The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study

Penelitian ini menunjukkan prevalensi defisiensi vitaminB₁₂ pada pasien diabetes tipe 2, terutama yang mendapatkan metformin. Perlu suplementasi multivitamin untuk mengatasi hal ini. 

 

The Journal of the American Board of Family Medicine September-October 2009 22 (5): 528-534 (2009) © 2009 American Board of Family Medicine
The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study. Matthew C. Pflipsen, MD, Robert C. Oh, MD, MPH, Aaron Saguil, MD, MPH, Dean A. Seehusen, MD, MPH, FAAFP and Richard Topolski, PhD.

 

Purpose: The purpose of this study is to define the prevalence of vitamin B₁₂ deficiency in a type 2 diabetic population within a primary care practice. Metformin use and advanced age are associated with vitamin B₁₂ deficiency and often present in type 2 diabetic patients, yet the prevalence of vitamin B₁₂ deficiency in the diabetic population is unknown.

Methods: We conducted a cross-sectional study of 203 outpatient type 2 diabetic patients at a large military primary care clinic. Patients completed a survey and had B₁₂ levels measured. Patients with borderline B₁₂ levels also had methylmalonic acid and homocysteine levels drawn. Serum B₁₂ levels <100 pg/mL or serum B₁₂ levels of 100 to 350 pg/mL with elevation of serum methylmalonic acid >243 nmol/L or homocysteine >11.9 nmol/L defined B₁₂ deficiency. Descriptive statistics described frequency and means. ² and student's t tests were used to analyze associations between categorical and continuous variables, respectively. Multivariate logistical regression identified covariates independently associated with B₁₂ deficiency.

Results: Twenty-two percent (n = 44) of diabetic patients had metabolically confirmed B₁₂ deficiency. Patients on metformin had lower serum B₁₂ levels (425.99 pg/mL vs 527.49 pg/mL; P = .012) and were at increased risk for B₁₂ deficiency (P = .04), as defined by a serum B₁₂ level <350 pg/mL. Prevalence of B₁₂ deficiency was significantly lower for patients using a multivitamin (odds ratio, 0.31; 95% CI, 0.15–0.63).

Conclusions: Our results found a 22% prevalence of metabolically confirmed B₁₂ deficiency in the primary care type 2 diabetic population. Although further research needs to be performed to determine the clinical implications of our findings, B₁₂ deficiency should be considered in type 2 diabetic patients, especially those taking metformin. Furthermore, a daily multivitamin may protect against B₁₂ deficiency.

Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Studi randomized ini membandingkan antara efek diet low-carbohydrate Mediterranean-style (LC) dengan diet low-fat  (LF) untuk orang2 yang baru terdiagnosis DM tipe 2. Setelah 4 tahun pasien yang menjalankan diet  LC 44% perlu obat antihiperglikemia, sedangkan pasien yang menjalankan diet LF 70% perlu obat antihiperglikemia (absolute difference, –26.0 percentage points [95% CI, –31.1 to –20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001).  Pasien yang menjalankan diet LC juga mengalami penurunan BB lebih besar dan mengalami perbaikan kontrol glikemik sera risiko koroner yang lebih rendah dibandingkan yang menjalankan diet LF. 

Satu lagi bukti bahwa diet rendah karbohidrat (Mediterrania style) lebih unggul dibandingkan diet rendah lemak.

Annals of Internal Medicine 151(5):306-314, 1 September 2009 © 2009 to the American College of Physicians
Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes-A Randomized Trial. Katherine Esposito, Maria Ida Maiorino, Miryam Ciotola, et al.

Background: Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes.

Objective: To compare the effects of a low-carbohydrate Mediterranean-style or a low-fat diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.

Design: Single-center, randomized trial. Randomization was computer-generated and unstratified. Allocation was concealed in sealed study folders held in a central, secure location until participants gave informed consent. Participants and investigators were aware of treatment assignment, and assessors of the primary outcome were blinded.

Setting: Teaching hospital in Naples, Italy.

Patients: 215 overweight people with newly diagnosed type 2 diabetes who were never treated with antihyperglycemic drugs and had hemoglobin A_1c (HbA_1c) levels less than 11%.

Intervention: Mediterranean-style diet (<50% of daily calories from carbohydrates) (n = 108) or a low-fat diet (<30% of daily calories from fat) (n = 107).

Measurements: Start of antihyperglycemic drug therapy, defined by protocol as indicated for follow-up HbA_1c level greater than 7% (primary outcome), and changes in weight, glycemic control, and coronary risk factors (secondary outcomes).

Results: After 4 years, 44% of patients in the Mediterranean-style diet group and 70% in the low-fat diet group required treatment (absolute difference, –26.0 percentage points [95% CI, –31.1 to –20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet.

Limitations: Investigators responsible for initiating drug therapy were not blinded to treatment assignment. Dietary intake was self-reported.

Conclusion: Compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes.

Cinnamon dapat menurunkan kadar HbA1C pasien DM tipe 2

Satu gram cinnamon (kayu manis) setiap hari dapat menurunkan kadar HbA1C pada pasien dengan diabetes tipe 2. Temuan ini dibuktikan dalam penelitian dengan desain randomized controlled trial.

The Journal of the American Board of Family Medicine September-October 22 (5): 507-512 (2009) ©
Effectiveness of Cinnamon for Lowering Hemoglobin A1C in Patients with Type 2 Diabetes: A Randomized, Controlled Trial. Paul Crawford, MD.

Original Research

Effectiveness of Cinnamon for Lowering Hemoglobin A1C in Patients with Type 2 Diabetes: A Randomized, Controlled Trial

Paul Crawford, MD

From the Nellis Family Medicine Residency, Mike O'Callaghan Federal Hospital, Las Vegas, NV

Correspondence: Corresponding author: Paul Crawford, MD, Assistant Residency Director, Nellis Family Medicine Residency, Mike O'Callaghan Federal Hospital, 4700 Las Vegas Blvd N, Las Vegas, NV 89191 (E-mail: paul.crawford@nellis.af.mil )

Purpose: Multiple trials in the past have shown conflicting results of whether cinnamon lowers glucose or hemoglobin A1C (HbA1C). The purpose of this study was to determine whether cinnamon lowers HbA1C in patients with type 2 diabetes. I performed a randomized, controlled trial to evaluate whether daily cinnamon plus usual care versus usual care alone lowers HbA1c.

Methods: I randomized 109 type 2 diabetics (HbA1C >7.0) from 3 primary care clinics caring for pediatric, adult, and geriatric patients at a United States military base. Participants were randomly allocated to either usual care with management changes by their primary care physician or usual care with management changes plus cinnamon capsules, 1g daily for 90 days. HbA1c was drawn at baseline and 90 days and compared with intention-to-treat analysis. This study was approved by an institutional review board.

Results: Cinnamon lowered HbA1C 0.83% (95% CI, 0.46–1.20) compared with usual care alone lowering HbA1C 0.37% (95% CI, 0.15–0.59).

Conclusions: Taking cinnamon could be useful for lowering serum HbA1C in type 2 diabetics with HbA1C >7.0 in addition to usual care.

Soluble or insoluble fibre in irritable bowel syndrome in primary care?

Serat larut atau tak larut untuk pasien dengan irritable bowel syndrome Penelitian ini membuktikan serat larut (psilium) lebih baik bagi pasien irritable bowel syndrome   Published 27 August 2009, doi:10.1136/bmj.b3154 Cite this as: BMJ 2009;339:b3154 Research Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial C J Bijkerk, general practitioner1, N J de Wit, associate professor of general practice1, J W M Muris, associate professor of general practice2, P J Whorwell, professor of medicine and gastroenterology3, J A Knottnerus, professor of general practice2, A W Hoes, professor of clinical epidemiology and general practice1 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands, 2 Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, Netherlands, 3 Department of Medicine and Gastroenterology, University of Manchester, Manchester, M23 9LT Objective To determine the effectiveness of increasing the dietary content of soluble fibre (psyllium) or insoluble fibre (bran) in patients with irritable bowel syndrome. Design Randomised controlled trial. Setting General practice. Participants 275 patients aged 18-65 years with irritable bowel syndrome. Interventions 12 weeks of treatment with 10 g psyllium (n=85), 10 g bran (n=97), or 10 g placebo (rice flour) (n=93). Main outcome measures The primary end point was adequate symptom relief during at least two weeks in the previous month, analysed after one, two, and three months of treatment to assess both short term and sustained effectiveness. Secondary end points included irritable bowel syndrome symptom severity score, severity of abdominal pain, and irritable bowel syndrome quality of life scale. Results The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month (57% v 35%; relative risk 1.60, 95% confidence interval 1.13 to 2.26) and the second month of treatment (59% v 41%; 1.44, 1.02 to 2.06). Bran was more effective than placebo during the third month of treatment only (57% v 32%; 1.70, 1.12 to 2.57), but this was not statistically significant in the worst case analysis (1.45, 0.97 to 2.16). After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared with 49 points in the placebo group (P=0.03) and 58 points in the bran group (P=0.61 versus placebo). No differences were found with respect to quality of life. Fifty four (64%) of the patients allocated to psyllium, 54 (56%) in the bran group, and 56 (60%) in the placebo group completed the three month treatment period. Early dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened. Conclusions Psyllium offers benefits in patients with irritable bowel syndrome in primary care. Trial registration Clinical trials NCT00189033

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