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      Papel do índice glicêmico e da carga glicêmica na prevenção e no controle metabólico de pacientes com diabetes melito tipo 2 Translated title: Glycemic index and glycemic load in the prevention and treatment of type 2 diabetes mellitus

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          Abstract

          O controle glicêmico intensificado pode prevenir e/ou retardar o aparecimento das complicações crônicas do diabetes melito (DM). O carboidrato da dieta é o principal determinante da glicemia pós-prandial, sendo o índice glicêmico (IG) e a carga glicêmica úteis para prever a resposta glicêmica aos alimentos. O objetivo deste manuscrito foi revisar criticamente o papel das dietas de baixo IG na prevenção e controle metabólico do diabetes melito tipo 2 (DMT2). O risco para desenvolvimento de DMT2 com dietas de alto IG variou de 1,21 a 1,59. A redução de 12 a 32 unidades no IG da dieta diminuiu em 0,39 a 0,50 pontos percentuais a HbA1c. Os efeitos dessas dietas no perfil lipídico e peso corporal no DMT2 permanecem controversos. Em conclusão, as evidências atuais indicam que a incorporação do IG no planejamento dietético de pacientes com DMT2 contribui para a melhora do controle glicêmico.

          Translated abstract

          The tight glycemic control can prevent and/or delay the development of chronic complications of diabetes mellitus (DM). Dietary carbohydrates are the main determinant of postprandial blood glucose and glycemic index (GI) and glycemic load are used to predict blood glucose response to foods. The aim of this paper was to critically review the role of low GI diets in type 2 diabetes mellitus (T2DM) prevention and metabolic control. The risk for development of T2DM with high GI diets ranged from 1.21 to 1.59.The reduction from 12-32 units in the GI of diets decreased 0.39-0.50% in HbA1c values. However, the effects of these diets on lipid profile and body weight in patients with T2DM remain controversial. In conclusion, the current evidence indicates that the inclusion of GI in the dietary planning for patients with T2DM contributes to the improvement of glycemic control.

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          Most cited references57

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          Glycemic index and disease.

          H-F Pi (2002)
          It has been suggested that foods with a high glycemic index are detrimental to health and that healthy people should be told to avoid these foods. This paper takes the position that not enough valid scientific data are available to launch a public health campaign to disseminate such a recommendation. This paper explores the glycemic index and its validity and discusses the effect of postprandial glucose and insulin responses on food intake, obesity, type 1 diabetes, and cardiovascular disease. Presented herein are the reasons why it is premature to recommend that the general population avoid foods with a high glycemic index.
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            Low glycaemic index, or low glycaemic load, diets for diabetes mellitus.

            The aim of diabetes management is to normalise blood glucose levels, since improved blood glucose control is associated with reduction in development, and progression, of complications. Nutritional factors affect blood glucose levels, however there is currently no universal approach to the optimal dietary treatment for diabetes. There is controversy about how useful the glycaemic index (GI) is in diabetic meal planning. Improved glycaemic control through diet could minimise medications, lessen risk of diabetic complications, improve quality of life and increase life expectancy. To assess the effects of low glycaemic index, or low glycaemic load, diets on glycaemic control in people with diabetes. We performed electronic searches of The Cochrane Library, MEDLINE, EMBASE and CINAHL with no language restriction. We assessed randomised controlled trials of four weeks or longer that compared a low glycaemic index, or low glycaemic load, diet with a higher glycaemic index, or load, or other diet for people with either type 1 or 2 diabetes mellitus, whose diabetes was not already optimally controlled. Two reviewers independently extracted data on study population, intervention and outcomes for each included study, using standardised data extraction forms. Eleven relevant randomised controlled trials involving 402 participants were identified. There was a significant decrease in the glycated haemoglobin A1c (HbA1c) parallel group of trials, the weighted mean difference (WMD) was -0.5% with a 95% confidence interval (CI) of - 0.9 to -0.1, P = 0.02; and in the cross-over group of trials the WMD was -0.5% with a 95% CI of -1.0 to -0.1, P = 0.03. Episodes of hypoglycaemia were significantly fewer with low compared to high GI diet in one trial (difference of -0.8 episodes per patient per month, P < 0.01), and proportion of participants reporting more than 15 hyperglycaemic episodes per month was lower for low-GI diet compared to measured carbohydrate exchange diet in another study (35% versus 66%, P = 0.006). No study reported on mortality, morbidity or costs. A low-GI diet can improve glycaemic control in diabetes without compromising hypoglycaemic events.
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              Carbohydrates in human nutrition. Report of a Joint FAO/WHO Expert Consultation.

              (1997)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abem
                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
                1677-9487
                July 2009
                : 53
                : 5
                : 560-571
                Affiliations
                [1 ] Universidade Federal do Rio Grande do Sul Brazil
                [2 ] Universidade de Kuopio Finlândia
                Article
                S0004-27302009000500009
                10.1590/S0004-27302009000500009
                29709126-b4e3-4fad-978a-e07c7d7eb06f

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2730&lng=en
                Categories
                ENDOCRINOLOGY & METABOLISM

                Endocrinology & Diabetes
                Carbohydrates,glycemic index,glycemic load,diabetes mellitus,Carboidratos,índice glicêmico,carga glicêmica,diabetes melito

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