Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus

Pada diabetesi tipe 2, konsumsi polong (low glicemic index diet) memperbaiki kontrol glikemik dan menurunkan risiko penyakit jantung koroner.

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Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus A Randomized Controlled Trial

David J. A. Jenkins, MD; Cyril W. C. Kendall, PhD; Livia S. A. Augustin, PhD; Sandra Mitchell, RD; Sandhya Sahye-Pudaruth, RD; Sonia Blanco Mejia, MD; Laura Chiavaroli, MSc; Arash Mirrahimi, MSc; Christopher Ireland, BSc; Balachandran Bashyam, PhD; Edward Vidgen, BSc; Russell J. de Souza, ScD; John L. Sievenpiper, MD; Judy Coveney, RD; Lawrence A. Leiter, MD; Robert G. Josse, MD

 

Arch Intern Med. 2012;():1-8. doi:10.1001/2013.jamainternmed.70

Background  Legumes, including beans, chickpeas, and lentils, are among the lowest glycemic index (GI) foods and have been recommended in national diabetes mellitus (DM) guidelines. Yet, to our knowledge, they have never been used specifically to lower the GI of the diet. We have therefore undertaken a study of low-GI foods in type 2 DM with a focus on legumes in the intervention.

Methods  A total of 121 participants with type 2 DM were randomized to either a low-GI legume diet that encouraged participants to increase legume intake by at least 1 cup per day, or to increase insoluble fiber by consumption of whole wheat products, for 3 months. The primary outcome was change in hemoglobin A_1c (HbA_1c) values with calculated coronary heart disease (CHD) risk score as a secondary outcome.

Results  The low-GI legume diet reduced HbA_1c values by −0.5% (95% CI, −0.6% to −0.4%) and the high wheat fiber diet reduced HbA_1c values by −0.3% (95% CI, −0.4% to −0.2%). The relative reduction in HbA_1c values after the low-GI legume diet was greater than after the high wheat fiber diet by −0.2% (95% CI, −0.3% to −0.1%; P < .001). The respective CHD risk reduction on the low-GI legume diet was −0.8% (95% CI, −1.4% to −0.3%; P = .003), largely owing to a greater relative reduction in systolic blood pressure on the low-GI legume diet compared with the high wheat fiber diet (−4.5 mm Hg; 95% CI, −7.0 to −2.1 mm Hg; P < .001).

Conclusion  Incorporation of legumes as part of a low-GI diet improved both glycemic control and reduced calculated CHD risk score in type 2 DM.

Mild Hypertension: Garlic, Drugs, or Cocoa?

Information sourced from BMJ:

BMJ 2012;345:e5450 

Research News

All you need to read in the other general journals

[EXCERPT]

Garlic, drugs, or cocoa for hypertension?

Cochrane Database Syst Rev2012;8:CD006742 [PubMed® abstract | Cochrane Library abstract PDF]

Cochrane Database Syst Rev2012;8: CD007653 [PubMed® abstract | Cochrane Library abstract PDF]

Cochrane Database Syst Rev2012;8:CD008893 [PubMed® abstract | Cochrane Library abstract PDF]

One review of four trials that comprised nearly 9000 participants looked at how well antihypertensive drugs prevent cardiovascular events and death in people with mild hypertension, defined as systolic blood pressure of 140-159 mm Hg or diastolic pressure 90-99 mm Hg (or both). All participants were free of cardiovascular disease at baseline.

No effects were seen over four to five years, compared with placebo, for overall mortality (relative risk 0.85, 95% CI 0.63 to 1.15), coronary heart disease (1.12, 0.80 to 1.57), stroke (0.51, 0.24 to 1.08), or total cardiovascular events (0.97, 0.72 to 1.32). One in 10 people stopped taking antihypertensives because of adverse effects, a fivefold increase over placebo. The review did not report effects of drugs on blood pressure, if any.

Another review found two small trials that compared garlic powder with placebo in people with mild hypertension. Garlic might help reduce blood pressure—possibly by about 10 mm Hg for systolic blood pressure and a little less for diastolic blood pressure. However, the confidence intervals were wide, and no data were available on which to assess the potency of garlic to prevent cardiovascular events.

Cocoa is rich in flavanols, which cause blood vessel dilatation and are thought to reduce blood pressure. Most of the 20 trials (about 850 participants) tested a daily dose of 500-750 mg of flavanols ingested through chocolate or cocoa products. Most participants were healthy and normotensive at baseline, and most trials lasted only about a month.

Small reductions in blood pressure were seen with cocoa, compared with placebo: −2.77 (−4.72 to −0.82) mm Hg for systolic pressure and −2.20 (−3.46 to −0.93) mm Hg for diastolic blood pressure. One in 20 people allocated cocoa had adverse effects, compared with one in 100 of those receiving placebo. Gastrointestinal effects and a dislike of the product's taste were the most common problems.

© 2012 BMJ Publishing Group Ltd

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Caffeine effective as an analgesic adjuvant

Caffeine effective as an analgesic adjuvant
September 17, 2012
PEARLS 362, July 2012, written by Brian R McAvoy

Clinical question: How effective is caffeine as an analgesic adjuvant for acute pain in adults?

Bottom line: Adding caffeine (at a dose equivalent to a mug of coffee, ie, about 100mg) to a standard dose of common analgesics, such as paracetamol or ibuprofen, increased the number of people with acute pain who experience a good level of pain relief (at least 50% of the maximum) by 5 to 10% (NNT* 15). The most common conditions studied were postoperative dental pain, postpartum pain, menstrual period pain and headache. One serious adverse event was reported with caffeine but was considered unrelated to any study medication. *NNT = number needed to treat to benefit 1 individual.

Caveat: Most comparisons individually demonstrated numerical superiority with caffeine but not statistical superiority.

Context: Caffeine is commonly used as a component in analgesics available from pharmacies without a prescription in the belief that it enhances analgesic efficacy.

Cochrane Systematic Review: Derry CJ et al. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Reviews, 2012, Issue 3. Article No. CD009281. DOI: 10.1002/14651858.CD009281.pub2. This review contains 19 studies involving 7238 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.