Is there an optimal diet for patients with type 2 diabetes? Yes, the one that works for them!

Abstract

Diet is fundamental in the aetiology and management of type 2 diabetes. The optimal diet remains unclear and the EASD and ADA have recently adopted increased flexibility with dietary composition, whilst maintaining a focus on reduced energy, reduced saturated fat and increased dietary fibre. This review draws three conclusions on the current evidence for three dietary approaches; high protein diets, very low carbohydrate diets and the Mediterranean diet, specifically for the management of weight, glycaemic control and cardiovascular risk in patients with type 2 diabetes. First, unless energy intake is reduced below energy expenditure over a sustained period of time, weight loss will not occur. Second, weight loss achieved with any dietary approach over the long-term is modest, though compared with the natural history of weight gain in obesity is clinically important. Third, the evidence supports flexibility in dietary composition with no approach superior to another for weight loss, glycaemic control or cardiovascular risk management. Most importantly there is evidence that adherence to any given dietary approach is more important than the macronutrient prescription. So the best diet for those with type 2 diabetes is the one that works for them, and critically the one that they can maintain in the long term.

Red meat, dairy, and insulin sensitivity: a randomized crossover intervention study

“…DBP, diastolic blood pressure; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; NGT, normal glucose tolerance; SBP, systolic blood pressure. 2 Mean 6 SD (all such values). 3 n = 45.…”

“…Improved diet quality, energy restriction, and weight loss and increased physical activity lowers risk of T2D, but the role of specific dietary components is still debated (2).…”

The role of celebrity diets versus medical nutrition therapy in type 2 diabetes

“…A 2-year RCT (n = 419) found no difference in postprandial glycemia or weight loss in T2DM patients who followed a high-protein (such as the Atkins) or highcarbohydrate diet although participants in the high-protein group found adherence to the diet difficult. [13] While limited duration studies have demonstrated improved hemoglobin A1c (HbA1c) and reduced requirements for oral hyperglycemic medication in T2DM patients who followed a very-low-CHO ketosis inducing diet, this was not reflected in a longer term RCT which found no significant improvement in HbA1c in the low-CHO (Atkins) or high-CHO-low-fat (conventional weight loss) study arms after 1 year. [13,14] The UK Nutrition Society advise patients with diabetes or pre-existing kidney disease to exercise caution with highprotein diets, whereas Diabetes UK highlight the lack of evidence for long-term safety and efficacy of low-CHO diets (Atkins, Dukan) while warning of the increased risk of hypoglycemia.…”

Dairy consumption and insulin sensitivity: A systematic review of short- and long-term intervention studies

“…Improvement in diet and increased physical activity lowers the risk for T2DM, and while energy restriction and weight loss have been proven to improve insulin sensitivity, the role of specific dietary components is uncertain [5]. Some epidemiological evidence indicates that a diet high in dairy foods may be protective against the onset of T2DM [6,7], but the data is mixed [8,9].…”