Louisiana Tech University Louisiana Tech Digital Commons Master's Theses Graduate School Spring 5-25-2019 The ffecE ts of a Low-Glycemic Index Diabetes Management Program on Weight, Body Mass Index, Triglycerides, Cholesterol and Hemoglobin A1C Values Morgan Williston Louisiana Tech University Follow this and additional works at: https://digitalcommons.latech.edu/theses Part of the Community Health and Preventive Medicine Commons, Dietetics and Clinical Nutrition Commons, and the Nutritional and Metabolic Diseases Commons Recommended Citation Williston, Morgan, "" (2019). Thesis. 15. https://digitalcommons.latech.edu/theses/15 This Thesis is brought to you for free and open access by the Graduate School at Louisiana Tech Digital Commons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Louisiana Tech Digital Commons. For more information, please contact [email protected]. THE EFFECTS OF A LOW-GLYCEMIC INDEX DIABETES MANAGEMENT PROGRAM ON WEIGHT, BODY MASS INDEX, TRIGLYCERIDES, CHOLESTEROL AND HEMOGLOBIN A1C VALUES by Morgan Williston, B.S., RDN, LDN A Thesis Presented in Partial Fulfillment of the Requirements of the Degree Master of Science SCHOOL OF HUMAN ECOLOGY COLLEGE OF APPLIED AND NATURAL SCIENCES LOUISIANA TECH UNIVERSITY May 2019 LOUISIANA TECH UNIVERSITY GRADUATE SCHOOL Click here to enter a date. March 29, 2019 Date of thesis defense We hereby recommend that the thesis prepared by Morgan Williston, B.S., RDN, LDN entitled The effects of a low-glycemic index diabetes management program on weight, body mass index, triglycerides, cholesterol, and hemoglobin A1c values be accepted in partial fulfillment of the requirements for the degree of Master of Science in Nutrition & Dietetics Dr. Catherine Fontenot, Supervisor of Thesis Research Dr. Ethel Jones, Head of Human Ecology Members of the Thesis Committee: Dr. Janet Pope Dawn Erickson Approved: Approved: _____________________________ _____________________________ Gary A. Kennedy Ramu Ramachandran Dean of Applied & Natural Sciences Dean of the Graduate School GS Form 13 (01/19) ABSTRACT The purpose of this study was to evaluate effects of a low-glycemic index diet on weight, body mass index (BMI), triglycerides, cholesterol levels, and hemoglobin A1c (HbA1c) following participation in a 12-hour outpatient diabetes self- management education (DSME) program. This DSME program is unique as it focuses on a low-glycemic index diet rather than the traditional carbohydrate consistent diet to control blood glucose levels. Health outcomes obtained post participation were compared to baseline data. Participants were 283 individuals with type 2 diabetes including 94 (33%) men and 189 (67%) women, with a mean baseline HbA1c of 8.7 ±2.2%. Statistically significant improvements were seen in mean BMI (-0.7±2.0 kg/m2, p<0.05), HbA1c (-1.1±1.9%, p<0.05), and total cholesterol (-12.3±37.3 mg/dL, p<0.05). No statistically significant differences in changes between men and women were found for the outcomes measured. Although males showed improvements in HDL cholesterol (+1.7±8.1 mg/dL, p =0.052), results were not statistically significant, unlike the significant improvements for the female group (+1.6±10.1 mg/dL, p<0.05). Traditionally, a carbohydrate consistent diet has been supported as the primary diet for diabetes management. This research shows a low-glycemic index diet can also be beneficial. Future research should include long-term randomized control trials to compare the two approaches to diabetes management. The effects of the low-glycemic index diet on medication use and quality of life also should be explored. iii APPROVAL FOR SCHOLARLY DISSEMINATION The author grants to the Prescott Memorial Library of Louisiana Tech University the right to reproduce, by appropriate methods, upon request, any or all portions of this Thesis. It is understood that “proper request” consists of the agreement, on the part of the requesting party, that said reproduction is for his personal use and that subsequent reproduction will not occur without written approval of the author of this Thesis. Further, any portions of the Thesis used in books, papers, and other works must be appropriately referenced to this Thesis. Finally, the author of this Thesis reserves the right to publish freely, in the literature, at any time, any or all portions of this Thesis. Author Date March 29, 2019 TABLE OF CONTENTS ABSTRACT...................................................................................................................... iii LIST OF TABLES............................................................................................................ vii CHAPTER 1 INTRODUCTION ....................................................................................... 1 Statement of the Problem........................................................................................ 1 Purpose of the Study .............................................................................................. 5 Hypotheses.............................................................................................................. 5 Justification............................................................................................................. 6 CHAPTER 2 REVIEW OF LITERATURE……...…………………………………….... 8 Prevalence of Diabetes……...…………………………………………................. 8 Diagnostic Criteria for Diabetes…….…………………….……………............. 10 Complications of Diabetes…………...…………………………………............. 10 Effectiveness of Nutrition Therapy in Diabetes Management .....….................... 11 Nutrition Therapy Interventions …………….......………………....….. 13 Prevalence of Nutrition Therapy ……………...…...………….....….… 14 Weight Loss Intervention and Glycemic Control……………………...........….. 15 Low-Glycemic Diet and Diabetes Management. .…...…………………............. 17 Carbohydrate Restriction ……………………..............……….....…….. 21 v Non-Nutritive Sweeteners…….............……………………………....... 22 Fats……………………………….........…………………………......… 24 Dietary Patterns and Diabetes Management……………........……..….............. 26 DASH Dietary Pattern…….……………………….……………......….. 26 Low-Fat Dietary Pattern……….........…………………………......…… 27 Vegetarian Dietary Pattern……………………………………….......… 27 Mediterranean Dietary Pattern……………………………………......... 28 Summary……….....……………..…………………………………...........…... 29 CHAPTER 3 METHODS ................................................................................................ 30 Subjects................................................................................................................. 30 Instruments............................................................................................................ 31 Data Collection..................................................................................................... 31 Data Analysis........................................................................................................ 32 CHAPTER 4 RESULTS................................................................................................... 33 CHAPTER 5 DISCUSSION............................................................................................. 39 APPENDIX A................................................................................................................... 47 A-1 Data Collection Instrument............................................................................ 48 APPENDIX B................................................................................................................... 49 B-1 Letter of Approval from HUC ...................................................................... 50 B-2 Letter of Approval from BRG’s IRB ............................................................ 51 REFERENCES................................................................................................................. 53 vi LIST OF TABLES Table 1: Low-Glycemic Index Diabetes Management Program Participant Demographics.................................................................................................... 34 Table 2: Clinical Baseline Data For Program Participants........................................... 35 Table 3: Clinical Follow-Up Data For Program Participants........................................ 35 Table 4: Changes In Outcomes Measures Following Participation In A Low-Glycemic Index Focused Diabetes Management Program In Participants......................... 37 Table 5: Changes In Outcome Measures Following Participation In A Low-Glycemic Index Focused Diabetes Management Program Based on Gender..................... 38 vii CHAPTER 1 INTRODUCTION According to the American Diabetes Association (ADA), diabetes is characterized by hyperglycemia triggered by an abnormal surge in insulin and/or a defect in insulin action (2014). The development of diabetes can be caused by autoimmune damage to pancreatic B-cells, promoting an insulin deficiency and defects in tissue insulin sensitivity. Often, diminishing insulin secretion and insulin resistance can occur simultaneously in the same individual, and it can be unclear which defect is the primary cause of hyperglycemia (ADA, 2014). Two general etiopathogenetic groups, Type 1 and Type 2 diabetes, categorize the majority of diabetes cases (ADA, 2014). Individuals diagnosed with type 1 diabetes have the inability to secrete insulin (ADA, 2014). On the other hand, individuals with both insulin resistance and insufficient compensatory insulin secretory response are