Nutrition Therapy

Abstract

People with diabetes should receive nutrition counselling by a registered dietitian. Nutrition therapy can reduce glycated hemoglobin (A1C) by 1.0% to 2.0% and, when used with other components of diabetes care, can further improve clinical and metabolic outcomes. Reduced caloric intake to achieve and maintain a healthier body weight should be a treatment goal for people with diabetes who are overweight or obese. The macronutrient distribution is flexible within recommended ranges and will depend on individual treatment goals and preferences. Replacing high glycemic index carbohydrates with low glycemic index carbohydrates in mixed meals has a clinically significant benefit for glycemic control in people with type 1 and type 2 diabetes. Intensive lifestyle interventions in people with type 2 diabetes can produce improvements in weight management, fitness, glycemic control and cardiovascular risk factors. A variety of dietary patterns and specific foods have been shown to be of benefit in people with type 2 diabetes. Consistency in carbohydrate intake and in spacing and regularity in meal consumption may help control blood glucose and weight. Energy As an estimated 80% to 90% of people with type 2 diabetes are overweight or obese, strategies that include energy restriction to achieve weight loss are a primary consideration (26). A modest weight loss of 5% to 10% of initial body weight can substantially improve insulin sensitivity, glycemic control, hypertension and Contents lists available at SciVerse ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w. c a n a d ia n j o u r n a l o f d i a b e t e s. c o m

Prevention and management of type 2 diabetes: dietary components and nutritional strategies

“…54 Although the 2013 Canadian Diabetes Association (CDA) provides ranges of ideal macronutrient distribution for the management of diabetes, the guidelines also emphasize the importance of individualized dietary goals and quality of specific macronutrients. 55 …”

“…70 Several organizations recommended increasing fiber intake for diabetes management (Table 2). 55, 56 However, the latest ADA guidelines did not recommend increasing above the level for the general public because the amount of fiber needed was unrealistically high (>50g/d) for modest lowering of HbA1C and preprandial glucose. 54 …”

“…71 However, naturally occurring fructose from whole fruits is unlikely to be deleterious because of its relatively slow digestion and absorption unless consumed in an excess amount (>10% of energy). 55 Nonnutritive sweeteners may have potential to reduce overall calorie and carbohydrate intake. 54 Short-term studies have shown that replacing added sugar with nonnutritive sweeteners reduces body weight and improves glycemic control, but the long-term effects need to be investigated.…”

Dietary salt intake and diabetes complications in patients with diabetes: An overview

“…Dietary salt restriction has been noted as an essential constituent of diabetes care in many guidelines,4, 5, 6, 7 although supportive evidence is apt to depend on studies of participants without diabetes or small short‐term studies of patients with diabetes. On the other hand, some longitudinal studies were recently reported regarding the association between dietary salt intake and diabetes complications in patients with diabetes 8, 9, 10.…”

“…Particularly, consistent dietary salt restriction is emphasized for patients at high risk for arteriosclerosis such as those with diabetes, dyslipidemia, or renal disease 2, 3, 4. Guidelines for the treatment of diabetes throughout the world include recommendations for restriction of dietary salt intake4, 5, 6, 7 to prevent or at least slow the development of diabetes complications related to macroangiopathy such as CVD and microangiopathy such as nephropathy, retinopathy, and neuropathy.…”