Hội nghị Lão khoa thường niên 2022 Đà Lạt - ngày 15, 16 & 17/4/2021 Vai trò inositol và hệ bột đường tiên tiến kiểm soát bệnh đái tháo đường BS Võ Tuấn Khoa Nội dung • Vai trị dinh dưỡng • Inositol • Hệ bột đường tiên tiến Vai trị dinh dưỡng Dinh dưỡng trị liệu • Nutrition therapy, Medical nutrition therapy • Treatment of a medical condition (ex DM) = change in diet – Quality – Quantity – Methods of nutrient intake https://www.nature.com/subjects/nutritiontherapy#:~:text=Nutrition%20therapy%20is%20the%20treatment,provided%20by%20a%20registered%20dietitian Dinh dưỡng chuyên biệt ĐTĐ • Diabetic specific nutritional formula; Diabetic specific formula (DSF) – specialized forms of therapy that consist of macro- and micronutrient ingredients to manage malnutrition, dysglycemia, and other cardiometabolic risk factors – low glycemic indices and complement dietary recommendations for patients with type diabetes Nutrients 2020, 12, 3616; doi:10.3390/nu12123616 Inositol Inositol gì? • 1850: Scherer J isolated from muscle cell: inosite – inos: muscle – ite: ester • Inositol (term) – in: fiber, sinew – ose: carbohydrate – ol: alcohol Irvine, R F A short history of inositol lipids J Lipid Res 2016 57: 1987–1994 Inositol gì? • Inositol (chemical) – – • Myo-inositol (MI) and D-chiroinositol (DCI) – – • six-carbon ring structure each hydroxylated carbon active common Source of Myo-inositol – dietary intake, with cereals, legumes, oil seeds and nuts (1g/day) – endogenously with kidneys (4g/day) Front Pharmacol 2019: 10:1172 doi: 10.3389/fphar.2019.01172; Int J Mol Sci 2017, 18, 2187 Vai trò inositol • Inositol: component of structural lipids: phosphatidyl-inositol (PI) and its various phosphates, including phosphatidyl-inositol phosphate (PIP) lipids • MI: as second messenger in the transduction of several endocrine signals (FSH, TSH and insulin) Figure Synthesis, sources and role of myo-inositol and D-chiro-inositol in insulin signaling pathway G6P, glucose-6-phosphate; MIPS1, myoinositol-phosphate synthase; IMPase, inositol monophosphatase; IP3, inositoltrisphosphate; IP2, inositol-biphosphate; MI, myo-inositol; DCI, D-chiro-inositol; GLUT4, glucose transporter type 4; FFA, free fatty acids; IRS2, insulin receptor type 2; PI3K, phosphoinositide 3-kinase; GSK3β, glycogen synthase kinase 3β Inositols as chemical insulin mediators Int J Mol Sci 2017, 18, 2187 Insulin signaling pathway IRS: insulin receptor substract PI3P: Phosphoinositite phosphate PDK: Protein 3-phosphoinositidedependent protein kinase Akt: protein kinase B GLUT4, glucose transporter type 4; 250 p=0.02 Baseline months 200 150 p=0.14 FPG (mg/dL) HbA1c (%) Weight (Kg) Baseline 192.6 8.6 80.5 months 160.9 7.7 79.8 100 p=0.02 50 FPG HbA1c Weight Supplementation with a combination of MI and DCI is an effective and safe strategy for improving glycemic control in T2DM Clin Nutr 2019;38(3):1146-1152 • 20 nghiên cứu phân tích tổng hợp • Inositol dẫn xuất MI, DCI, Pinitol • Đối tượng: ĐTĐ; tiền ĐTĐ; mãn kinh; PCOS; thừa cân Outcome Inositol Control Mean different or RR (95%CI) P FPG (mmol/l) 524 532 -0.44 (-0.65; -0.23)