The SA Journal Diabetes & Vascular Disease Vol 12 No 1 (July 2015)

45 / 48

VOLUME 12 NUMBER 1 • JULY 2015 43
SA JOURNAL OF DIABETES & VASCULAR DISEASE NEWS
Arandomised, controlled trial has
indicated that a vegan diet may be
beneficial in relieving diabetic nerve pain.
Diabetic peripheral neuropathy, which
occurs in about half of all patients with
type 2 diabetes, is underdiagnosed, partly
because physicians aren’t able to offer
anything to treat the underlying cause of
this condition. Current therapies treat only
the pain.
The vegan diet is a plant-based diet, and
studies show that it can help ease the pain
caused by diabetic neuropathy. In an earlier
observational study conducted by Crane
and Sample, 21 type 2 diabetes patients
with nerve pain were put on a low-fat, high-
fibre vegan diet for one month, and 81%
of the participants achieved complete pain
relief and lost around 5 kg on average.
Additionally, the diet enabled most of these
patients to reduce their diabetes and blood
pressure medications.
Anne Bunner, PhD, and Caroline Trapp,
MSN, of the Physicians Committee for
Responsible Medicine, sought to see
whether these same benefits could be
seen in a randomised, controlled trial. They
conducted the Dietary Intervention for
chronic diabetic Neuropathy pain (DINE)
study, in which 15 patients with type 2
diabetes and diabetic neuropathy were
Diabetic neuropathy improved with vegan diet
randomised to either a low-fat, high-fibre
vegan diet and vitamin B12 supplementation
or vitamin B 12 supplementation alone.
The patients had a mean age of 57
years, half of them were female, and half
had a college education or higher. Bunner
noted that there tended to be a deficiency
in vitamin B 12 in diabetic patients, especially
those taking metformin. The participants
who were put on the diet had to attend
20 weekly nutrition classes involving
nutrition education, social support, cooking
demonstrations and food product sampling,
eat plant-based foods that had a low
glycaemic index, get at least 40 g of fibre
per day, and limit their consumption of fatty
foods, such as oils and nuts, to 20–30 g
per day. Since high-fibre foods are low in
calories, there were no portion limits.
Five out of the seven patients who were
put on the vegan diet were fully adherent.
According to Bunner and Trapp, with good
adherence, the participants who were put on
the diet alongwith vitamin B12 reported greater
improvements in McGill Pain Questionnaire
pain scores (p = 0.04) and significantly greater
reductions in body mass index (p = 0.01) when
compared with the control group.
The results of the study indicated that
there were also improvements in cholesterol
and HbA1c levels, neuropathy symptom
scores (NTSS-6), and quality-of-life scores in
which the changes differed significantly from
the baseline. These improvements were not
significantly greater in the diet group when
compared to the control group.
There was a greater decrease in cholesterol
and HbA1c levels in the diet group, but many
of the patients in the diet group discontinued
their lipid and diabetes medications, while
those in the control group were put on more
lipid and diabetes medications, so the graphs
were artificially lowered. Participants on the
vegan diet had significant improvement in
NTSS-6 and similar changes in quality-of-life
scores not matched by the control group, but
at the end of the trial, the differences among
both groups were not significant, which
Bunner believes may possibly have been due
to the small number of patients or maybe
even the effect of participating in the study
in the control group.
The researchers plan to follow their study
participants for one year to examine the
long-term effects observed in these patients.
They believe the study has shown that this
particular dietary intervention can provide
promising potential for treating diabetic
nerve pain.
Source:
php?option=com_content&view=article&id=16788&cat
id=1&Itemid=17
Younger age groups may be at higher risk
of developing complications of type 2
diabetes, possibly due to statin medications
only being added to their treatment
regimen much later on, a study from Asia
has found.
Type 2 diabetes can occur at a wide range
of ages. Recent data have shown that the
success rate of managing the disease may
vary depending on the age of diagnosis.
According to an ongoing prospective
study from the Joint Asia Diabetes
Evaluation (JADE), patients diagnosed with
type 2 diabetes at a younger age had poorer
management of their disease than patients
who were diagnosed at a later age. (People
who developed diabetes before the age of
40 years are considered ‘young onset’ while
Type 2 diabetes management more difficult with early onset
those who developed diabetes aged 41
years and older are defined as ‘late onset’
in the study.)
The study also found that people
diagnosed with diabetes before age 40
were more likely to develop complications.
Compared to patients developing diabetes
after the age of 40, these patients had
a higher HbA1c level and the chances of
their achieving HbA1c levels less than 7%
were very unlikely. They also had high LDL
cholesterol levels and were at higher risk of
developing diabetic retinopathy.
Researchers believe the reason behind
those with younger-onset diabetes
developing more complications is associated
with statin therapy. Younger-onset patients
were less likely to receive statins or renin
angiotensin system inhibitors for organ
protection.
A more aggressive approach is suggested
for patients who develop diabetes before the
age of 40 years. Younger patients have to live
with the disease for longer. Statin therapy
should therefore be initiated in all diabetic
patients, regardless of the age of diabetes
onset, to prevent associated long-term
complications. Findings from the JADE study
suggested the results were consistent across
all the countries participating in the study.
Source: Yeung RO, Zhang Y, Luk A, et al. Metabolic
profiles and treatment gaps in young onset type 2
diabetes in Asia: a cross sectional study of a prospective
cohort. Lancet Diabetes Endocrinol 2014; July 28. http://
ntent&view=article&id=16786&catid=1&Itemid=17