Mediterranean Diet And Glycaemic Load In Relation To Diabetes: A Systematic Review

Systematic Review

According to the Australian Institute of Health and Welfare [AIHW] (2018), chronic diseases are long lasting conditions which are characterised with persistent effects. The social and the economic consequences of chronic health conditions hamper the health-related quality of life of the affected individuals. AIHW reports 8 major chronic health conditions namely asthma, arthritis, cancer, back pain, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental health conditions. This paper will mainly structure its literature review framework via focusing on the diabetes as a chronic health condition

According to Ryanet al. (2013)diabetes especially type 2 diabetes mellitus is a major health related problem worldwide. Numerous compelling evidences showed that diabetes can be prevented by lifestyle changes. The lifestyle modification mainly encompasses modification of diet which promotes weight loss through restricted calorie intake. Ryanet al. (2013) highlighted that Mediterranean diet is moderately rich in fat (fat from vegetable source) and relatively low in dairy products.  This energy is found to promote decreased incidence of diabetes in comparison to other crash diet or sugar-free diet pattern.

The main research question is how Mediterranean diet plan helps in effective management of diabetes in comparison to other diet.

Espositoet al. (2014)conducted a primary research in relation to the role of the diet in controlling type 2 diabetes mellitus. The main aim of the study is to assess the long-term effects of the dietary interventions on the glycemic control and the requirement of the diabetes medications and subsequent remission of type 2 diabetes. Espositoet al. (2014) used two-arm trial design over middle-aged men and women who are over-weight and has recently been diagnosed with diabetes. The authors randomly allocated the focus group into two different groups. One in low-carbohydrate Mediterranean diet (LMD) and another group to low fat diet. This is the main strength of the study design as it allocated randomly the selected focus groups in to two different groups and accordingly to Brannen(2017), this helps to decrease the chances of obtaining biased results arising from allocation bias. The two-arm trial study design further helped to improve the quality of the study (Brannen, 2017). However, they selected only over-weight men and women in order to check the efficacy of the Mediterranean diet over the glycemic level and this again stood out for bias selection of the focus group.The research paradigm selected by the author is positivism research paradigm. According to Brannen(2017), positivism research paradigm is best suited for the quantitative research. Espositoet al. (2014) mainly conducted quantitative research as they used statistical analysis in order to compare the efficacy of LCMD and low fat diet. One limitations of the study is, Espositoet al. (2014) used 4 years of follow-up and this lead to the decrease in the overall sample size which might lead to biased outcome.

Research topic

According to the objective 1of National Strategic Framework for Chronic Conditions, primary focus should be given on prevention for the promotion of a healthier Australia. The health promotion and prevention strategies mainly promote minimization or prevention of the disease progression among the vulnerable population with chronic conditions. Another implication of objective one is reduction of the risk developing additional conditions and associated complications along with an improvement of the overall quality of life. According to Georgoulis, Kontogianni and Yiannakouris(2014),Mediterranean diet helps to minimize the severity of diabetes mellitus and at the same time helps in the reduction of the glycemic index of the body. This decreases the overall disease progression. The research conducted by Sleiman, Al-Badri andAzar(2015) highlighted that observance of Mediterranean diet helps in the reduction of the development of cardiovascular risk associated with diabetes. Cardiovascular risk is defined as the macro and microvascular complications which are associated with diabetes and thus reduction in the risk of developing cardiovascular helps to decrease the chances of getting affected with the additional disease complications. Thus it can be said that the research topic mainly aims at the prevention of the disease outcome along with reduction in the associated health related complication. Thus providing a comprehensive disease prevention approach.

In relation to the Mediterranean diet Salas-Salvadóet al. (2014)conducted a multicenter randomised control trial under primary care centres in Spain. The principal aim of the study is to evaluate whether dietary changes without any strict calorie restriction helps to provide protection from diabetes. They randomly assigned participants to three different diet plans, like Mediterranean diet which is supplemented with extra-virgin olive oil (EVOO), Mediterranean diet which is supplemented with nuts and another control diet (low-fat diet). Salas-Salvadóet al. (2014) devised no specific interventions in order to increase the physical activity in order to lose weight. The analysis of the results highlighted that Mediterranean diet which is rich with EVOO but without any form of strict energy restriction was successful in decreasing the overall risk of diabetes among patients upon long term intervention. This decrease in the threat of diabetes among the older person further helped to reduce the cardiovascular risk. Salas-Salvadóet al. (2014) are of the opinion that this beneficial effect was mainly attributed to the overall versatility of the dietary pattern and not on calorie restriction or increase in the rate of physical activity. In relation to Mediterranean diet and blood glycaemic load and its association with the type 2 diabetes mellitus, Rossi et al. (2013) conducted a population based cohort study. Rossi et al. (2013) are of the opinion that effect of diet in the prevention of diabetes is uncertain. The aim of their study is to investigate the effect of two different dietary aspects in relation to diabetes control and management. The two different diets which are taken into consideration include Mediterranean diet and Glycaemic load. They mainly included 22,295 participants and followed for a median of 11.32 years. Then semi-quantitative food frequency questionnaire is used to analyse the results and Mediterranean diet score (MDS) was used to calculate the results. The results highlighted that observance of Mediterranean diet is helpful in reducing the incidence of type 2 diabetes via decreasingthe glycaemic load (Rossi et al., 2013). Rossi et al. (2013) are of the opinion that the overall rate of absorption and digestion of different carbohydrate sources increases the risk of diabetes. This increase in the risk of diabetes in narrated in terms of dietary index and is known as glycaemic index (GI). GI is an indicator of the ability of carbohydrate to increase the blood sugar levels. It is highlighted that long-term intake of high-GI containing food increases the overall insulin demand in the body along with promotion of insulin resistance or impairment of the pancreatic beat cells in providing insulin thus leading to the generation of diabetes mellitus. However, the observance of the Mediterranean diet helps to lower the overall GI and thereby helping to reduce the susceptibility of developing diabetes (Rossi et al., 2013).Espositoet al. (2014) conducted a follow-up randomised control trail in order to access the long-term effects of the dietary interventions on the glycaemic control and subsequent requirement for diabetes medicines and cure of type 2 diabetes. They mainly used a two-arm trial design over middle-aged men and women who are over-weight and have recently been diagnosed with type 2 diabetes. They randomly assigned the participants into different group, one with low-carbohydrate Mediterranean diet (LCMD) and another group with low-fat diet. The four years of follow up highlighted that patients who are recently diagnosed with type 2 diabetes, showed greater reduction in the blood glucose level upon observance of LCMD and required less demand for pharmacologic medication in comparison to low-fat diet (Esposito et al., 2014).

Literature Review

Thus from the research findings it can be said that the main implications for change in nursing practice is to take the diet of the patients with diabetes into active consideration for the effective management of the disease. The Mediterranean diet must be designed in such a way that it is rich in fat which are derived from the plant source and are low in the carbohydrate and the sugar content. Such restricted carbohydrate intake will help to lower the blood glucose level. Reduction in the in-take of the carbohydrate will help to decrease the calorific value of the diet and will limit the overall calorie intake too. Moreover, proper regulation of the fat and protein from the natural sources will help to maintain the nutritional value of the body. However, it is the duty of the nursing professionals to take help from the professional dietician in devising the Mediterranean diet plan for the patient with diabetes. The planning of the diet chart should be done on the basis of the body mass index, age and the glycemic level of the body. Proper monitoring of the blood glucose level must be undertaken in order to regulate the calorific intake of the body and thus help in healthy functioning of the body(Munshi et al., 2016).

According to Bohanny et al. (2013), devising of the proper diet plan in order to regulate the glycemic level of the blood among the diabetic patient is not comprehensive in overall reduction of the blood glucose level. Bohanny et al. (2013) proper the proper healthy literacy promotes proper adherence of the diet plan and thereby helping in the effective self-management of the disease. This is because there is strong relationship between health literacy, self-efficacy and self-care behaviour of the individuals with diabetes. Proper strategies are required to be devised in order to incorporate the concept of self-efficacy in designing the care plan for the chronic disease like diabetes. The concept of self-efficacy is promoted via providing health education in self-care behaviours on managing hypoglycaemic and hyperglycaemic shocks via abiding diet plan and checking the blood sugar levels.Halali et al. (2016) further highlighted the observance of a strict diet plan for long-term intervention for the diabetes control can generate a sense of monotony. So in order to bring change in the taste buds, it is the duty of the nursing professionals to make cyclic rotation of the menus under the Mediterranean diet plan. This cyclic rotation must be done on weekly basis under the controlled supervision of the professional dieticians.

References

Australian Health Ministers’ Advisory Council (2017).

Australian Institute of Health and Welfare.(2018). Chronic Disease Overview. Access date: 25^th September 2018. Retrieved from: https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/chronic-disease/overview

Bohanny, W., Wu, S. F. V., Liu, C. Y., Yeh, S. H., Tsay, S. L., & Wang, T. J. (2013). Health literacy, self?efficacy, and self?care behaviors in patients with type 2 diabetes mellitus. Journal of the American Association of Nurse Practitioners, 25(9), 495-502.

Brannen, J. (2017). Mixing methods: Qualitative and quantitative research.Routledge.

Esposito, K., Maiorino, M. I., Petrizzo, M., Bellastella, G., &Giugliano, D. (2014). The effects of a Mediterranean diet on need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes care, DC_132899.

Georgoulis, M., Kontogianni, M. D., &Yiannakouris, N. (2014).Mediterranean diet and diabetes: prevention and treatment. Nutrients, 6(4), 1406-1423.

Halali, F., Mahdavi, R., Mobasseri, M., Jafarabadi, M. A., &Avval, S. K. (2016). Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran. Eating behaviors, 21, 205-210.

Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., …& Haas, L. B. (2016). Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes care, 39(2), 308-318.

Rossi, M., Turati, F., Lagiou, P., Trichopoulos, D., Augustin, L. S., La Vecchia, C., &Trichopoulou, A. (2013). Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia, 56(11), 2405-2413.

Ryan, M. C., Itsiopoulos, C., Thodis, T., Ward, G., Trost, N., Hofferberth, S., …& Wilson, A. M. (2013). The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. Journal of hepatology, 59(1), 138-143.

Salas-Salvadó, J., Bulló, M., Estruch, R., Ros, E., Covas, M. I., Ibarrola-Jurado, N., …&Romaguera, D. (2014). Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Annals of internal medicine, 160(1), 1-10.

Sleiman, D., Al-Badri, M. R., &Azar, S. T. (2015).Effect of mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review. Frontiers in public health, 3, 69.

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