Cardiovascular effects of a nutritional educational intervention in diabetic patients with poor control

Introduction: Currently there are changes in lifestyle that have been modifying the nutritional culture, moving away from the Mediterranean diet (DMed) and acquiring a more sedentary lifestyle, a fact that has contributed to a significant increase in risk factors. (CVRF) such as obesity and type 2 diabetes mellitus (DM2), and consequently to a global increase in metabolic syndrome (MS) and cardiovascular diseases (CVD), which in the 21st century continue to be the leading cause of morbidity and mortality To reduce this pandemic, a multidisciplinary approach is required focused on the application of primary and secondary prevention strategies for modifiable CVRFs, focused on nutritional promotion and education by promoting a healthier lifestyle and diet from childhood, as the one that encompasses the MedD. This dietary pattern, together with physical exercise, has been shown to contribute to the primary and secondary prevention of DM2 and coexisting CVRF. Objective: To analyze the effects of a nutritional educational intervention from Primary Care on the control of cardiovascular risk factors in patients with poorly controlled type 2 diabetes, through the degree of adherence to the Mediterranean diet, and to determine the prevalence of risk factors. cardiovascular risk pre and post intervention. Material and methods: Descriptive observational study and quasi-experimental analytical study (before-after) in 93 patients diagnosed with type 2 diabetes mellitus with poor glycemic control (Hb1Ac >= 7%), carried out in various health centers in Albacete and Cuenca between 2018 and 2019, in which the relationship between adherence to MedDM and CVRF is evaluated, before and after an educational intervention on MedDM. They are administered a data collection sheet that includes a MedD adherence survey (MEDAS-14) at baseline and at 6 months, after completing an education on MedD in Primary Care (PC) medical and nursing consultations. The pre- and post-intervention variables were analyzed: age groups, sex, years of evolution of DM2, body mass index (BMI), abdominal perimeter (PAB), systolic blood pressure (SBP), diastolic blood pressure (TAD) as well as basal glycemia parameters (GB), glycosylated hemoglobin (HbA1c), total cholesterol, HDL-C, LDL-C, triglycerides. The main variable "MEDAS-14" is related to the rest of the variables, before and after the intervention.Results: Initially, the score of the survey of adherence to the Mediterranean diet was relatively low (7.44 +/- 0.22 points), being in women (7.66 points) than in men (7.1 points). Both poor glycemic control and having a high BMI are related to low adherence to the Mediterranean diet. Pre-intervention in women there is a higher proportion of obesity (56%), AHT (44%), hypercholesterolemia 32%) and hypertriglyceridemia (46%). Instead, it was observed that active smoking (74%) prevailed in men. Post-intervention in men, better BMI figures were observed (less obesity) and in women there was better control of basal glycemia, hypertension and lipid parameters. Likewise, HDL-C values increase with greater adherence (p < 0.04); Elevated LDL-C and total cholesterol values are related to lower adherence to the Mediterranean diet (p < 0.01 and p < 0.05, respectively), as are elevated triglycerides (p < 0.00). The high levels of basal glycemia are also related to the low adherence to the Mediterranean diet (p < 0.04), as well as the increase in glycosylated hemoglobin (p < 0.06). Therefore, cardiovascular risk increases with low adherence (p < 0.08). After the educational intervention, we observed a moderate increase in the completion of the MedD (score of 8.5) and a notable improvement in the control of all the CVRF.Conclusions: A nutritional educational intervention improves adherence to the Mediterranean diet and optimizes the best metabolic control of CVRF (obesity, arterial hypertension, mixed dyslipidemia) in patients with DM2