Lifestyle advice follow-up improves dietary consumption and cardiometabolic risk in type 2 diabetes patients treated with oral antidiabetics

Abstract

The lifestyle intervention is one of the most effective therapeutic options for improving glycemic control and reducing cardiovascular risk factors in patients with type 2 diabetes (T2D). The aim of this study was to investigate if monitoring of lifestyle advices could improve glycemic control and atheroma ratios in T2D patients treated with oral anti diabetics (OAD). Patients ( n = 85, sex ratio F/M, 40/45) aged 50 ± 8 years, with T2D since 9 ± 3 years and initially treated with oral anti diabetics during 8 ± 1 years, were recruited. At the beginning of the study (d0), nutritional advices (i.e. consumption of fish, fruits and vegetables diet, with 250 g of carbohydrates distributed over daily different meals) associated to 30 to 45 min walking per day, were recommended, with a follow-up at 3 (d90) and 6 months (d180). The 24-hour recall, followed by a 3-days record, and daily energy expenditure (DEE) questionnaire were realized. Serum glucose and glycated hemoglobin (HbA 1c ) were measured. Serum insulin was determined by ELISA and homeostatic model assessment insulin resistance (HOMA-IR) index was calculated. Serum total cholesterol (TC), HDL-C and triglycerides (TG) levels were measured by enzymatic colorimetric tests. Apolipoproteins Apo A-1 and Apo B level were analyzed by immuno-turbidimetric test. A significant increase of total energy intake (TEI) (MJ/24 h) was noted in T2D, at d90 and d180, compared to d0 ( P < 0.05). A negative balance (TEI-EE) was noted at d0 (−0.75 MJ),andd90 (−1.42 MJ/24 h) of lifestyle advices follow-up, whereas, a positive balance (+0.42 MJ/24 h)was observed atd180. There was no significant difference in carbohydrate intake distribution between the different meals, over the time. Compared to d0, serum glucose concentration, and HbA 1c value were reduced respectively by 19% and 35%at d90, and by 12% and 14%, at d180. Plasma insulin and HOMA-IR remained unchanged. Serum TG concentrations decreased by 36% at d90 vs. d0, and serum TC levels were lowered by 16% and 26%, at d90 and d180 respectively compared to d0. TC/HDL-C and Apo A-I/ApoB100 ratios were respectively reduced by 32% and 49% at d90, and by 57% and 68%, at d180 compared with d0. The six-month follow-up of dietary advice, associated with regular physical activity by T2D patients, improves their food consumption, HbA 1c as well as atheroma risk.