Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Abstract

■ AbstractMedical nutrition therapy constitutes an important lifestyle intervention in diabetes management. Several nutrition patterns have been effective in improving diabetes control, but there has been a debate about the optimal macronutrient composition in diabetes meal planning. For many years, the recommended diets for persons with and without diabetes were similar, i.e. heart-healthy and low in fat. For almost three decades, carbohydrates have been lauded, lipids demonized, and proteins considered of little importance. However, in the past few years, this concept has been questioned and reassessed. Modern nutritional recommendations for people with diabetes are headed towards individualization, but lack specific guidelines. Nutritional algorithms may help nutritionists in diabetes meal planning. This review aims to discuss: 1) the effects of the three major macronutrients (carbohydrates, proteins, and lipids) on glucose levels, 2) current recommendations for macronutrient intake for people with diabetes, and 3) specific parameters that need to be taken into consideration when determining the macronutrient composition for a person with diabetes, for example body mass index, degree of insulin resistance, HbA1c value, and lipid profile (especially triglycerides and HDL cholesterol). These aspects are analyzed in the context of the results of recent studies, especially randomized controlled trials (RCTs). Finally, we introduce an individualized nutritional concept that proposes carbohydrate over lipid restriction, substitution of SFAs with MUFAs and PUFAs, and adequate intake of dietary fiber, which are key factors in optimizing diabetes management.

Influences of added sugar consumption in adults with type 2 diabetes risk: A principle‐based concept analysis

“…Each study reviewed all sources of added sugars consumed in the diet and did not limit added sugar consumption to individual dietary products (eg, beverages only). However, certain dietary products like sweets and desserts were often mentioned due to their high added sugar content . The studies reviewing dietary added sugar sources did so in the context of T2D risk; however, one researcher discussed implications of added sugar on noncommunicable disease, including T2D risk .…”

“…Specifically, dietary self‐report is associated with intentional misreporting; typically, under‐reporting of dietary intake . Diagnostic methods to determine added sugar's impact on T2D risk were typically measured using blood‐serum laboratory tests like glycosylated hemoglobin (HbA1c), fasting blood glucose, oral glucose tolerance testing, or the homeostatic model assessment for insulin resistance (HOMA‐IR) …”

“…These examples include words like sugar, sucrose, free sugars, dietary sugars, nutritive sweeteners, sugar‐sweetened beverages (SSB), high glycemic carbohydrates, high‐fructose corn syrup (HFCS), fructose, and fructose‐containing sugars . Several publications studied SSB consumption which was not always portrayed as an exclusive “added sugar product”, but rather as a product containing HFCS . A few publications described SSBs as caloric sweeteners instead of products containing added sugar …”

“…However, certain dietary products like sweets and desserts were often mentioned due to their high added sugar content. 14,[41][42][43][44][45][46] The studies reviewing dietary added sugar sources did so in the context of T2D risk; however, one researcher discussed implications of added sugar on noncommunicable disease, including T2D risk. 46 Additionally, El-Sayed et al 41 discussed how higher added sugar consumption was more common among individuals with diabetes, though did not specify which form of diabetes (eg, type 1, type 2, prediabetes).…”

“…11 Diagnostic methods to determine added sugar's impact on T2D risk were typically measured using blood-serum laboratory tests like glycosylated hemoglobin (HbA1c), fasting blood glucose, oral glucose tolerance testing, or the homeostatic model assessment for insulin resistance (HOMA-IR). 5,11,35,45,50 In summary, the concept added sugar is applicable and useful in nursing and health-related disciplines and can be appropriately operationalized using a variety of dietary assessment tools and questionnaires. These methods allow researchers, nurses, and other healthcare professionals ways to analyze added sugar quantities and identify typical dietary sources.…”