Aberystwyth University Dietary interventions for type 2 diabetes: How millet comes to help Kam, Jason; Puranik, Swati; Yadav, Rama; Manwaring, Hanna Rose; Pierre, Sandra; Srivastava, R. K.; Yadav, Rattan Published in: Frontiers in Plant Science DOI: 10.3389/fpls.2016.01454 Publication date: 2016 Citation for published version (APA): Kam, J., Puranik, S., Yadav, R., Manwaring, H. R., Pierre, S., Srivastava, R. K., & Yadav, R. (2016). Dietary interventions for type 2 diabetes: How millet comes to help. 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Sep. 2021 fpls-07-01454 September 24, 2016 Time: 15:39 # 1 REVIEW published: 27 September 2016 doi: 10.3389/fpls.2016.01454 Dietary Interventions for Type 2 Diabetes: How Millet Comes to Help Jason Kam1, Swati Puranik1, Rama Yadav1, Hanna R. Manwaring1, Sandra Pierre1, Rakesh K. Srivastava2 and Rattan S. Yadav1* 1 Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Gogerddan, Aberystwyth, UK, 2 International Crops Research Institute for the Semi-Arid Tropics, Patancheru, India Diabetes has become a highly problematic and increasingly prevalent disease world- wide. It has contributed toward 1.5 million deaths in 2012. Management techniques for diabetes prevention in high-risk as well as in affected individuals, beside medication, are mainly through changes in lifestyle and dietary regulation. Particularly, diet can have a great influence on life quality for those that suffer from, as well as those at risk of, diabetes. As such, considerations on nutritional aspects are required to be made to include in dietary intervention. This review aims to give an overview on the general consensus of current dietary and nutritional recommendation for diabetics. In light of such recommendation, the use of plant breeding, conventional as well as more recently developed molecular marker-based breeding and biofortification, are Edited by: Marta Wilton Vasconcelos, discussed in designing crops with desired characteristics. While there are various Catholic University of Portugal, recommendations available, dietary choices are restricted by availability due to geo-, Portugal political-, or economical- considerations. This particularly holds true for countries such Reviewed by: as India, where 65 million people (up from 50 million in 2010) are currently diabetic and Deepmala Sehgal, International Maize and Wheat their numbers are rising at an alarming rate. Millets are one of the most abundant crops Improvement Center, Mexico grown in India as well as in Africa, providing a staple food source for many poorest of the Elisabete Pinto, Universidade Católica Portuguesa, poor communities in these countries. The potentials of millets as a dietary component Portugal to combat the increasing prevalence of global diabetes are highlighted in this review. *Correspondence: Keywords: millet, diabetes, hyperglycaemia, crop, nutritional characteristics, diet, plant breeding Rattan S. Yadav [email protected] Specialty section: TYPE 2 DIABETES OVERVIEW AND ASSOCIATED This article was submitted to COMPLICATIONS Plant Nutrition, a section of the journal Diabetes is a chronic disease that is characterized by high level of blood glucose also known as Frontiers in Plant Science hyperglycaemia. According to WHO 2015 published figure1, 9% of the world population aged 18 Received: 31 May 2016 and above has contracted diabetes and an estimated 1.5 million deaths per year are attributed to Accepted: 12 September 2016 diabetes directly. It is well known that glucose level of a diabetic patient increases dramatically Published: 27 September 2016 beyond the normal range after a meal. It is also true that their blood glucose level would soon drop Citation: as the body failed to store the excess glucose for later use. Kam J, Puranik S, Yadav R, Diabetes is classified into Types 1 and 2. Type 1 diabetes is also known as juvenile diabetes Manwaring HR, Pierre S, or insulin-dependent diabetes as the patients’ pancreas cannot produce or produces little insulin Srivastava RK and Yadav RS (2016) Dietary Interventions for Type 2 and often presents itself from childhood (Diabetes.co.uk, 2016c). Type 2 diabetes (T2D), however, Diabetes: How Millet Comes to Help. often first appears in adults when the body becomes resistant to insulin or fails to make sufficient Front. Plant Sci. 7:1454. doi: 10.3389/fpls.2016.01454 1http://www.who.int/diabetes/en/ Frontiers in Plant Science | www.frontiersin.org 1 September 2016 | Volume 7 | Article 1454 fpls-07-01454 September 24, 2016 Time: 15:39 # 2 Kam et al. Millets for Type 2 Diabetes amounts of insulin (Martin et al., 1992; Weyer et al., 2001). further physical as well as psychological complications to the T2D comprises 90% of people with diabetes around the world patients. (NHS choice, 2014). This can largely be the result of excess body weight and physical inactivity. Added complication to T2D is that it presents less marked symptoms than Type 1 diabetes WHY DIET IS AN IMPORTANT and is often diagnosed only when complications have already INTERVENTION arisen. Major complications caused by hyperglycaemia include Diabetic patients experience fluctuation of blood glucose causing atherosclerosis that hardens and narrows the blood vessels. various health complications (Coppell et al., 2010; Jali et al., Other diabetes-related complications are heart disease, stroke, 2012). One of the interventions is to control this fluctuation using retinopathy, and kidney failure (Bitzur et al., 2009; Sone dietary regulation with or without exercise and medications. et al., 2011). Diabetic retinopathy leads to blindness by causing With the number of people suffering from diabetes on the rise cumulative damage to the small blood vessels in the retina and globally (WHO, 2016), it is imperative to develop preventative contributes to 1% blindness globally. Similarly, kidney failure measures involving intervention of diet and lifestyle, which due to prolonged restricted blood flow is a very common would greatly reduce the risk of developing diabetes (Diabetes complication. Elevated blood glucose can also cause nerve Prevention Program Research Group, 2002; Lindstrom et al., damage (Boulton et al., 2005) that may lead to the need of limb 2006). In addition, the risk of subsequent health complication can amputation (Brownlee, 2001). Such ailments reduce the patients’ be reduced with the right treatment (Gaede et al., 1999). Indeed, quality of life, and potentially relationship with others around decline of diabetes-related complication such as retinopathy has them. been shown to be positively correlated with earlier intervention Other additional complications also include increased bone (Vallance et al., 2008). This results in the reduction of financial fracture risks in both Types 1 and 2 diabetics (Saito et al., burden on the health services as well as improving the well-being 2006; Vestergaard, 2006; Oei et al., 2015). Interestingly, however, for the patients. Types 1 and 2 diabetics have lower and higher bone mineral A study by the Diabetes Prevention Program Research Group density than healthy subjects, respectively, even though both are (2002) concluded that lifestyle intervention resulted in 39% at elevated risk of fracturing (Ma et al., 2012; Oei et al., 2013; lower incidence of diabetes than another group using only Strotmeyer, 2013; NIH Osteoporosis and Related Bone Disease metformin, an interventive medication for people who are at risk National Resource Center, 2015). Fracturing risks associated of diabetes. The same study found that both lifestyle intervention with different bone mineral densities can be explained by and metformin were effective in restoring normal fasting glucose other diabetes related factors. Firstly, T2D subjects are often values. Indeed, lifestyle intervention, including dietary habit found to have higher body mass index and less physical reform, was found to be more effective in restoring normal exercise making any fall carrying a higher risk of fracture glucose values after ingestion. Though this experiment was not (Vestergaard, 2006; Ma et al., 2012). Also, other complications designed to investigate dietary change or increased physical such as retinopathy, as well as often-associated habits such activities individually, it was undeniable that both contributed as higher alcohol consumption interfering with the sense of significantly toward lowering the risk of developing diabetes. balance, making fall more frequent adding to the fracture It is notable that there are different prescribed diets across risk (Rubin,