Welcome to DMPs second professional publication – a monthly publication to help health professionals like you put more evidence into practice when treating patients with type 2 diabetes and prediabetes.
Feature: Saturated Fat – Far from harmful
As health professionals it has been common practice over the years to encourage people to reduce their saturated fat intake to less than 10% of total daily calories and include more unsaturated fats (mono and poly's). These guidelines have long been recommended with the belief that it reduces people's risk of cardiovascular disease and death.
However, in recent years literature has been demonstrating that there was never any strong evidence to suggest such recommendations to the public. And even worse, that encouraging people to do so may worsen the incidence of disease and risk of death.
This review confirms these views by analyzing both findings and non-findings associated with saturated fat from various RCT and epidemiological studies, concluding that the recommendations for saturated are not only unfounded but may be harmful.
Overall, the message is that we need to stop the fear surrounding saturated fat and it's link to LDL cholesterol and cardiovascular disease, because the relationship does not exist, period.
Something we must all recognize is that saturated fat is found in ALL foods, with the only exception being table sugar (pure sucrose). Even when you take lettuce and add a large amount of it to a nutrition calculator you will find traces of saturated fat. The question then being: how can a food found in everything from meat to lettuce be bad for you?
Another important thing to recognize is that fat-containing foods contain all 3 types of fats – saturated, monounsaturated and polyunsaturated – at varying levels depending on the food. The only food group that naturally contains more saturated fat than mono or poly is dairy, which is not bad, its just a fact.
KEY POINT: Saturated fat is far from harmful. It is found naturally in natural foods.
When making dietary recommendations to people, our focus should be a focus on food intake overall, rather than just saturated fat. And more importantly, the recommendation to eat real food over processed food is always a driving goal in the modern world we live in.
Interesting New Research
Association of Serum Cholesterol Levels With Peripheral Nerve Damage in Patients With Type 2 Diabetes
Dyslipidemia is a common comorbidity in type 2 diabetes. In clinical practice it has commonly been a goal to lower blood cholesterol levels, sometimes with an aggressive approach being that the belief is it will help people avoid heart disease.
However, new research shows that lipid metabolism may be involved in the development and progression of peripheral nerve damage in people with type 2 diabetes. And more specifically that lower levels of total blood cholesterol and LDL-C may increase risk of the diabetic complication, distal symmetric diabetic polyneuropathy (DPN), which affects about 200 million people each year.
The message here is that in a clinical setting, health practitioners need to pay close attention to signs of nerve damage, especially if taking an aggressive cholesterol-lowering approach, or when a patient is prescribed PCSK9 inhibitors.
Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials
This research investigates the outcomes of 42 randomized trials for telemedicine interventions achieving reductions in A1c for people with type 1 and type 2 diabetes. The results show that people can significantly reduce A1c via telemedicine interventions, particularly in people with type 2 diabetes and with longer term programs of 6 months or more delivering more benefits.
The overall average A1c reduction from the meta-analysis was -0.37%. Including only type 2 diabetes patients, this result was further reduced to an average of -0.48%. And in older patients between 41-50 years these results were further reduced to an average -1.82%.
The conclusion was that telemedicine interventions are more effective than usual care, especially for type 2 diabetes, older patients and for interventions 6 months of longer.
PhD Project Update
DMPs Founder, Jedha Dening, is currently doing a PhD in type 2 diabetes nutrition and digital technologies. Each month we will provide an update on how the project is progressing.
The title of the project is: Effectiveness of an Internet-Based Low Carbohydrate Diet in People with Type 2 Diabetes
Systematic Review (almost complete)
The title of this paper is: Web-based interventions for dietary behavior change in people with type 2 diabetes
*We are now in the final editing stages preparing the manuscript for journal submission.
PhD Project Plan:
The PhD project will be a series of papers that represent the study progression. We are still refining the overall project plan, but at this time it stands as follows:
Planned study/publication 1: Theory-based user-centred design of an internet-based low carb diet intervention for people with type 2 diabetes.
Detailing the theoretical background of the intervention and engaging people with type 2 diabetes (end-users) in qualitative research to investigate adherence and engagement factors we can implement during the program.
Planned study/publication 2: Randomized optimization trial of an internet-based low carb diet intervention in people with type 2 diabetes.
Groups will be randomized to several scenarios of the same intervention for a period of 3-6 months so that we can test adherence and engagement factors and reveal the best intervention that would get the best results at scale.
Planned study/publication 3: Mixed methods process evaluation of an internet-based low carb diet intervention in people with type 2 diabetes.
A deep investigation of website statistics to discover and explore engagement factors of the intervention, along with qualitative interviews with participants to discover barriers and facilitators.
Thank you for browsing our second professional publication.
As health professionals it's so important to stay up-to-date with research, but since we're all so busy it can also be difficult to find time to do. Therefore, we hope this monthly publication will be a valuable resource that you can browse through to help your patients achieve better results.
If you have ideas or requests for this monthly publication, please contact us and let us know – we welcome your input.
Founder, Diabetes Meal Plans
Nutritionist (MNutr), Social Scientist (BSocSc)
PhD Candidate (Diabetes Nutrition/ Digital Interventions) – currently in progress
P.S. Please share our professional publication with others so we can engage more health professionals and make a difference, together.