Suplementação nutricional no tratamento e controle de complicações e progressão do diabetes mellitus tipo 1: uma revisão sistemática com metanálise de ensaios clínicos aleatórios

Abstract

Type 1 Diabetes Mellitus (T1DM) is a subtype of Diabetes Mellitus that has an autoimmune etiology, characterized by the destruction of pancreatic cells via apoptosis induced by autoantibodies, making the individual unable to produce insulin. The disease appears mainly in children or adolescents and there is still no safe or effective method for its prevention. The standard and essential therapy is based on the exogenous replacement of insulin, making it a costly and difficult treatment for most individuals. Furthermore, psychosocial repercussions among patients and their families are common in the first years of the disease due to sudden appearance and economic problems due to the cost of treatment, besides the micro and macrovascular complications caused by the disease. Regarding nutritional treatment, international and national guidelines focus on controlling carbohydrate consumption, with no specific recommendations for micronutrients and other compounds. Aiming to contribute to the debate about adjuvant therapies for the treatment of T1DM, this dissertation presents an article: a systematic review that includes a meta-analysis of randomized clinical trials of oral supplementation of vitamins, minerals, trace elements, non-essential compounds with antioxidant properties, amino acids and fatty acids. This review followed the Cochrane recommendations and was reported in accordance with PRISMA 2020, with searches for reports from the MEDLINE, Embase, CENTRAL, LILACS, The Gray Literature Report and ClinicaTrials.gov databases, in addition to citations of previous reviews, including reports published up to January 2023. The Risk Of Bias 2 (RoB2) tool was used to analyze the risk of bias and GRADE to assess the quality of the results. At the end of the study selection process, 58 (n=3,038) were included in the qualitative analysis and 18 (n=497) in meta-analyses. In the qualitative analysis of the results of the included studies, it was possible to observe only punctual and isolated positive results for specific compounds and functions, not related to glycemic control. After performing seven meta-analyses for the markers HbA1c, fasting C-peptide and required insulin dose, it was possible to observe positive effects for HbA1c with omega-3 (RMD= -0.33; 95%CI: -0.53, - 0.12, p=0.002; I²=0%; GRADE: low quality) and for fasting c-peptide with vitamin D (RMD= 0.05; 95%CI: 0.01, 0.9, p=0.023; I²=0%; GRADE: very low quality). Despite these findings, it is not possible to establish a recommendation on the use of nutritional supplements in DM1, mainly due to the inconsistency of the data and the high risk of bias in the included studies, which consequently revealed a low quality of evidence according to the GRADE evaluation of the meta-analyses carried out by this search. However, this work intends to compile information about the use of nutritional supplements in DM1, in addition to opening gaps for future research with this type of intervention, mainly with the use of vitamin D in controlling the progression of DM1 in the initial phase, since the result of this work consolidates the findings of other reviews and observational studies with vitamin D and its relationship with the disease.