Caloric restriction, diabetes

Diet/Exercise In initiating treatment for type 2 diabetes, emphasize diet as the primary form of treatment. Caloric restriction and weight loss are essential in the obese diabetic patient. Also, stress the importance of regular physical activity and aid the patient in identifying cardiovascular risk factors and taking corrective measures where possible. 

In a multicenter, double-blind, randomized, parallel-group, placebo-controlled trial in 22 European centers for specialist diabetes care over 6 months, sibutramine, in conjunction with moderate caloric restriction, enabled obese patients with type 2 diabetes taking sulfonylureas to achieve clinically significant weight loss (7). This was... 

Diet and exercise remain the primary considerations of diabetic patient management. Caloric restriction and weight loss are essential in the obese diabetic. These drugs are an adjunct to, not a substitute for, dietary regulation. In patients with Type-II diabetes who have few or no symptoms... 

D-Fructose is the sweetest natural sugar. Its use as a natural sweetener is, therefore, increasing rapidly. It is absorbed slowly from the intestine, and thus does not cause abrupt changes in the serum levels of carbohydrates. It has little, if any, effect on insulin secretion. Thus, it exerts beneficial effects as a component of diets for mild and well-balanced diabetes, but should be taken within caloric restriction,445 as obesity impairs D-glucose tolerance and increases the insulin resistance of peripheral tissue.446 Use of D-fructose in the direct treatment of diabetic ketoacidosis does not offer advantages over routine, fluid therapy, and may even be dangerous on the basis that rapid infusion of large amounts of D-fructose may cause lactate acidosis. 

Finally, caloric restriction and food deprivation have been shown to modulate hepatic expression of sex-dependent liver steroid-metabolizing enzymes, including CYP2C11 (ref [233]) which is suppressed, and CYP3A9 (ref [234]) and steroid 5a-reductase, which are induced. These are situations in which glucagon levels are high and insulin levels are low, analogous to the diabetic state (see Section 5.3.1). 

The PDF formalism has been tested and validated in control subjects and in those with a wide range of cardiac pathologies and loads including hypertension [31], heart failure [54], diabetes [55], and caloric restriction [42]. We will discuss in greater detail some of the pertinent predictions and clinical findings of the PDF model below. 

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