ROLE OF DIETARY PRACTICES IN ON-SET OF TYPE-II DIABETES AND ITS MANAGEMENT AMONGST FEMALE POPULATION

Abstract

The risk of type 2 diabetes is increased in adolescent obese people. More than 11 percent female population in Pakistan is known diabetics. The condition has become even worse with a low literacy rate among the female population. Unawareness about the risk factors related to impaired glucose tolerance and complications associated with hyperglycemia have further aggravated the problem. The intervention trial involved 200 type 2 diabetic female subjects selected from diabetic center. These subjects were studied for physical and biochemical parameters. They were grouped according to their age, duration of illness (Table 1, Fig-1) degree of obesity and disease complications (Fig-2, Table 2 and 3). This grouping was carried out to assign particular diet patterns to these patients. These diet patterns consisted of strict, moderate and liberal diet control based on diabetic exchange system. The dietary intervention aimed at reducing total intake of fat to less than 30 percent of the daily intake of energy. Saturated fats were reduced to less than 10 percent of the total calories per day. More emphasis was on increasing the amount of polyunsaturated fats and fiber through rich sources. The diet plans consisted of fifteen days diet with low (1500-1800 kcal/day), moderate (1800-2100 kcal/day) and liberal (2100-2400 kcal/day) caloric intake. These diets consisted of simple easily digestible foods. Seasonal availability and cost of food items was especially taken into consideration. Subjects were given low fat recipes. Cooking techniques for reduced use of oils and fats were explained to them. The distribution of day’s caloric intake was the same as practiced by most diabetic clinics (Coulston et. al 2001). According to which 40 percent of the total calories were based on protein sources, 30 percent were provided from fats and 30 percent from carbohydrates. Simple easily understandable menus (Appendix “A”) were given to the patients. Flexibility and choice was also provided. Patients could replace any breakfast, lunch or dinner from the fifteen days schedule, as caloric intake was the same. Patients were recommended to take at least 8-10 glasses of plain water in addition to other fluids included in their diet plans. Readings for systolic and diastolic blood pressure were noted in the regular clinical visits. Reduction in body weight and BMI were also noted. These parameters served as a source of encouragement for the patients to follow the diet plans more strictly. Patients increased their physical activity in response to the follow up. They were recommended to take light to moderate exercise for at least 30 minutes three to five times weekly. Patients who used to smoke were encouraged towards smoking cessation. Insulin dose was adjusted from time to time on the basis of the morning fasting blood glucose concentration. For patients who were unable to maintain glycosylated hemoglobin values below 7.5-8.5% despite maximal dose of oral agents, the addition of NPH (neutral protamine hagedorn) insulin at bedtime was recommended as suggested by physician. Patients were also given a vitamin – mineral supplement containing at least 250 mg of vitc, 100 mg of (alpha) tocopherol, and 400 mg of folic acid. Supplements having minimum iron content were chosen as majority of the subjects had kidney malfunction. Intensive treatment was aimed at maintaining HbA1c level of 7.0 or less. Laboratory investigations were repeated at the completion of six months follow up to see the effect of diet therapy and final investigations were carried out at the end of the study. The results of diet therapy and life style intervention were analyzed in the following changes;  a reduction in the incidence of hypertension (lowering of systolic and diastolic blood pressure shown in table 17),  lowering of HbA1c levels,  improved results of urea, creatinine, uric acid cholesterol, triglycerides, HDL-C, LDL-C, albumin, globulin, total lipids, total proteins and ALT/SGPT values (Table 18),  reduction in body weight and BMI (Fig-5, 6 Table 14), ix  increased awareness in relation to understanding of risk factors or contributing factors for the disease.  awareness in relation to better management of disease and beliefs related to prevention (Table 7, 8),  a change from previous to present eating practices (Table 9 10, 11),  a change in smoking practices after diet therapy (Table 12),  a lifestyle change apparent in the form of improved physical activity (Fig-4, Table 13),  a reduction in the dosage of antihypertensive drugs and hypoglycemic agents (Fig-8, Fig-9, Table 15, 16). Data was collected to find out the main cause of disease. So information regarding age at onset of disease, duration, total number of pregnancies, birth weight of children and family history was gathered. Outcome measures told that with women in a country like Pakistan stress of repeated pregnancy and multiplied weight gain with every pregnancy were the main cause. Every 2nd or 3rd subject having 4-5 children had gestational diabetes at 3rd or 4th child. While birth weight of the children was either less than or above normal birth weight for the gestational age. Patients with a positive family history for diabetes were diagnosed at an earlier age between four to seven years as compared to patients with no

family history. Family history was an independent predictor of age at diagnosis in patients with type 2 diabetes. Awareness was increased when subjects were provided information regarding the grim consequences of uncontrolled diabetes. Weight reduction was a big incentive and majority told that they felt lighter with changes in diet and they agreed that these are the types of food that should be eaten. But all subjects couldn’t continue same pattern of eating for a longer period. A period of 3-4 years of intervention was found to be enough for bringing about a pattern change in life style of diabetic patients. They were not only convinced for a better way towards improved health but also were ready to convey this practical knowledge to other diabetics. They were able to follow a carefully chosen diet pattern with healthy choices. In addition some were more convinced to assure that their diet should match the lifestyle and physical activity level, they adapt throughout their routine. The knowledge and information gained through present study not only updates the previous attempts in the same field but also provides a ready reference to the control of diabetes symptoms. This work has signified type 2 diabetes as a major health hazard and various suggestive measures about how to go for its control.