The effect of medical nutrition therapy on glycemic control, inflammatory cytokines, and intestinal barrier function in Type 2 diabetic patients

This research was conducted to evaluate the effect of Medical Nutrition Therapy (MNT) on glycemic control, inflammatory cytokines, and intestinal barrier function in individuals with Type 2 diabetes. Forty individuals between the ages of 20-64,9 with Type 2 diabetes, who applied to the Diabetes Unit of the Department of Endocrinology at Gazi University Medical Faculty, were included in the study. The individuals were divided into two groups: the Medical Nutrition Therapy group (n=21) and the control group (n=19). The 3-day dietary records and anthropometric measurements, Diabetes Quality of Life Questionnaire (DQOL), Self-Care Activities Questionnaire for Diabetes (SDSCA), glycemic control parameters, blood lipids, inflammatory cytokines, and intestinal barrier function marker levels of all individuals were obtained and recorded at the beginning of the study and at the end of the 12th week. The individuals in the MNT group received medical nutrition therapy for a duration of 12 weeks, and their glycemic control and anthropometric measurements were monitored every two weeks. The therapy was adjusted according to the patient's needs. Conversely, the control group was referred to the hospital's nutrition and diet unit by providing a referral note. At the end of the study, there was a significant decrease in body weight in the MNT group compared to the baseline (p<0,05). The individuals receiving medical nutrition therapy showed a significant decrease in APG (Δ: -56,5±33,9 mg/dL, p=0,001), HbA1c (Δ: -1,54±0,5%, p<0,001), total cholesterol (Δ: -35,0 (39,5) mg/dL, p=0,001), LDL cholesterol (Δ: -28,2±23,2 mg/dL, p=0,012), and triglyceride (Δ: -66,7 (72,5) mg/dL, p<0,001) levels compared to the control group.The individuals in the MNT group showed a significant decrease in TNF-α (Δ: -9,6 (6,4) ng/L, p<0,001), IL-6 (Δ: -4,4 (10,6) ng/L, p<0,001), CRP (Δ: -1,1 (2,1) ng/L, p<0,001), and ZO-1 (Δ: -0,8 (1,4) ng/L, p<0,001) levels compared to the control group. There was a positive correlation between the change in APG levels and the change in TNF-α (r=0,654, p<0,001), IL-6 (r=0,578, p<0,001), CRP (r=0,406, p=0,009), and ZO-1 levels (r=0,390, p=0,013). There was a positive correlation between the change in HbA1c levels and the change in TNF-α (r=0,833, p<0,001), IL-6 (r=0,773, p<0,001), CRP (r=0,315, p=0,014), and ZO-1 levels (r=0,645, p<0,001). Following medical nutrition therapy, individuals in the MNT group showed a significant increase in DQOL (Δ: 72,9±10,6, p<0,001) and SDSCA (Δ: 26,5±2,9, p<0,001) scores. A one-unit decrease in ZO-1 levels resulted in a 2,938-unit decrease in APG value (CI: 1,134-4,742, p=0,002), a 0,063-unit decrease in HbA1c level (CI: 0,003-0,122, p=0,041), and a 1,673-unit decrease in TNF-α level (CI: 0,455-2,892, p=0,002). In conclusion, strict monitoring of medical nutrition therapy has been shown to improve glycemic control, cardiovascular risk factors, inflammation, and intestinal permeability in individuals with Type 2 diabetes.