Comprehensive Approach to Medical Nutrition Therapy in Patients with Type 2 Diabetes Mellitus: From Diet to Bioactive Compounds

Abstract

In the pathogenesis of type 2 diabetes mellitus (T2DM), diet plays a key role. Individualized medical nutritional therapy, as part of lifestyle optimization, is one of the cornerstones for the management of T2DM and has been shown to improve metabolic outcomes. This paper discusses major aspects of the nutritional intervention (including macro- and micronutrients, nutraceuticals, and supplements), with key practical advice. Various eating patterns, such as the Mediterranean-style, low-carbohydrate, vegetarian or plant-based diets, as well as healthy eating plans with caloric deficits have been proven to have beneficial effects for patients with T2DM. So far, the evidence does not support a specific macronutrient distribution and meal plans should be individualized. Reducing the overall carbohydrate intake and replacing high glycemic index (GI) foods with low GI foods have been shown as valid options for patients with T2DM to improve glycemic control. Additionally, evidence supports the current recommendation to reduce the intake of free sugars to less than 10% of total energy intake, since their excessive intake promotes weight gain. The quality of fats seems to be rather important and the substitution of saturated and trans fatty acids with foods rich in monounsaturated and polyunsaturated fats lowers cardiovascular risk and improves glucose metabolism. There is no benefit of supplementation with antioxidants, such as carotene, vitamins E and C, or other micronutrients, due to the lack of consistent evidence showing efficacy and long-term safety. Some studies suggest possible beneficial metabolic effects of nutraceuticals in patients with T2DM, but more evidence about their efficacy and safety is still needed.

Adherence to the Mediterranean Diet and its association with gastric cancer: health benefits from a Planeterranean perspective

“…In contrast, the dietary pattern of Mediterranean countries, known for its multiple health benefits [75][76][77][78], is characterized by high consumption of extra virgin olive oil, cereals, nuts, fruits, legumes, and white meats; moderate consumption of low-fat dairy products and alcohol; and low consumption of sugars, fats, red meat, and processed foods [79]. These foods are rich in polyphenols, which act as antioxidants, reduce oxidative stress, modulate cell signaling pathways involved in inflammation, regulate the production of proinflammatory cytokines, and influence immune system cells [80,81].…”

Ultra-processed foods consumption, depression, and the risk of diabetes complications in the CARTaGENE project: a prospective cohort study in Quebec, Canada

“…Type 2 diabetes (T2D) is a chronic metabolic condition which requires intensive self-care management (1). Adopting and/or maintaining a healthy diet remains one of the main strategies for the management of T2D and its complications (2). Research has demonstrated that following healthy diets such as the Mediterranean diet (high in olive oil, fruit, nuts, vegetables, and cereals intakes) can reduce the risk of micro-and macrovascular complications among individuals with T2D (3)(4)(5)(6).…”

The effects of probiotics supplementation on glycaemic control among adults with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised clinical trials

“…Recent studies have shown that the gut microbiota plays a key role in the maintenance of host homeostasis and pathogenesis of T2DM [ 9 , 10 ]. Probiotics are microbial dietary supplements that alter the gut microbiota.…”