What is type 1 diabetes?
Diabetes is a disease in which blood glucose levels are too high. In type 1 diabetes (T1D), the immune system attacks and destroys pancreatic beta cells that make insulin — a hormone that tells cells to absorb and use glucose for energy.[1] T1D usually begins during childhood or adolescence, but it can occur at any age. The prevalence of T1D tends to increase as you travel away from the equator, with rates substantially greater in Finland and other Northern European nations than in China and Venezuela.[2]
What are the main signs and symptoms of type 1 diabetes?
The signs and symptoms of T1D overlap with those of type 2 diabetes (T2D), which commonly results in many adults with T1D being mistakenly diagnosed with T2D. A classical sign of T1D is unintentional weight loss; other symptoms include:
- Increased thirst
- Extreme hunger
- Frequent urination
- Fatigue and weakness
- Blurred vision
- Impaired wound healing
Sometimes the first indication of T1D is a life-threatening condition called diabetic ketoacidosis (DKA), which is characterized by excessively high levels of ketone bodies in combination with high blood glucose.[1] Symptoms of DKA include fruity-smelling breath, deep and rapid breathing, dry or flushed skin, and nausea or vomiting.[1]
How is type 1 diabetes diagnosed?
Like T2D, T1D is diagnosed using blood tests to assess plasma glucose levels. A fasting plasma glucose, 2-hour plasma glucose during a 75-gram oral glucose tolerance test, or HbA1c value can be used to diagnose T1D. To differentiate T1D from T2D, a blood test is used to detect the presence of two or more autoantibodies, namely autoantibodies to insulin, glutamic acid decarboxylase, islet antigen 2, or zinc transport 8.[3]
What are some of the main medical treatments for type 1 diabetes?
Because the hallmark of T1D is insulin deficiency, the main medical treatment is multiple daily injections of prandial (i.e., with meals) and basal (i.e., background or between meals) insulin or continuous subcutaneous insulin infusion.[4] There are multiple approaches to insulin treatment, but in general, some form of insulin is given in a planned regimen tailored to the individual's unique situation to prevent DKA and avoid severe hypoglycemia while meeting their glycemic targets.[4]
In addition, adjunctive therapies to augment insulin treatment are being studied to optimize glycemic control. Pramlintide (an amylin analog) is the only option approved for use, but evidence from clinical trials suggests that common medications such as glucagon-like peptide-1 receptor agonists may also provide benefits.[5]
Have any supplements been studied for type 1 diabetes?
Supplements have not been studied for treating T1D, specifically, but for improving glycemic control or helping to maintain healthy blood glucose levels in general. A variety of micronutrients have been examined, most notably zinc, selenium, chromium, vitamin D, vitamin B3, and vitamin C.[6] Other common supplements marketed to improve glycemic control include dietary fiber, probiotics, cinnamon, aloe vera, and panax ginseng.
How could diet affect type 1 diabetes?
Nutrition — especially carbohydrates — has a substantial effect on blood glucose levels, so it’s important for people with T1D to plan their meals and corresponding insulin doses accordingly to optimize glycemic control. There is currently insufficient evidence to support one dietary pattern over another for managing T1D.[7] Consequently, the eating plan should be individualized based on personal preferences, socioeconomic status, and comorbidities, with the goal of achieving individual glycemic, cardiovascular, and body weight goals and preventing disease complications.[8] Additionally, eating plans should revolve around principles common among healthy dietary patterns, such as emphasizing nonstarchy vegetables, minimizing added sugars and refined grains, and choosing whole foods over ultraprocessed foods.[7]
Are there any other treatments for type 1 diabetes?
People with T1D should ideally perform at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week and 2–3 resistance exercise sessions, with no more than two consecutive days without activity to increase insulin sensitivity and lower the risk of cardiovascular disease.[9]
The glycemic response to exercise is highly variable and is affected by baseline fitness status; the type, intensity, and duration of exercise; the amount of insulin in circulation; preexercise blood glucose level; and preexercise meal composition.[5] As such, special care needs to be taken with respect to carbohydrate intake and insulin delivery around exercise to prevent hypoglycemia.
What causes type 1 diabetes?
Although known to be an autoimmune disease, the precise triggers of T1D are largely unknown but genetic susceptibility and environmental factors both contribute to the development of the disease. The most significant contributor to genetic risk is the presence of certain HLA alleles, but other genes contribute to heritability as well.[10] The research on environmental factors is comparatively less clear, but exposure to certain viruses (e.g., human enterovirus B), dietary factors (e.g., unsaturated fat, cow’s milk, vitamin D), and gut microbiota composition have all been associated with either a higher or lower risk of T1D.[10]
Examine Database: Type 1 Diabetes
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Frequently asked questions
Diabetes is a disease in which blood glucose levels are too high. In type 1 diabetes (T1D), the immune system attacks and destroys pancreatic beta cells that make insulin — a hormone that tells cells to absorb and use glucose for energy.[1] T1D usually begins during childhood or adolescence, but it can occur at any age. The prevalence of T1D tends to increase as you travel away from the equator, with rates substantially greater in Finland and other Northern European nations than in China and Venezuela.[2]
Together with insulin, glucagon keeps the blood glucose levels of healthy individuals stable within a narrow range. When blood glucose levels go down, glucagon secretion goes up[11] to increase blood glucose levels. As such, both pancreatic hormones are intimately linked, and the levels of one control the levels of the other directly[12]. Therefore, it seems plausible that there might also be a dysregulation in glucagon in people with type 1 diabetes. In recent years, there has been increasing evidence that suggests glucagon secretion is dysregulated in type 1 diabetes and contributes[13] to both hypo- and hyperglycemia. Hence, current therapeutic efforts[14] include treating both glucagon and insulin alterations for better glycemic control.
Of all diabetics, about 90% are T2. The classification of T1D and T2D isn’t always clear. Both conditions are the result of various genetic and environmental factors that cause progressive loss of beta-cell mass and/or function that manifests as hyperglycemia.[15]
Unlike T2D, T1D is an autoimmune condition. Additionally, T1D is characterized by insulin deficiency, whereas T2D is characterized by insulin resistance and inadequate insulin secretion.
People with T1D are more often diagnosed at a younger age (< 30 years); have a lower BMI (< 25); report unintentional weight loss, polyuria (excessive urination), and polydipsia (excessive thirst); and almost half present with diabetic ketoacidosis.[3]. The risk of developing T1 diabetes is not strongly affected by lifestyle factors whereas risk of T2D is.
However, there are exceptions to these generalities. A number of adults aged > 30 years diagnosed with T2D actually have T1D (known as “latent autoimmune diabetes of adults”) and some children and adolescents are diagnosed with T2D (known as “maturity-onset diabetes of the young”). Also, patients with T2D occasionally present with diabetic ketoacidosis.
A relatively reliable way to differentiate between T1D and T2D is to test for the presence of islet autoantibodies in the blood.
The signs and symptoms of T1D overlap with those of type 2 diabetes (T2D), which commonly results in many adults with T1D being mistakenly diagnosed with T2D. A classical sign of T1D is unintentional weight loss; other symptoms include:
- Increased thirst
- Extreme hunger
- Frequent urination
- Fatigue and weakness
- Blurred vision
- Impaired wound healing
Sometimes the first indication of T1D is a life-threatening condition called diabetic ketoacidosis (DKA), which is characterized by excessively high levels of ketone bodies in combination with high blood glucose.[1] Symptoms of DKA include fruity-smelling breath, deep and rapid breathing, dry or flushed skin, and nausea or vomiting.[1]
Like T2D, T1D is diagnosed using blood tests to assess plasma glucose levels. A fasting plasma glucose, 2-hour plasma glucose during a 75-gram oral glucose tolerance test, or HbA1c value can be used to diagnose T1D. To differentiate T1D from T2D, a blood test is used to detect the presence of two or more autoantibodies, namely autoantibodies to insulin, glutamic acid decarboxylase, islet antigen 2, or zinc transport 8.[3]
Because the hallmark of T1D is insulin deficiency, the main medical treatment is multiple daily injections of prandial (i.e., with meals) and basal (i.e., background or between meals) insulin or continuous subcutaneous insulin infusion.[4] There are multiple approaches to insulin treatment, but in general, some form of insulin is given in a planned regimen tailored to the individual's unique situation to prevent DKA and avoid severe hypoglycemia while meeting their glycemic targets.[4]
In addition, adjunctive therapies to augment insulin treatment are being studied to optimize glycemic control. Pramlintide (an amylin analog) is the only option approved for use, but evidence from clinical trials suggests that common medications such as glucagon-like peptide-1 receptor agonists may also provide benefits.[5]
Supplements have not been studied for treating T1D, specifically, but for improving glycemic control or helping to maintain healthy blood glucose levels in general. A variety of micronutrients have been examined, most notably zinc, selenium, chromium, vitamin D, vitamin B3, and vitamin C.[6] Other common supplements marketed to improve glycemic control include dietary fiber, probiotics, cinnamon, aloe vera, and panax ginseng.
Nutrition — especially carbohydrates — has a substantial effect on blood glucose levels, so it’s important for people with T1D to plan their meals and corresponding insulin doses accordingly to optimize glycemic control. There is currently insufficient evidence to support one dietary pattern over another for managing T1D.[7] Consequently, the eating plan should be individualized based on personal preferences, socioeconomic status, and comorbidities, with the goal of achieving individual glycemic, cardiovascular, and body weight goals and preventing disease complications.[8] Additionally, eating plans should revolve around principles common among healthy dietary patterns, such as emphasizing nonstarchy vegetables, minimizing added sugars and refined grains, and choosing whole foods over ultraprocessed foods.[7]
Alcohol has a variable effect on blood glucose. In the short term, beer and wine and mixed drinks raise blood glucose levels, while distilled spirits (gin, vodka, etc.) contain no carbohydrates and will not raise glucose levels (assuming you don’t add carbohydrate loaded mixes). In the longer term, alcohol has a hypoglycemic effect and increases the risk of delayed hypoglycemia — meaning that blood glucose levels substantially drop several hours after alcohol consumption — in people with T1D.[16] This effect seems to be a result of inhibition of gluconeogenesis (i.e., the production of glucose from noncarbohydrate substrates), a blunted growth hormone response, and impaired cognitive function and hypoglycemic awareness.[16] Consuming alcohol with food and having a snack before bed can help to minimize the risk of alcohol-induced hypoglycemia.[16]
The calculation of mealtime insulin doses is primarily based on the carbohydrate content of the meal because carbohydrate has the largest effect on postprandial blood glucose levels among the macronutrients. However, the fat and protein content of the meal can also influence postprandial blood glucose levels. In people with T1D, increasing the protein and/or fat content of a carbohydrate-containing meal increases postprandial blood glucose levels 2–5 hours after consumption[17] in a seemingly dose-dependent manner,[18][19] which necessitates additional insulin. It’s unclear how much more insulin is needed to optimize blood glucose control following a mixed meal containing large amounts of fat and protein, as it significantly varies between individuals.[17][20]
In studies that compared a low-carbohydrate diet (50–100 grams of carbohydrate per day) to a high-carbohydrate diet (205–245 grams of carbohydrate per day), total daily insulin dose was lower with the low-carbohydrate diet.[21][22][23]
People with T1D should ideally perform at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week and 2–3 resistance exercise sessions, with no more than two consecutive days without activity to increase insulin sensitivity and lower the risk of cardiovascular disease.[9]
The glycemic response to exercise is highly variable and is affected by baseline fitness status; the type, intensity, and duration of exercise; the amount of insulin in circulation; preexercise blood glucose level; and preexercise meal composition.[5] As such, special care needs to be taken with respect to carbohydrate intake and insulin delivery around exercise to prevent hypoglycemia.
Although known to be an autoimmune disease, the precise triggers of T1D are largely unknown but genetic susceptibility and environmental factors both contribute to the development of the disease. The most significant contributor to genetic risk is the presence of certain HLA alleles, but other genes contribute to heritability as well.[10] The research on environmental factors is comparatively less clear, but exposure to certain viruses (e.g., human enterovirus B), dietary factors (e.g., unsaturated fat, cow’s milk, vitamin D), and gut microbiota composition have all been associated with either a higher or lower risk of T1D.[10]
References
- ^The content of this page was partially adapted from MedlinePlus of the National Library of Medicine
- ^Lucier J, Weinstock RDiabetes Mellitus Type 1National Library of Medicine.
- ^American Diabetes Association Professional Practice Committee2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022Diabetes Care.(2022 Jan 1)
- ^, Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022.Diabetes Care.(2022-01-01)
- ^Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters ALThe management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).Diabetologia.(2021-12)
- ^Hannon BA, Fairfield WD, Adams B, Kyle T, Crow M, Thomas DMUse and abuse of dietary supplements in persons with diabetes.Nutr Diabetes.(2020-04-27)
- ^Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen S, Urbanski PB, Yancy WS JrNutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus ReportDiabetes Care.(2019 May)
- ^, , Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022.Diabetes Care.(2022-01-01)
- ^Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DFPhysical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes AssociationDiabetes Care.(2016 Nov)
- ^Ilonen J, Lempainen J, Veijola RThe heterogeneous pathogenesis of type 1 diabetes mellitus.Nat Rev Endocrinol.(2019-11)
- ^Taborsky GJ JrThe physiology of glucagonJ Diabetes Sci Technol.(2010 Nov 1)
- ^Farhy LS, McCall ALOptimizing reduction in basal hyperglucagonaemia to repair defective glucagon counterregulation in insulin deficiencyDiabetes Obes Metab.(2011 Oct)
- ^Cryer PEMinireview: Glucagon in the pathogenesis of hypoglycemia and hyperglycemia in diabetesEndocrinology.(2012 Mar)
- ^Farhy LS, McCall ALGlucagon - the new 'insulin' in the pathophysiology of diabetesCurr Opin Clin Nutr Metab Care.(2015 Jul)
- ^Skyler JS, Bakris GL, Bonifacio E, Darsow T, Eckel RH, Groop L, Groop PH, Handelsman Y, Insel RA, Mathieu C, McElvaine AT, Palmer JP, Pugliese A, Schatz DA, Sosenko JM, Wilding JP, Ratner REDifferentiation of Diabetes by Pathophysiology, Natural History, and Prognosis.Diabetes.(2017-02)
- ^Tetzschner R, Nørgaard K, Ranjan AEffects of alcohol on plasma glucose and prevention of alcohol-induced hypoglycemia in type 1 diabetes-A systematic review with GRADE.Diabetes Metab Res Rev.(2018-03)
- ^Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HAImpact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era.Diabetes Care.(2015-Jun)
- ^Paterson MA, Smart CEM, Lopez PE, Howley P, McElduff P, Attia J, Morbey C, King BRIncreasing the protein quantity in a meal results in dose-dependent effects on postprandial glucose levels in individuals with Type 1 diabetes mellitus.Diabet Med.(2017-06)
- ^Kirstine J Bell, Chantelle Z Fio, Stephen Twigg, Sally-Anne Duke, Gregory Fulcher, Kylie Alexander, Margaret McGill, Jencia Wong, Jennie Brand-Miller, Garry M SteilAmount and Type of Dietary Fat, Postprandial Glycemia, and Insulin Requirements in Type 1 Diabetes: A Randomized Within-Subject TrialDiabetes Care.(2020 Jan)
- ^Bell KJ, Toschi E, Steil GM, Wolpert HAOptimized Mealtime Insulin Dosing for Fat and Protein in Type 1 Diabetes: Application of a Model-Based Approach to Derive Insulin Doses for Open-Loop Diabetes Management.Diabetes Care.(2016-Sep)
- ^Signe Schmidt, Merete B Christensen, Nermin Serifovski, Camilla Damm-Frydenberg, Jens-Erik B Jensen, Tina Fløyel, Joachim Størling, Ajenthen Ranjan, Kirsten NørgaardLow versus high carbohydrate diet in type 1 diabetes: A 12-week randomized open-label crossover studyDiabetes Obes Metab.(2019 Jul)
- ^Ranjan A, Schmidt S, Damm-Frydenberg C, Holst JJ, Madsbad S, Nørgaard KShort-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trialDiabetes Obes Metab.(2017 Oct)
- ^Jeremy D Krebs, Amber Parry Strong, Pip Cresswell, Andrew N Reynolds, Aoife Hanna, Sylvan HaeuslerA randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into accountAsia Pac J Clin Nutr.(2016)
Examine Database References
- Oxidative Stress Biomarkers - Davison GW, Ashton T, George L, Young IS, McEneny J, Davies B, Jackson SK, Peters JR, Bailey DMMolecular detection of exercise-induced free radicals following ascorbate prophylaxis in type 1 diabetes mellitus: a randomised controlled trialDiabetologia.(2008 Nov)
- Plasma Vitamin C - Bishop N, Schorah CJ, Wales JKThe effect of vitamin C supplementation on diabetic hyperlipidaemia: a double blind, crossover studyDiabet Med.(1985 Mar)
- Blood glucose - Klein F, Juhl B, Christiansen JSUnchanged renal haemodynamics following high dose ascorbic acid administration in normoalbuminuric IDDM patientsScand J Clin Lab Invest.(1995 Feb)
- Blood glucose - Guerrero-Romero F, Rodríguez-Morán MThe effect of lowering blood pressure by magnesium supplementation in diabetic hypertensive adults with low serum magnesium levels: a randomized, double-blind, placebo-controlled clinical trialJ Hum Hypertens.(2009 Apr)
- LDL Oxidation - I De Leeuw, W Engelen, P Aerts, S SchransEffect of intensive magnesium supplementation on the in vitro oxidizability of LDL and VLDL in Mg-depleted type 1 diabetic patientsMagnes Res.(1998 Sep)
- Diabetic Neuropathy Symptoms - De Leeuw I, Engelen W, De Block C, Van Gaal LLong term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm)Magnes Res.(2004 Jun)
- Blood glucose - Serag H, El Wakeel L, Adly ACoenzyme Q10 administration has no effect on sICAM-1 and metabolic parameters of pediatrics with type 1 diabetes mellitusInt J Vitam Nutr Res.(2020 Jan 16)
- Blood glucose - Fallah M, Askari G, Soleimani A, Feizi A, Asemi ZClinical trial of the effects of coenzyme Q10 supplementation on glycemic control and markers of lipid profiles in diabetic hemodialysis patientsInt Urol Nephrol.(2018 Nov)
- Blood glucose - Gunton JE, Cheung NW, Hitchman R, Hams G, O'Sullivan C, Foster-Powell K, McElduff AChromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: a randomized, placebo-controlled, double-blind trial of supplementation in subjects with impaired glucose toleranceDiabetes Care.(2005 Mar)
- HbA1c - Omid Asbaghi, Naeini Fatemeh, Rezaei Kelishadi Mahnaz, Ghaedi Ehsan, Eslampour Elham, Nazarian Behzad, Ashtary-Larky Damoon, Alavi Naeini AmirmansourEffects of chromium supplementation on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trialsPharmacol Res.(2020 Jul 28)
- Blood glucose - Ranjan A, Schmidt S, Damm-Frydenberg C, Holst JJ, Madsbad S, Nørgaard KShort-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trialDiabetes Obes Metab.(2017 Oct)
- Blood glucose - Sheyu Li, Xiang Chen, Qianrui Li, Juan Du, Zhimin Liu, Yongde Peng, Mian Xu, Qifu Li, Minxiang Lei, Changjiang Wang, Shaoxiong Zheng, Xiaojuan Zhang, Hongling Yu, Jinyu Shi, Shibing Tao, Ping Feng, Haoming TianEffects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trialJ Diabetes Investig.(2016 Sep)
- Blood glucose - Barriocanal LA, Palacios M, Benitez G, Benitez S, Jimenez JT, Jimenez N, Rojas VApparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans. A pilot study of repeated exposures in some normotensive and hypotensive individuals and in Type 1 and Type 2 diabeticsRegul Toxicol Pharmacol.(2008 Jun)
- Heart Rate - Moloney MA, Casey RG, O'Donnell DH, Fitzgerald P, Thompson C, Bouchier-Hayes DJTwo weeks taurine supplementation reverses endothelial dysfunction in young male type 1 diabeticsDiab Vasc Dis Res.(2010 Oct)
- Total cholesterol - Fraser DA, Diep LM, Hovden IA, Nilsen KB, Sveen KA, Seljeflot I, Hanssen KFThe effects of long-term oral benfotiamine supplementation on peripheral nerve function and inflammatory markers in patients with type 1 diabetes: a 24-month, double-blind, randomized, placebo-controlled trialDiabetes Care.(2012 May)
- Total cholesterol - Amirani E, Milajerdi A, Reiner Ž, Mirzaei H, Mansournia MA, Asemi ZEffects of whey protein on glycemic control and serum lipoproteins in patients with metabolic syndrome and related conditions: a systematic review and meta-analysis of randomized controlled clinical trials.Lipids Health Dis.(2020-Sep-21)
- HbA1c - Joseph J Matthews, Eimear Dolan, Paul A Swinton, Lívia Santos, Guilherme G Artioli, Mark D Turner, Kirsty J Elliott-Sale, Craig SaleEffect of Carnosine or β-Alanine Supplementation on Markers of Glycemic Control and Insulin Resistance in Humans and Animals: A Systematic Review and Meta-analysisAdv Nutr.(2021 Jul 31)
- HbA1c - M Horvaticek, J Djelmis, M Ivanisevic, S Oreskovic, M HermanEffect of eicosapentaenoic acid and docosahexaenoic acid supplementation on C-peptide preservation in pregnant women with type-1 diabetes: randomized placebo controlled clinical trialEur J Clin Nutr.(2017 Aug)
- Type 1 Diabetes Incidence - Kempf K, Manzo G, Hanifi-Moghaddam P, Kappler S, Seissler J, Jaeger C, Boehm B, Roden M, Kolb H, Martin S, Schloot NC; PRODIAB Study GroupEffect of combined oral proteases and flavonoid treatment in subjects at risk of Type 1 diabetesDiabet Med.(2009 Dec)
- Type 1 Diabetes Incidence - Mohr SB, Garland CF, Gorham ED, Garland FCThe association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwideDiabetologia.(2008 Aug)
- Risk Of Cardiovascular Disease - Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, Clarke A, Franco OHLevels of vitamin D and cardiometabolic disorders: systematic review and meta-analysisMaturitas.(2010 Mar)
- Blood Flow - Skyrme-Jones RA, O'Brien RC, Berry KL, Meredith ITVitamin E supplementation improves endothelial function in type I diabetes mellitus: a randomized, placebo-controlled studyJ Am Coll Cardiol.(2000 Jul)
- Glycemic Control - Crandall JP, Oram V, Trandafirescu G, Reid M, Kishore P, Hawkins M, Cohen HW, Barzilai NPilot Study of Resveratrol in Older Adults With Impaired Glucose ToleranceJ Gerontol A Biol Sci Med Sci.(2012 Jan 4)
- Endothelial Function - Shannon OM, Mendes I, Köchl C, Mazidi M, Ashor AW, Rubele S, Minihane AM, Mathers JC, Siervo MMediterranean Diet Increases Endothelial Function in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.J Nutr.(2020-May-01)