Diabetes Type 1 and 2

DM: Prevention and Treatment of CVD (2007)

• Intervention
  Are there specific nutrition interventions (for at least 1 year) in the prevention of cardiovascular disease in people with diabetes?

  • Conclusion
    Diabetes is associated with an increased risk of complications related to cardiovascular disease.  Nutrition interventions lasting 1 year or more, such as Mediterranean dietary patterns and multifactorial interventions, reduced A1C, blood pressure and body weight and improved serum lipid profile, all of which reduce the risk for the development of cardiovascular disease.
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence supporting specific nutrition interventions (for at least 1 year) in the prevention of cardiovascular disease in people with diabetes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ciccarone E, Di Castelnuovo A, Salcuni M, Siani M, Giacco A, Donati MB, De Gaetano G, Capani F, Iacoviello L, Gendiabe Investigators.  A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes.  J Thromb Haemost 2003;1(8):1744-52.
      • The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986.  
      • Dhindsa P, Scott AR, Donnelly R.  Metabolic and cardiovascular effects of very-low-calorie diet therapy in obese patients with Type 2 diabetes in secondary failure:  outcomes after 1 year.  Diabet Med 2003;20(4):319-24.
      • Diakoumopoulou E, Tentolouris N, Kirlaki E, Perrea D, Kitsou E, Psallas M, Doulgerakis D, Katsilambros N. Plasma homocysteine levels in patients with type 2 diabetes in a Mediterranean population: relation with nutritional and other factors. Nutrition, Metabolism & Cardiovascular Diseases 2005; 15: 109-117.
      • Faulkner MS, Chao W, Kamath SK, Quinn L, Fritschi C, Maggiore JA, Williams RH, Reynolds RD. Total homocysteine, diet, and lipid profiles in type 1 and type 2 diabetic and nondiabetic adolescents. J of Cardiovascular Nursing 2006; 21: 47-55. 
      • Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O.  Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.  N Engl J Med 2003;348(5):383-93.
      • Gill GV, Woodward A, Pradhan S, Wallymahmed M, Groves T, English P, Wilding JP.  Intensified treatment of type 2 diabetes--positive effects on blood pressure, but not glycaemic control.  Q J Med 2003; 96:833-836.
      • Mayer-Davis EJ, Levin S, Marshall JA.  Heterogeneity in associations between macronutrient intake and lipoprotein profile in individuals with type 2 diabetes. Diabetes Care 1999;22:1632-1639.
      • Mukamal KJ, Nesto RW, Cohen MC, Muller JE, Maclure M, Sherwood JB, Mittleman MA.  Impact of diabetes on long-term survival after acute myocardial infarction. Comparability of risk with prior myocardial infarction. Diabetes Care. 2001;24:1422-1427.
      • Orchard TJ, Forrest KY, Kuller LH, Becker DJ.  Lipid and blood pressure treatment goals for type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care. 2001;24:1053-1059.
      • Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Annals of Internal Medicine 2004; 141: 421-431.
      • Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23). BMJ. 1998; 316: 823-828.
  • Search Plan and Results: Prevention of Cardiovascular Disease 2006
     
  Are there specific nutrition interventions in the treatment of cardiovascular disease in people with diabetes?

  • Conclusion
    Twenty-one studies, based on a variety of interventions over different time periods, were evaluated in people with diabetes and cardiovascular disease.  Interventions based on currently accepted guidelines, low-fat diets and the consumption of specific fatty acids, combination drug and diet therapies, Mediterranean diets and reduced sodium diets resulted in improved measures of endothelial health, improved serum lipid profile and reductions in blood pressure.  There is limited research on the effect of high protein diets, low glycemic index diets, phytosterol consumption and vitamin supplements; further research is needed in these areas.   
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence supporting specific nutrition interventions in the treatment of cardiovascular disease in people with diabetes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Didangelos TP, Thanapoulou AK, Bousboulas SH, Sambanis CL, Athyros VG, Spanou EA, Dimitriou KC, Pappas SI, Karamanos BG, Karamitsos DT.  The ORLIstat and CArdiovascular risk profile in patients with metabolic syndrome and type 2 DIAbetes (ORLICARDIA) study.  Current Medical Research and Opinion 2004; 20:1393-1401.
      • Houlihan CA, Casley DJ, Allen TJ, Cooper ME, Baxter AL, Jerums G, Panangiotopoulos S.  a low-sodium diet potentiates the effects of Losartan in type 2 diabetes.  Diabetes Care 2002; 25:663-671.
      • Karantonis HC, Fragopoulou E, Antonopoulou S, Rementzis J, Phenekos C, Demopoulos CA.  Effect of fast-food Mediterranean-type diet on type 2 diabetics and healthy human subjects' platelet aggregation.  Diabetes Research and Clinical Practice 2006; 72:33-41.
      • Krook A, Holm I, Pettersson S, Wallberg-Henriksson H.  Reduction of risk factors following lifestyle modification programme in subjects with type 2 (non-insulin dependent) diabetes mellitus.  Clinical Physiology and Functional Imaging 2003; 23:21-30.
      • Lee YM, Haastert B, Scherbaum W, Hauner H.  A phytosterol-enriched spread improves the lipid profile of subjects with type 2 diabetes mellitus.  Eur J Nutr 2003; 42:111-117.
      • Lonn E, Dagenais G, Yusuf S, Mann JFE, Hoogwerf B, Gerstein HC, Pogue J, Qilong Y, Zinman B, Bosch J.  Effects of vitamin E on cardiovascular and microvascular outcomes in high-risk patients with diabetes: results of the HOPE Study and MICRO-HOPE Substudy.  Diabetes Care 2002; 25:1919-1927.
      • Lovejoy JC, Most MM, Lefevre M, Greenway FL, Rood JC.  Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes.  Am J Clin Nutr 2002; 76:1000-1006.
      • Mantzoros CS, Williams CJ, Manson JE, Meigs JB, Hu FB. Adherence to the Mediterranean dietary pattern is positively associated with plasma adiponectin concentrations in diabetic women. Am J Clin Nutr 2006; 84: 328-335.
      • Mostad IL, Qvigstad E, Bjerve KS, Grill VE.  Effects of a 3-day low-fat diet on metabolic control, insulin sensitivity, lipids, and adipocyte hormones in Norwegian subjects with hypertriacylglycerolaemia and type 2 diabetes.  Scand J Clin Lab Invest 2004; 64:565-574.
      • Neyestani TR, Alipour-Birgani R, Siassi F, Rajayi M, Djalali M, Mohamadi M.  Glycemic optimization may reduce lipid peroxidation independent of weight and blood lipid changes in Type 2 diabetes mellitus.  Diab Nutr Metab 2004; 17:275-279.
      • Osende JI, Badimon JJ, Fuster V, Herson P, Rabito P, Vidhun R, Zaman A, Rodriguez OJ, Lev EI, Rauch U, Heflt G, Fallon JT, Crandall JP.  Blood thrombogenicity in type 2 diabetes mellitus patients is associated with glycemic control.  Journal of the American College of Cardiology 2001; 38:1307-1312.
      • Parker B, Noakes M, Luscombe N, Clifton P. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes.  Diabetes Care 2002;25:425-430.
      • Perassolo MS, Moulin CC, Almeida JC, Camargo JL, Pra RL, Zelmanovitz T, Mello VD, Azevedo MJ, Maia AL, Gross JL.  Fatty acid composition of serum lipid fractions in type 2 diabetic patients with microalbuminuria.  Diabetes Care 2003; 26:613-618.
      • Rizkalla SW, Boillot J, Taghrid L, Rigoir A, Laromiguiere M, Elgrably F, Huet D, Slama G.  Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial.  Diabetes Care 2004; 27:1866-1872.
      • Rodriguez-Villar C, Perez-Heras A, Mercade I, Casals E, Ros E.  Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with type 2 diabetes mellitus.  Diabetic Medicine 2004; 21:142-149.
      • Storm H, Thomsen C, Pedersen E, Rasmussen O, Christiansen C, Hermansen K. Comparison of a carbohydrate-rich diet and diets rich in stearic or palmitic acid in NIDDM patients. Diabetes Care 1997; 20:1807-1813.
      • Tapsell LC, Owen A, Gillen LJ, Bare M, Patch CS, Kennedy M, Betterham M.  Including walnuts in a low-fat/modified-fat diet improves HDL cholesterol-to-total cholesterol ratios in patients with type 2 diabetes.  Diabetes Care 2004; 27:2777-2783.
      • Vedovato M, Lepore G, Coracina A, Dodesini AR, Jori E, Tiengo A, Del Prato S, Trevisan R.  Effect of sodium intake on blood pressure and albuminuria in Type 2 diabetic patients:  the role of insulin resistance.  Diabetologia 2004; 47:300-303. 
      • West SG, Hecker KD, Mustad VA, Nicholson S, Schoemer SL, Wagner P, Hinderliter AL, Ulbrecht J, Ruey P, Kris-Etherton PM. Acute effects of monosaturated fatty acids with and without omega-3 fatty acids on vasular reactivity in individuals with type 2 diabetes. Diabetologia 2005; 48: 113-122.
      • Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM. Effects of the National Cholesterol Education Program’s Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr. 1999;69:632-646.
  • Search Plan and Results: Treatment of Cardiovascular Disease 2006