects of low glycemic index (LGI) nutrition education on dietary management and glycemic control of patients with type 2 diabetes mellitus. The subjects were 48 sex-matched patients with type 2 diabetes mellitus, aged 66.5 +/- 6.2 years, visiting a public health center. They were divided into two groups: the control group (males 10, females 14) and the educated group (males 10, females 14). The educated group was provided with a LGI nutrition education program for 7 weeks. The control group was educated only one time for general diabetic education. Anthropometric indices, knowledge and perception of efficacy of low glycemic index carbohydrates, dietary glycemic index (DGI) and glycemic load (DGL), fasting blood glucose, and HbA1c were assessed. In the educated group body weight, body mass index and systolic blood pressure (from 138.0 +/- 18.9 mmHg to 130.6 +/- 15.0 mmHg) were significantly reduced after the nutrition education (p < 0.05). The scores of knowledge and perception of efficacy of low glycemic index carbohydrates increased significantly in the educated group. Dietary glycemic index and glycemic load of the educated group decreased significantly from 103.4 +/- 67.6 to 45.4 +/- 27.1 (p < 0.001), and from 173.3 +/- 135.9 to 66.8 +/- 50.4 (p < 0.001), respectively. Also fasting blood glucose and HbA1c levels of the educated group significantly decreased from 124.5 +/- 28.8 mg/dL to 96.7 +/- 21.6 mg/dL (p < 0.001) and from 7.1 +/- 1.3% to 6.4 +/- 1.2% (p < 0.05), respectively. The score of knowledge and perception of efficacy of low glycemic index significantly correlated with fasting blood glucose and HbA1c levels negatively. DGI, DGL and duration of diabetes significantly correlated with HbA1c level positively. From stepwise multiple linear regression analysis, DGI, DGL and the duration of diabetes were extracted as factors influencing HbA1c level of the subjects. The results of this study suggest that low glycemic index nutrition education programs is an effective intervention measure for the glycemic control in type 2 diabetic patients.

Keyword

diabetes mellitus; low glycemic index nutrition education; dietary glycemic index; dietary glycemic load; HbA1c

MeSH Terms

Aged
Blood Glucose
Blood Pressure
Body Mass Index
Body Weight
Carbohydrates
Diabetes Mellitus
Diabetes Mellitus, Type 2
Dietary Carbohydrates
Fasting
Female
Glycemic Index
Humans
Linear Models
Public Health
Blood Glucose
Carbohydrates
Dietary Carbohydrates

Reference

1. Korea Centers for Disease Control and Prevention. In-Depth Analysis on the 3rd (2005) Korea Health and Nutrition Examination Survey-Nutrition Survey-. 2007.

2. Park GS, Ly SY. Compliance and need assessment for diet Therapy among diabetics and their caregivers. Korean J Community Nutr. 2003. 8(1):91–101.

3. Kim JH. Effect of education on knowledge, attitude and behavior about dietary therapy and blood glucose control in type 2 diabetic patients[master thesis]. 2002. Daegu: Keimyung University.

4. Jenkins DJA, Leeds AR, Gassull MA, Wolever TMS, Goff DV, Alberti KGMM, Hockaday TDR. Unabsorbable carbohydrates and diabetes: Decreased post-prandial hyperglycemia. Lancet. 1976. 2(7978):172–174.

5. Yunsheng Ma, Olendzki B, Chiriboga D, Hebert JR, Youfu Li, Wenjun Li, Campbell MJ, Gendreau K, Ockene IS. Association between dietary carbohydrates and body weight. Am J Epidemiol. 2005. 161:359–367.

6. Murakami K, Sasaki S, Okubo H, Takahashi Y, Hosoi Y, Itabashi M. Dietary fiber index: a cross-sectional study of 3931 Japanese women aged 18-20 years. Eur J Clin Nutr. 2007. 61(8):986–995.

7. Jenkins DJ, Wolever TM, Taylor RH, Barkder H, Fielden H, Baldwin JM. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981. 34(3):362–366.

8. Roberts SB. High glycemic index foods, hunger and obesity: Is there a connection? Nutr Rev. 2000. 58:163–169.

9. Tan KCB, Chow WS, Tam SCF. Atrovastatin lower C-reactive protein and improves endothelium-dependent vasodilation in type 2 DM. J Clin Endocrinology and Metabolism. 2002. 87(2):563–568.

10. Willett W, Manson J, Lui S. Glyemic index, glycemic load, and risk of type 2 Diabetes. Am J Clin Nutr. 2002. 76(1):274S–280S.

11. Yoon SK, Kim MA. Glycemic responses of Korean domestic meals and diabetic meals in normal subjects. J Korean Soc Food Sci Nutr. 1998. 11(3):303–311.

12. Lee C, Shin JS. Effects of different fiber content of rice on blood glucose and triglyceride levels in normal subject. J Korean Soc Food Sci Nutr. 2002. 31(6):1048–1051.

13. Lee JS, Lee JS, Yang CB, Shin HK. Blood glucose response to some cereals and determination of their glycemic index to rice as the standard food. Korean J Nutr. 1997. 30:1170–1179.

14. Sahyuun NR, Anderson AL, Kanaya AM, Koh-Banerjee P, Kritchevsky SB, de Rekeneire N, Tylavsky FA, Schwartz AV, Lee JS, Harris TB. Dietary glycemic index and load, measures of glucose metabolism and body fat distribution in older adults. Am J Clin Nutr. 2005. 82(3):547–552.

15. Du H, Van der ADL, Feskens EJ. Dietary glycaemic index: a review of the physiological mechanical mechanism and observed health impacts. Acta Cardiol. 2006. 61:383–397.

16. Korea Diabetes Association. Guidelines of diabetes education. 2006.

17. Son SM, Kim MJ. The effect of nutrition education program for various chronic disease in elderly visiting public health center. Korean J Nutr. 2001. 6(4):668–677.

18. Lee HJ, Yoon JS. Analysis of dietary behavior of type 2 diabetic visiting Public Health Center. J Korean Diet Assoc. 2005. 11(2):223–232.

19. Burani J, Longo PJ. Low-glycemic index carbohydrates: an effective behavioral change for glycemic control and weight management in patients with type 1 and 2 diabetes. The Diabetes Educator. 2006. 32:78–88.

20. www.gitest.co.kr.

21. Foster-Powell K, Holt SHA, Brand-Miler JC. International table of glycemic index and glycemic load values. Am J Clin Nutr. 2002. 76:5–56.

22. Lee SL. GI (Glycemic Index). Korean Clin Diabetes. 2006. 7(2):155–159.

23. Wolever TM, Jenkins DJ, Jenkins AL, Josse RG. The glycemic index: methodology and clinical implications. Am J Clin Nutr. 1991. 54(5):846–854.

24. Wolever TM, Nguyen PM, Chiasson JL, Hunt JA, Josse RG, Palmason C, Rodger NW, Ross SA, Ryan EA, Tan MH. Determinants of diet glycemic index calculated retrospectively from diet records of 342 individuals with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1994. 59(6):1265–1269.

25. Chai HJ, Hong HO, Kim HS, Lee JS, Yu CH. Relationship between food intakes, glycemic index, glycemic load, and body weight among high school boys in Seoul. Korean J Nutr. 2008. 41(7):645–657.

26. Kim EK, Lee JS, Hong HO, Yu DH. Association between glycemic index glycemic load, dietary carbohydrates and diabetes from Korean National Health and Nutrition Survey 2005. Korean J Nutr. 2009. 42(7):622–630.

27. Shin YS, Kim OY, Lee HK. Risk factors for non-insulin dependent diabetes mellitus. J Korean Diabetes Assoc. 1996. 20:14–24.

28. Ministry for health, welfare and family affairs. The third Korea national health and nutrition examination survey (2005)-nutrition survey-. 2006.

29. www.kosso.or.kr.

30. Davis JN, Alexander KE, Ventura EE, Kelly LA, Lane CJ, Byrd-Williams CE, Toledo-Corral CM, Robers CK, Spruijt-Metz D, Weigensberg MJ, Goran MI. Associations of dietary sugar and glycemic index with adiposity and insulin dynamice in overweight Lation youth. Am J Clin Nutr. 2007. 86:1331–1339.

31. Kim TY, UM SH. Older adults with type 2 diabetes improve glycemic control after nutrition education program at the public health center. J Korean Diet Assoc. 2004. 10(2):205–217.

32. Yim KS, Min YH, Lee TY. Evaluations of the elderly nutrition improvement program in the Community Health Center: effects of nutrition counseling and education program on elderly dietary behavior. J Korean Diet Assoc. 1997. 3(2):197–210.

33. American Diabetes Association. The prevention of delay of type 2 diabetes. Diabetes Care. 2003. 26:62–69.

34. Rosner BA, Speizer FE, Manson JE. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women: the Nurses' Health Study. Am J Epidemiol. 1997. 145:614–619.

35. Kelley DE. Managing obesity as first-line therapy for diabetes mellitus. Nutr Clin Care. 1998. 1:38–43.

36. Ludwig DS. Dietary glycemic index and obesity. J Nutr. 2000. 130:2S Suppl. 280S–300S.

37. Spieth LE, Harnish JD, Lenders CM, Raezer LB, Pereia MA, Hangen SJ, Ludwig DS. A low-glycemic index diet in the treatment of pediatric obesity. Arch Pediatr Adolesc Med. 2000. 154(9):947–951.

38. Matti U. The maintenance of improved metabolic control after intensified diet therapy in recent type 2 Diabetes. Diabetes Res Clin Pract. 1993. 19(3):227–238.

39. Moon SJ, Sohn CY, Kim HS, Lim HS, Lee HC, Huh KB. Measurement of nutrition counseling effects for diabetes mellitus patients. Korean J Nutr. 1994. 27(10):1070–1077.

40. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2008. 31:Suppl 1. 12–54.

41. Kim ES, Lee SJ, Ryu OH, Lee JY, Yun HS, Choi MJ. The relationship of family support with blood glucose control in elderly type 2 diabetic patients. Korean Clin Diabetes. 2007. 31(5):435–443.

42. Lee SL, Kim YL, Lee SJ, Cho YK, Choi YK, Chun CH, Chang YK. Effects of diabetes education on diabetic management in non-insulin-dependent diabetes mellitus patients. J Korean Diet Assoc. 2004. 10(3):300–308.

43. Lee HJ, Yoon JS. Analysis of dietary behavior of type 2 diabetic patients visiting public health center. J Korean Diet Assoc. 2005. 11(2):223–232.