Glycaemic control: The role of nutritional intake, postprandial glycaemia, nutrition therapy adherence, and diabetes complications

摘要

This thesis analysed the associations between several clinical and psychometric variables that can determine glycaemic control: nutritional intake, barriers to nutrition therapy adherence, postprandial glycaemia, and diabetes complications perception.A group of 66 patients previously diagnosed with type 2 diabetes mellitus was recruited and categorized into patients with HbA1c below 7% (proper glycaemic control) and patients with HbA1c of 7% or above (poor glycaemic control).All subjects were interviewed and offered a nutritionally controlled breakfast. The glucose response to the experimental breakfast was monitored for 120 minutes after the meal, in order to record postprandial glycaemia levelsThe results show that subjects with adequate glycaemic control have a better compliance of nutrition recommendations, but all patients have excess intakes of energy, total cholesterol, saturated fatty acids, and sugars.There are no significant differences in postprandial glycaemia between patients with adequate glycaemic control and those with poor glycaemic control, which may imply that some subjects are unaware that they exceed the recommended rise in postprandial glucose, and thus may be at a higher than expected risk for macro and microvascular events. As self-monitoring is the only practical way to detect postprandial hyperglycaemia, efforts should be made to promote regular glucose self-monitoring.Patients with poor glycaemic control have a more biased opinion of their likelihood of personal disease risk. Additionally, exposures such as medical tests, air pollution, pesticides, or household chemicals, are considered as likely to cause health problems as several known and common diabetes complications, like high blood pressure or cardiovascular disease. Younger age, high body mass index, and biased personal disease risk perceptions are important predictors of glycaemic control and should be addressed by education interventions.Health professionals need to consider specific patient characteristics in order to provide proper continued medical care, and nutrition education should be tailored to the perceptions of patients and should positively discriminate subjects above or below the internationally proposed HbA1c cut-points for glycaemic control.