Diabetes UK evidence‐based nutrition guidelines for the prevention and management of diabetes

Abstract

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines.

Diabetes UK nutrition guidelines: reinforcing the foundations of diabetes care

“…So, finding an approach that works for each individual is key,’ says Mr McArdle, a member of the committee that developed the 2018 guidelines. For example, individualised dietary approaches should prioritise eating more foods that support good health such as wholegrains, fruit and vegetables, fish, nuts and legumes (pulses), and less red and processed meat, refined carbohydrates and sugar‐sweetened beverages …”

“…The guidelines suggest that people who want to lose weight to reduce their risk of T2D should restrict energy intake, eat less total and saturated fat, and increase their fibre intake and exercise. Further studies, however, need to identify the most effective dietary intervention to promote weight loss …”

“…Even in the first few years after insulin's launch, the diet for a person with diabetes typically included, at most, 70g of carbohydrate a day – about three slices of modern bread . Today, people with diabetes can eat, essentially, a normal healthy diet as part of ‘an integrated package of education and clinical care’ …”

“…Yet many people with, or at risk of, diabetes still do not eat a healthy diet. So, in March 2018, Diabetes UK published the latest version of its Evidence‐based nutrition guidelines for the prevention and management of diabetes . The guidelines focus on food, rather than individual nutrients, and note that there is no ‘one‐size‐fits‐all prescriptive approach’.…”

Type 1 diabetes in adults: supporting self management

“…The most important feature is that carbohydrate intake and insulin doses should be matched. 35 Adults with type 1 diabetes should not routinely be advised to follow a low glycaemic index diet. 38 A prospective randomised controlled trial found no clinical benefit of a low glycaemic index diet versus a high glycaemic index diet.…”