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21.1 Diabetes and Nutritional Status
21.1 Diabetes and Nutritional Status
Module 21.1.
Dr. Irit Chermesh
Medical Director of Clinical
Nutrition
Gastroenterology Dept
Rambam Healthcare Campus
Israel
21.03.2016
When was this written?
“There are entirely too many diabetic patients in the
1.1920
country. Statistics for the last thirty years show
so great 2.1950
an increase in the number that, unless
this were3.1980
in part explained by a better
recognition of the disease, the outlook for the
4.2010
future would be startling.”
2004
2010
Metabolism and
Nutrition in DM
–High BMR
–Vitamin (25) D
–Vitamin B12
–Magnesium
–Vitamin E
–Vitamin B1 (thiamine)
–Chromium
Vitamin (25) D
Role in D.M?
• Improvement insulin secretion and/or
action?
• Vitamin D
Recent meta-analysis
OR for B12 deficiency with Metformin 2.45
patients 390
Tosiello Arch Intern Med 1996 Mooren Diabetes, Obesity and Metabolism 2015
Håglin Acta Diabetol. 2007 Nasri J Renal Inj Prev. 2014
Barragan-Rodríguez Arch Med Res. 2007 Rodríguez-Hernández Arch Med Res. 2005
Pham Clin Nephrol. 2005 Atabek Diabetes Res Clin Pract. 2006
Sales Clin. Nutr 2006
Hypomagnesemia
• Early atherosclerosis
~>20% diabetics low Mg- serum and/or intracellular
• DM retinopathy
Correlates with
A definitive cause-and-effect relationship between
• Renal dysfunction
magnesium
•Impairedstatus
fastingand glucose
glucose homeostasis
(IFG), remains
impaired glucose
5to be demonstrated
• Early neuropathy
tolerance (IGT) and metabolic syndrome
••Incidence ofsymptoms
Depressive type DMT2
• hyperlipidemia
•Complications of DMT2
• All cause mortality