Effects of adding a low glycaemic index diet to a carbohydrate exchange dietary advice for women with gestational diabetes mellitus
Carbohydrate exchange (CE) or low glycaemic index (GI) dietary advice for women with gestational diabetes mellitus (GDM) produces comparable benefits. Whether adding a low GI diet to CE dietary advice would further enhance glycaemic control in women with GDM is unclear. This study investigated...
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| Format: | Thesis |
| Language: | English |
| Published: |
2017
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| Online Access: | http://psasir.upm.edu.my/id/eprint/76664/1/FPSK%28M%29%202018%2046%20-%20IR.pdf |
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| Summary: | Carbohydrate exchange (CE) or low glycaemic index (GI) dietary advice for
women with gestational diabetes mellitus (GDM) produces comparable benefits.
Whether adding a low GI diet to CE dietary advice would further enhance
glycaemic control in women with GDM is unclear. This study investigated the
effects of adding a low GI diet to the CE dietary advice on maternal glycaemia,
metabolic outcomes, weight gain and dietary intake in women with GDM.
This study employed a quasi-experimental study design conducted at Hulu
Langat District Health Clinics. Four from the 12 clinics with the highest number
of GDM cases were selected. Then, women with confirmed GDM at their second
trimester from the two clinics were assigned to the CE alone (CE; n = 26). The
other two were assigned to the intervention (addition of GI diet to the CE dietary
advice) (LGI; n = 26). A simple random sampling were used when allocating the
health clinics into it assigned group. The intervention performed at four visits
similarly conducted for each group with the duration of intervention is 10 to 22
weeks. At baseline visit, similar CE dietary advice were given to each group by
a research dietitian. Then, at visit 1, low GI dietary advice were given to the
intervention group while the comparison group (CE) continues with the previous
dietary plan. Maternal glycaemia (fasting blood glucose (FBG), glycated
haemoglobin (HbA1c) and self-monitoring blood glucose (SMBG)) was a primary
outcomes measure. The secondary outcome measures were maternal metabolic
outcomes (blood pressure, high sensitivity C-reactive protein (hs-CRP) and
insulin level), maternal weight gain and dietary intake.In this study, the response rate was 87% with 13% of attrition rate. The baseline
characteristics were homogenous between LGI and CE group. Regarding
primary outcome measures, no differences were observed for FBG and HbA1c
between groups even though the HbA1c increased significantly in both groups
over time (time effect; p < 0.05). The SMBG at pre-breakfast and post-breakfast
were significantly lower in LGI than the CE group (group effect; p < 0.05). The
SMBG at post-lunch were significantly reduced over time (time effect; p < 0.05)
with no significant differences between groups.
Regarding secondary outcome measures, the fasting insulin increased in both
group, significantly higher in CE than LGI (group effect p < 0.05). Systolic blood
pressure increased in LGI over time which on the other hand, reduced in CE
group (time*group effect; p < 0.05). Other secondary outcomes did not differ
significantly between groups. In dietary intake assessments, the energy, fat,
dietary fibre, sugars, dietary GI and glycaemic load (GL) were significantly
reduced in LGI than CE over time (time effect; p < 0.05) with no significant
difference between groups. The sugars and dietary GI in LGI group reduced
which on the other hand the dietary GI increased in CE (time*group effect; p <
0.05). LGI shows better adherence for fat and dietary GI intake compared to CE
group (p < 0.05).
In conclusion, adding a low GI to CE dietary advice improved SMBG at pre and
post breakfast meal, and improve intake of energy, fat, dietary fibre, sugars,
dietary GI and GL. However, the increase in systolic blood pressure warrants
future investigation. The low GI dietary advice is feasible and well accepted
among GDM women. Low GI can be added to a current advice to further improve
the postprandial glycaemic management in GDM. |
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