Prevalence of Wine Consumption in Type 2 Diabetics after a Dietary Nutritional Intervention from Primary Care

Special Issue: Alcohol Addiction

Austin Diabetes Res. 2023; 8(1): 1027.

Prevalence of Wine Consumption in Type 2 Diabetics after a Dietary Nutritional Intervention from Primary Care

Carmen Celada Roldan¹*; Jaime Lopez Diez¹; M Angeles Cerezuela¹; Faustino Rider¹; Almudena Tarraga Marcos²; Pedro J Tárraga López²

¹Medico Familia Cartagena (Murcia), Spain

²Medico Bienestar Social Centro Base de Albacete, Spain

³Medico familia zona 5 de Albacete, Spain

*Corresponding author: Pedro Tarraga Lopez Medico familia zona 5 de Albacete, Spain. Email: pjtarraga@sescam.jccm.es

Received: May 25, 2023 Accepted: June 27, 2023 Published: July 04, 2023

Summary

Introduction: At present there are changes in the lifestyle that have been modifying the nutritional culture, moving away from the Mediterranean diet (DMed), with a higher consumption of alcoholic beverages, a fact that together with the acquisition of a more sedentary lifestyle, has contributed to a significant increase in Cardiovascular Risk Factors (CVRF) such as obesity and type 2 Diabetes Mellitus (DM2), and consequently to a global increase in Metabolic Syndrome (MS) and Cardiovascular Diseases (CVD), which in the 21st century continue to be the leading cause of morbidity and mortality. To reduce this pandemic and try to reduce alcohol consumption in patients with high cardiovascular risk, a multidisciplinary approach is required focused on the application of primary and secondary prevention strategies focused on nutritional education through the promotion of a healthy lifestyle from childhood and a healthier diet, such as the one included in the DMed. This dietary pattern, together with physical exercise, has been shown to contribute to the primary and secondary prevention of DM2.

Objective: To determine the initial adherence to the DMed, as well as the consumption of wine by sex, in patients with poorly controlled DM2 and to analyze the effects of a nutritional educational intervention from Primary Care on the consumption of wine, the degree of adherence to the DMed and the glycemic control.

Material and Methods: Descriptive observational study and quasi-experimental analytical study (before-after) in 93 patients diagnosed with type 2 diabetes mellitus with poor glycemic control (A1c≥7%), carried out in various health centers in Albacete and Cuenca between 2018 and 2019, in which the relationship between adherence to MedDM and CVRF is evaluated, before and after an educational intervention on MedDM. They are administered a data collection sheet that includes a MedD adherence survey (MEDAS-14) at baseline and at 6 months, after completing an education on MedD in Primary Care (PC) medical and nursing consultations).

The pre- and post-intervention variables were analyzed: age groups, sex, years of evolution of DM2, Body Mass Index (BMI), as well as Basal Glycemia (GB) and Glycosylated Hemoglobin (HbA1c). The main variable “MEDAS-14” is related to the rest of the variables. Specifically, item 8 assesses the consumption of more than or equal to 7 glasses of wine per week.

Results: Pre-intervention the score of the survey of adherence to the Mediterranean diet was relatively low (7.44±0.22 points), being in women (7.66 points) than in men (7.1 points). Of the 14 dietary items of the MEDAS-14, high compliance with the recommended intake of wine stands out (≥7 glasses/week, 69%), specifically there is a higher initial consumption in women (45%) than in men (28%). In general terms, despite the high consumption of olive oil, a large number of processed products are consumed (sweetened beverages, butter, commercial confectionery), with a low consumption of fruit, fish and nuts. Post-intervention, adherence to the DMED increased by 1.09±2.56 points (8.55 points). Men being those who present 0.4 points more (8.7 points) than women (8.4 points). The biggest changes have been in relation to the increase in the consumption of white meat, olive oil, nuts, vegetables and stir-fry. Just as a decrease in the consumption of processed foods and the weekly consumption of wine (down to 58%) is observed, specifically it has been higher in women, it has decreased by 11% (34.4%), maintaining itself in men (28%).

Conclusions: In diabetic patients with poor control, a nutritional educational intervention that promotes MedDM from PC improves adherence to said diet, increasing the consumption of healthy foods and decreasing harmful ones, thus optimizing metabolic control.

Keywords: Mediterranean diet; Type 2 diabetes; MEDAS-14; Item 8; Wine; Nutritional education

Introduction

Human nutrition has been essential in the evolution of man, modifying eating habits throughout history. Changes in lifestyle derived from a reduction in physical activity, work pressures, new forms of teleworking, widespread use of electronic devices and unlimited access to the food consumption market in developed countries have been modifying nutritional culture, transforming the habits of our traditional diet since childhood [1]. Likewise, the state of confinement COVID-19 has implied changes in the life habits and dietary profiles of the population [2].

The Mediterranean Diet (DMed) is classically defined as the eating pattern typical of the early sixties in the countries of the Mediterranean area (Greece, southern Italy and Spain) [3]. Its main characteristics are: a) high fat consumption, mainly in the form of olive oil; b) high consumption of whole grains, fruit, vegetables, legumes and nuts; c) moderate-high consumption of fish; d) moderate-low consumption of white meat and dairy products; e) low consumption of red meat and meat products, and f) moderate consumption of wine with meals. This pattern and the proportions of the different foods that compose it are graphically displayed in the form of a “food pyramid” [4].

Alcohol consumption is a culturally approved process in society and in different scenarios of human socialization this behavior has been present in the history of humanity [6], but when this consumption becomes frequent and excessive, the consequences are multiple (accidents, liver disease, neurological and psychiatric pathologies) increased the cardiovascular risk of patients who suffer from it, generating high socioeconomic costs and health resources. It has been pointed out that alcohol has diabetogenic effects in people with DM2 that include increased obesity, induction of pancreatitis, alterations in carbohydrate and glucose metabolism, presenting periods of hypoglycemia when alcohol is consumed excessively and there are long fasting periods, however it can also cause hyperglycemia when consumed in smaller quantities or to accompany food [7]. The ADA does not prohibit a person with DM2 from consuming alcohol, but it does not advise it either, it recommends limiting moderate consumption (one drink a day for women and two a day for men).

When analyzing the current situation in Spain, a country where there is a high prevalence of DM2 together with obesity (diabesity), two of the great epidemics of the 21st century that increase CVD, being the first cause of morbidity and mortality worldwide and in Spain, derived from current lifestyles far from a Mediterranean lifestyle. For this reason, it was proposed to assess the effects of MedDM in the prevention of this disease [8].

It has been shown that an intervention with MedD is a very effective instrument in the prevention of T2DM in subjects with high vascular risk [9,10]. The American Diabetes Association [11], among its general recommendations, makes explicit reference to MedDM, mentioning the improvement in glycemic control and its cardiovascular benefits in patients with T2DM. Although, as we said, it has been systematically shown that MedD helps protect against cardiovascular, inflammatory and metabolic diseases, as well as numerous chronic degenerative diseases [12-15]; the protective effect of MD has been very different between the studies [16-18].

Consequently, many adherence scores of the MedMD are being created to determine the relationship between diet and health [19]. Therefore, this work planet, due to its ease of use, use the MEDAS-14 in diabetic patients with poor glycemic control to assess the degree of adherence to the DMed, objectify their consumption of wine and other variables.

Method

This is a multicenter study in which adult type 2 diabetic patients with poor glycemic control (HbA1c greater than 7%) from various health centers in Albacete and Cuenca participated during the period between June 2018 and September 2019. In the first stage, a descriptive observational study was carried out to determine the degree of adherence to the MedD, through the compilation of the MedD Adherence questionnaire (MEDAS-14) [20] (Figure 1) and anthropometric parameters (BMI, waist circumference) and glycemic biochemical parameters (GB, A1c). In a second stage, a quasi-experimental analytical study of the before-after type is carried out, relating the main variable "MEDAS-14" with the rest (IMC, GB, A1c) before and after the intervention.